Publications by authors named "Rebecca C Brown"

40 Publications

Prospective Intention-Based Lifestyle Contracts: mHealth Technology and Responsibility in Healthcare.

Health Care Anal 2021 Jan 11. Epub 2021 Jan 11.

Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.

As the rising costs of lifestyle-related diseases place increasing strain on public healthcare systems, the individual's role in disease may be proposed as a healthcare rationing criterion. Literature thus far has largely focused on retrospective responsibility in healthcare. The concept of prospective responsibility, in the form of a lifestyle contract, warrants further investigation. The responsibilisation in healthcare debate also needs to take into account innovative developments in mobile health technology, such as wearable biometric devices and mobile apps, which may change how we hold others accountable for their lifestyles. Little is known about public attitudes towards lifestyle contracts and the use of mobile health technology to hold people responsible in the context of healthcare. This paper has two components. Firstly, it details empirical findings from a survey of 81 members of the United Kingdom general public on public attitudes towards individual responsibility and rationing healthcare, prospective and retrospective responsibility, and the acceptability of lifestyle contracts in the context of mobile health technology. Secondly, we draw on the empirical findings and propose a model of prospective intention-based lifestyle contracts, which is both more aligned with public intuitions and less ethically objectionable than more traditional, retrospective models of responsibility in healthcare.
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http://dx.doi.org/10.1007/s10728-020-00424-8DOI Listing
January 2021

A public health ethic should inform policies on COVID-19 immunity passports - Authors' reply.

Lancet Infect Dis 2020 Dec 7. Epub 2020 Dec 7.

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford OX11PT, UK.

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http://dx.doi.org/10.1016/S1473-3099(20)30922-1DOI Listing
December 2020

Personal responsibility for cardiac health: what are the ethical demands?

Heart 2020 Nov 4. Epub 2020 Nov 4.

Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK

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http://dx.doi.org/10.1136/heartjnl-2020-317518DOI Listing
November 2020

The scientific and ethical feasibility of immunity passports.

Lancet Infect Dis 2021 03 16;21(3):e58-e63. Epub 2020 Oct 16.

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK; Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Melbourne Law School, Melbourne University, Melbourne, VIC, Australia.

There is much debate about the use of immunity passports in the response to the COVID-19 pandemic. Some have argued that immunity passports are unethical and impractical, pointing to uncertainties relating to COVID-19 immunity, issues with testing, perverse incentives, doubtful economic benefits, privacy concerns, and the risk of discriminatory effects. We first review the scientific feasibility of immunity passports. Considerable hurdles remain, but increasing understanding of the neutralising antibody response to COVID-19 might make identifying members of the community at low risk of contracting and transmitting COVID-19 possible. We respond to the ethical arguments against immunity passports and give the positive ethical arguments. First, a strong presumption should be in favour of preserving people's free movement if at all feasible. Second, failing to recognise the reduced infection threat immune individuals pose risks punishing people for low-risk behaviour. Finally, further individual and social benefits are likely to accrue from allowing people to engage in free movement. Challenges relating to the implementation of immunity passports ought to be met with targeted solutions so as to maximise their benefit.
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http://dx.doi.org/10.1016/S1473-3099(20)30766-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567527PMC
March 2021

Cortical thickness and resting-state cardiac function across the lifespan: A cross-sectional pooled mega-analysis.

Psychophysiology 2020 Oct 10. Epub 2020 Oct 10.

Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS-or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.
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http://dx.doi.org/10.1111/psyp.13688DOI Listing
October 2020

Passport to freedom? Immunity passports for COVID-19.

J Med Ethics 2020 10 15;46(10):652-659. Epub 2020 Aug 15.

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.

The COVID-19 pandemic has led a number of countries to introduce restrictive 'lockdown' policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people's civil liberties. We make tentative recommendations for the ethical introduction of immunity passports.
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http://dx.doi.org/10.1136/medethics-2020-106365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525773PMC
October 2020

Passport to freedom? Immunity passports for COVID-19.

J Med Ethics 2020 10 15;46(10):652-659. Epub 2020 Aug 15.

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.

The COVID-19 pandemic has led a number of countries to introduce restrictive 'lockdown' policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of immunity passports raises a number of practical and ethical challenges. In this paper, we seek to review the challenges relating to various practical considerations, fairness issues, the risk to social cooperation and the impact on people's civil liberties. We make tentative recommendations for the ethical introduction of immunity passports.
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http://dx.doi.org/10.1136/medethics-2020-106365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525773PMC
October 2020

Differential neural processing of unpleasant sensory stimulation in patients with major depression.

Eur Arch Psychiatry Clin Neurosci 2020 Apr 11. Epub 2020 Apr 11.

Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany.

An altered processing of negative salient stimuli has been suggested to play a central role in the pathophysiology of major depression (MD). Besides negative affective and social stimuli, physical pain as a subtype of negative sensory stimulation has been investigated in this context. However, the few neuroimaging studies on unpleasant sensory stimulation or pain processing in MD report heterogeneous findings. Here, we investigated 47 young females, 22 with MD and 25 healthy controls (HC) using fMRI (3.0 T). Four levels of increasingly unpleasant electrical stimulation were applied. Ratings of stimulus intensity were assessed by a visual analogue scale. fMRI-data were analyzed using a 2 × 4 ANOVA. Behavioral results revealed no group differences regarding accuracy of unpleasant stimulation level ratings and sensitivity to stimulation. Regarding neural activation related to increasing levels of unpleasant stimulation, we observed increasing activation of brain regions related to the pain and salient stimulus processing corresponding to increasingly unpleasant stimulation in controls. This modulation was significantly smaller in MD compared to controls, particularly in the dorsal anterior cingulate cortex, the somatosensory cortex, and the posterior insula. Overall, brain regions associated with the processing of unpleasant sensory stimulation, but also associated with the salience network, were highly reactive but less modulated in female patients with MD. These results support and extent findings on altered processing of salience and of negative sensory stimuli even of a non-painful quality in female patients with MD.
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http://dx.doi.org/10.1007/s00406-020-01123-0DOI Listing
April 2020

Differential neural processing of unpleasant sensory stimulation in patients with major depression.

Eur Arch Psychiatry Clin Neurosci 2020 Apr 11. Epub 2020 Apr 11.

Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany.

An altered processing of negative salient stimuli has been suggested to play a central role in the pathophysiology of major depression (MD). Besides negative affective and social stimuli, physical pain as a subtype of negative sensory stimulation has been investigated in this context. However, the few neuroimaging studies on unpleasant sensory stimulation or pain processing in MD report heterogeneous findings. Here, we investigated 47 young females, 22 with MD and 25 healthy controls (HC) using fMRI (3.0 T). Four levels of increasingly unpleasant electrical stimulation were applied. Ratings of stimulus intensity were assessed by a visual analogue scale. fMRI-data were analyzed using a 2 × 4 ANOVA. Behavioral results revealed no group differences regarding accuracy of unpleasant stimulation level ratings and sensitivity to stimulation. Regarding neural activation related to increasing levels of unpleasant stimulation, we observed increasing activation of brain regions related to the pain and salient stimulus processing corresponding to increasingly unpleasant stimulation in controls. This modulation was significantly smaller in MD compared to controls, particularly in the dorsal anterior cingulate cortex, the somatosensory cortex, and the posterior insula. Overall, brain regions associated with the processing of unpleasant sensory stimulation, but also associated with the salience network, were highly reactive but less modulated in female patients with MD. These results support and extent findings on altered processing of salience and of negative sensory stimuli even of a non-painful quality in female patients with MD.
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http://dx.doi.org/10.1007/s00406-020-01123-0DOI Listing
April 2020

Designing and using incentives to support recruitment and retention in clinical trials: a scoping review and a checklist for design.

Trials 2019 Nov 9;20(1):624. Epub 2019 Nov 9.

MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK.

Background: Recruitment and retention of participants are both critical for the success of trials, yet both remain significant problems. The use of incentives to target participants and trial staff has been proposed as one solution. The effects of incentives are complex and depend upon how they are designed, but these complexities are often overlooked. In this paper, we used a scoping review to 'map' the literature, with two aims: to develop a checklist on the design and use of incentives to support recruitment and retention in trials; and to identify key research topics for the future.

Methods: The scoping review drew on the existing economic theory of incentives and a structured review of the literature on the use of incentives in three healthcare settings: trials, pay for performance, and health behaviour change. We identified the design issues that need to be considered when introducing an incentive scheme to improve recruitment and retention in trials. We then reviewed both the theoretical and empirical evidence relating to each of these design issues. We synthesised the findings into a checklist to guide the design of interventions using incentives.

Results: The issues to consider when designing an incentive system were summarised into an eight-question checklist. The checklist covers: the current incentives and barriers operating in the system; who the incentive should be directed towards; what the incentive should be linked to; the form of incentive; the incentive size; the structure of the incentive system; the timing and frequency of incentive payouts; and the potential unintended consequences. We concluded the section on each design aspect by highlighting the gaps in the current evidence base.

Conclusions: Our findings highlight how complex the design of incentive systems can be, and how crucial each design choice is to overall effectiveness. The most appropriate design choice will differ according to context, and we have aimed to provide context-specific advice. Whilst all design issues warrant further research, evidence is most needed on incentives directed at recruiters, optimal incentive size, and testing of different incentive structures, particularly exploring repeat arrangements with recruiters.
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http://dx.doi.org/10.1186/s13063-019-3710-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842495PMC
November 2019

Response to Commentaries on 'Responsibility in Healthcare Across Time and Agents'.

J Med Ethics 2019 10 8;45(10):652-653. Epub 2019 Oct 8.

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.

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http://dx.doi.org/10.1136/medethics-2019-105804DOI Listing
October 2019

Response to Commentaries on 'Responsibility in Healthcare Across Time and Agents'.

J Med Ethics 2019 10 8;45(10):652-653. Epub 2019 Oct 8.

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.

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http://dx.doi.org/10.1136/medethics-2019-105804DOI Listing
October 2019

Against Moral Responsibilisation of Health: Prudential Responsibility and Health Promotion.

Public Health Ethics 2019 Jul 25;12(2):114-129. Epub 2019 May 25.

Oxford Uehiro Centre for Practical Ethics, University of Oxford.

In this article, we outline a novel approach to understanding the role of responsibility in health promotion. Efforts to tackle chronic disease have led to an emphasis on personal responsibility and the identification of ways in which people can 'take responsibility' for their health by avoiding risk factors such as smoking and over-eating. We argue that the extent to which agents can be considered responsible for their health-related behaviour is limited, and as such, state health promotion which assumes certain forms of moral responsibility should (in general) be avoided. This indicates that some approaches to health promotion ought not to be employed. We suggest, however, that another form of responsibility might be more appropriately identified. This is based on the claim that agents (in general) have prudential reasons to maintain their health, in order to pursue those things which make their lives go well-i.e. that maintenance of a certain level of health is (all-things-considered) rational for many agents, given their pleasures and plans. On this basis, we propose that agents have a self-regarding responsibility to maintain their health. We outline the implications of a prudential responsibility approach to health promotion.
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http://dx.doi.org/10.1093/phe/phz006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6655424PMC
July 2019

Responsibility in healthcare across time and agents.

J Med Ethics 2019 10 20;45(10):636-644. Epub 2019 Jun 20.

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.

It is unclear whether someone's responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour.
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http://dx.doi.org/10.1136/medethics-2019-105382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855791PMC
October 2019

Responsibility in healthcare across time and agents.

J Med Ethics 2019 10 20;45(10):636-644. Epub 2019 Jun 20.

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.

It is unclear whether someone's responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour.
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http://dx.doi.org/10.1136/medethics-2019-105382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855791PMC
October 2019

Responsibility in healthcare across time and agents.

J Med Ethics 2019 10 20;45(10):636-644. Epub 2019 Jun 20.

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK.

It is unclear whether someone's responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour.
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http://dx.doi.org/10.1136/medethics-2019-105382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855791PMC
October 2019

Irresponsibly Infertile? Obesity, Efficiency, and Exclusion from Treatment.

Health Care Anal 2019 Jun;27(2):61-76

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8 Littlegate House, 16-17 St Ebbes Street, OX1 1PT, Oxford, UK.

Many countries tightly ration access to publicly funded fertility treatments such as in vitro fertilisation (IVF). One basis for excluding people from access to IVF is their body mass index. In this paper, I consider a number of potential justifications for such a policy, based on claims about effectiveness and cost-efficiency, and reject these as unsupported by available evidence. I consider an alternative justification: that those whose subfertility results from avoidable behaviours for which they are responsible are less deserving of treatment. I ultimately stop short of endorsing or rejecting such a justification, though highlight some reasons for thinking it is unlikely to be practicable.
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http://dx.doi.org/10.1007/s10728-019-00366-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548064PMC
June 2019

Resisting Moralisation in Health Promotion.

Ethical Theory Moral Pract 2018 8;21(4):997-1011. Epub 2018 Nov 8.

Oxford Uehiro Centre for Practical Ethics, University of Oxford, Suite 8 Littlegate House, 16-17 St Ebbe's Street, Oxford, OX1 1PT UK.

Health promotion efforts are commonly directed towards encouraging people to discard 'unhealthy' and adopt 'healthy' behaviours in order to tackle chronic disease. Typical targets for behaviour change interventions include diet, physical activity, smoking and alcohol consumption, sometimes described as 'lifestyle behaviours.' In this paper, I discuss how efforts to raise awareness of the impact of lifestyles on health, in seeking to communicate the (perceived) need for people to change their behaviour, can contribute to a climate of 'healthism' and promote the moralisation of people's lifestyles. I begin by summarising recent trends in health promotion and introducing the notion of healthism, as described by Robert Crawford in the 1980s. One aspect of healthism is moralisation, which I outline (alongside the related term moralism) and suggest is facilitated by efforts to promote health via information provision and educational strategies. I propose that perceived responsibility plays a role in mediating the tendency to moralise about health and behaviour. Since I argue that states ought to avoid direct and indirect moralisation of people's health-related behaviour, this suggests states must be cautious with regard to the use of responsibility-indicating interventions (including informational and educational campaigns) to promote health.
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http://dx.doi.org/10.1007/s10677-018-9941-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304181PMC
November 2018

Associations of adverse childhood experiences and bullying on physical pain in the general population of Germany.

J Pain Res 2018 6;11:3099-3108. Epub 2018 Dec 6.

Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany.

Background: Chronic pain is a frequent burden in the general population. Child maltreatment and bullying are risk factors for the development of chronic pain. Aim of this cross-sectional study was to investigate the association of child maltreatment and bullying and pain experiences in a representative sample of the general population.

Materials And Methods: A total of N=2,491 people from the general population of Germany participated in the study (M=48.3 years [SD=18.2], 53.2 % female). Child maltreatment was assessed with the Childhood Trauma Questionnaire (CTQ), pain was rated with the Polytrauma Outcome (POLO)-physical state domain, depression scores were assessed with the Patient Health Questionnaire, and anxiety scores via the General Anxiety Disorder Questionnaire. Regression analyses were calculated to investigate the effect of bullying and child maltreatment, as well as depression, anxiety, and gender on pain experiences.

Results: A significant correlation between increasing pain levels and number of adverse childhood experiences was found. With regard to specific types of maltreatment, largest effect sizes were found for emotional abuse. Bullying was significantly, but overall rather moderately, related to pain suffering. In women, all forms of maltreatment were associated with pain, while in men only sexual and physical abuse revealed significant effects. Although depression and anxiety scores were significantly associated with the experience of current pain, they did not change the effect of child maltreatment on pain significantly.

Conclusion: In this sample of the general population, adverse childhood experiences were significantly associated with pain and showed cumulative effects, over and above depressive and anxiety symptoms.
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http://dx.doi.org/10.2147/JPR.S169135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287510PMC
December 2018

Associations of adverse childhood experiences and bullying on physical pain in the general population of Germany.

J Pain Res 2018 6;11:3099-3108. Epub 2018 Dec 6.

Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany.

Background: Chronic pain is a frequent burden in the general population. Child maltreatment and bullying are risk factors for the development of chronic pain. Aim of this cross-sectional study was to investigate the association of child maltreatment and bullying and pain experiences in a representative sample of the general population.

Materials And Methods: A total of N=2,491 people from the general population of Germany participated in the study (M=48.3 years [SD=18.2], 53.2 % female). Child maltreatment was assessed with the Childhood Trauma Questionnaire (CTQ), pain was rated with the Polytrauma Outcome (POLO)-physical state domain, depression scores were assessed with the Patient Health Questionnaire, and anxiety scores via the General Anxiety Disorder Questionnaire. Regression analyses were calculated to investigate the effect of bullying and child maltreatment, as well as depression, anxiety, and gender on pain experiences.

Results: A significant correlation between increasing pain levels and number of adverse childhood experiences was found. With regard to specific types of maltreatment, largest effect sizes were found for emotional abuse. Bullying was significantly, but overall rather moderately, related to pain suffering. In women, all forms of maltreatment were associated with pain, while in men only sexual and physical abuse revealed significant effects. Although depression and anxiety scores were significantly associated with the experience of current pain, they did not change the effect of child maltreatment on pain significantly.

Conclusion: In this sample of the general population, adverse childhood experiences were significantly associated with pain and showed cumulative effects, over and above depressive and anxiety symptoms.
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http://dx.doi.org/10.2147/JPR.S169135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287510PMC
December 2018

Association of child maltreatment subtypes and long-term physical health in a German representative sample.

Eur J Psychotraumatol 2018 7;9(1):1510278. Epub 2018 Sep 7.

Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany.

: Child maltreatment is a major public problem, associated with enormous consequences on the individual and socioeconomic level. Studies show a clear impact of child maltreatment on long-term physical health. However, there is a lack of analyses comprising a wide variety of subtypes of maltreatment and addressing cumulative effects of different maltreatment subtypes experienced during childhood on physical health. : The objective of this analysis was to assess the association of different subtypes and the intensity of child maltreatment with long-term physical health outcomes. : In a cross-sectional observational approach, a representative sample of the German population (N=2510) was assessed regarding socioeconomic information, their current health status, and their experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ). Chi-Tests were performed to compare differences of physical health conditions in adulthood in association with child maltreatment and binary regression analyses to assess the relationship of physical health and number of different subtypes of maltreatment experienced during childhood. : Odds increased significantly for obesity (1.8), diabetes (1.26), cancer (1.28), hypertension (1.16), chronic obstructive pulmonary disease (1.51), history of myocardial infarction (1.29) and stroke (1.31) with increasingenhancing number of experienced subtypes of child maltreatment. Growing intensity of each subtype of maltreatment was associated with higher rates of all assessed physical health conditions, which could point towards a dose-dependency of the relationship between maltreatment and long-term physical health. : Child maltreatment is associated with increased odds for the leading morbidity and mortality causes in Germany. Interventions encompassing secondary and primary preventive strategies are critical to target this major public health problem and its devastating consequences.
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http://dx.doi.org/10.1080/20008198.2018.1510278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136347PMC
September 2018

Association of child maltreatment subtypes and long-term physical health in a German representative sample.

Eur J Psychotraumatol 2018 7;9(1):1510278. Epub 2018 Sep 7.

Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany.

: Child maltreatment is a major public problem, associated with enormous consequences on the individual and socioeconomic level. Studies show a clear impact of child maltreatment on long-term physical health. However, there is a lack of analyses comprising a wide variety of subtypes of maltreatment and addressing cumulative effects of different maltreatment subtypes experienced during childhood on physical health. : The objective of this analysis was to assess the association of different subtypes and the intensity of child maltreatment with long-term physical health outcomes. : In a cross-sectional observational approach, a representative sample of the German population (N=2510) was assessed regarding socioeconomic information, their current health status, and their experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ). Chi-Tests were performed to compare differences of physical health conditions in adulthood in association with child maltreatment and binary regression analyses to assess the relationship of physical health and number of different subtypes of maltreatment experienced during childhood. : Odds increased significantly for obesity (1.8), diabetes (1.26), cancer (1.28), hypertension (1.16), chronic obstructive pulmonary disease (1.51), history of myocardial infarction (1.29) and stroke (1.31) with increasingenhancing number of experienced subtypes of child maltreatment. Growing intensity of each subtype of maltreatment was associated with higher rates of all assessed physical health conditions, which could point towards a dose-dependency of the relationship between maltreatment and long-term physical health. : Child maltreatment is associated with increased odds for the leading morbidity and mortality causes in Germany. Interventions encompassing secondary and primary preventive strategies are critical to target this major public health problem and its devastating consequences.
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http://dx.doi.org/10.1080/20008198.2018.1510278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136347PMC
September 2018

Association of child maltreatment subtypes and long-term physical health in a German representative sample.

Eur J Psychotraumatol 2018 7;9(1):1510278. Epub 2018 Sep 7.

Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany.

: Child maltreatment is a major public problem, associated with enormous consequences on the individual and socioeconomic level. Studies show a clear impact of child maltreatment on long-term physical health. However, there is a lack of analyses comprising a wide variety of subtypes of maltreatment and addressing cumulative effects of different maltreatment subtypes experienced during childhood on physical health. : The objective of this analysis was to assess the association of different subtypes and the intensity of child maltreatment with long-term physical health outcomes. : In a cross-sectional observational approach, a representative sample of the German population (N=2510) was assessed regarding socioeconomic information, their current health status, and their experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ). Chi-Tests were performed to compare differences of physical health conditions in adulthood in association with child maltreatment and binary regression analyses to assess the relationship of physical health and number of different subtypes of maltreatment experienced during childhood. : Odds increased significantly for obesity (1.8), diabetes (1.26), cancer (1.28), hypertension (1.16), chronic obstructive pulmonary disease (1.51), history of myocardial infarction (1.29) and stroke (1.31) with increasingenhancing number of experienced subtypes of child maltreatment. Growing intensity of each subtype of maltreatment was associated with higher rates of all assessed physical health conditions, which could point towards a dose-dependency of the relationship between maltreatment and long-term physical health. : Child maltreatment is associated with increased odds for the leading morbidity and mortality causes in Germany. Interventions encompassing secondary and primary preventive strategies are critical to target this major public health problem and its devastating consequences.
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http://dx.doi.org/10.1080/20008198.2018.1510278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136347PMC
September 2018

Trends in child maltreatment in Germany: comparison of two representative population-based studies.

Child Adolesc Psychiatry Ment Health 2018 25;12:24. Epub 2018 May 25.

1Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany.

Background: Child maltreatment of all types is a serious concern for society, and it is important to monitor trends in incidence in order to inform child welfare agencies and policy-makers about emerging issues. In Germany, however, information on such trends is limited: apart from official sources, the only published study is a comparison of surveys conducted in 1992 and 2011 that had focused primarily on sexual abuse. The present study is the first to look at more recent trends and to examine other types of maltreatment as well.

Methods: We compared the datasets of two population-based nationwide surveys, one conducted in 2010 (N = 2504) and the other in 2016 (N = 2510). Both had used identical methodology. Participants aged 14 years and older had been selected randomly using the Kish selection grid method, and information about childhood experiences of abuse had been solicited using the Childhood Trauma Questionnaire.

Results: The overall percentage of respondents who reported having experienced at least one type of child maltreatment decreased over the 6 years, from 35.3% in 2010 to 31.0% in 2016; however, the percentages who reported multiple types of maltreatment remained stable. The decrease in any type of maltreatment was mainly driven by fewer reports of physical neglect, which was likelier to be reported by older respondents who had experienced privation during the (post-) war years and whose representation was lower in the later survey. There was a significant increase over time in the prevalence of emotional abuse, with respondents aged 26-45 years reporting higher rates of this type of maltreatment. The prevalence rates of other types of maltreatment remained unchanged. All effect sizes were very small.

Conclusions: At present, the systems in place in Germany for monitoring the occurrence of child maltreatment are insufficient. While this study contributes to a better understanding, more information is needed, particularly on populations that have been excluded or underrepresented in previous research efforts. As has been done elsewhere, large databases should be set up, using identical methodologies and definitions, in order to accurately assess trends over time in different types of abuse and neglect.
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http://dx.doi.org/10.1186/s13034-018-0232-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970447PMC
May 2018

Knowledge transfer: a worldwide challenge in child mental health: a recommendation to the readership of CAPMH concerning the revised version of the IACAPAP Textbook of Child and Adolescent Mental Health.

Child Adolesc Psychiatry Ment Health 2018 17;12:14. Epub 2018 Feb 17.

Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany.

Background: Transfer of knowledge is an important issue throughout all scientific disciplines, especially in the medical and psycho-social field. The issue of worldwide knowledge transfer in child mental health is one of the aims and goals of the journal (CAPMH). The demand for mental health training is high worldwide, and especially in low- to lower-middle income countries, where inadequate access to knowledge resources in the field of child and adolescent mental health (CAMH) is prevalent. At the same time, many of these countries are showing an increased risk for mental health issues in children and adolescents. The International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) counters this problem. It is an open-access e-textbook aiming to provide an overview of current and established treatment and practical approaches for child and adolescent psychiatrists, psychotherapists and allied (mental health) professionals worldwide. First published in 2012, the updated and revised version was launched in 2015. The aim of this commentary is to review and disseminate the usefulness and practicability of content and further material included in the new version of the textbook.

Review: Overall, the textbook contains ten sections divided into 59 chapters, with a total of 1435 pages. The original version of the textbook was written in English. The revised version contains translations of 49 chapters into different languages (to date French, Spanish, Hebrew, Arabic, Portuguese, Russian, Norwegian and/or Japanese), with additional material for knowledge dissemination and self-directed learning (e.g. videos and quizzes) for several chapters. The textbook and the add-on materials for dissemination are of high quality and convey a great introduction to important topics concerning mental health. Apart from knowledge transfer, there is a pragmatic focus on clinical practice and on regional and cultural differences.

Conclusion: The textbook is a new and unique opportunity for professionals all over the world to improve their knowledge, skills and expertise in CAMH. High-quality, up-to-date and freely accessible materials in the field of CAMH are combined with the opportunity to share insights with colleagues.
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http://dx.doi.org/10.1186/s13034-018-0220-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816398PMC
February 2018

Knowledge transfer: a worldwide challenge in child mental health: a recommendation to the readership of CAPMH concerning the revised version of the IACAPAP Textbook of Child and Adolescent Mental Health.

Child Adolesc Psychiatry Ment Health 2018 17;12:14. Epub 2018 Feb 17.

Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany.

Background: Transfer of knowledge is an important issue throughout all scientific disciplines, especially in the medical and psycho-social field. The issue of worldwide knowledge transfer in child mental health is one of the aims and goals of the journal (CAPMH). The demand for mental health training is high worldwide, and especially in low- to lower-middle income countries, where inadequate access to knowledge resources in the field of child and adolescent mental health (CAMH) is prevalent. At the same time, many of these countries are showing an increased risk for mental health issues in children and adolescents. The International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) counters this problem. It is an open-access e-textbook aiming to provide an overview of current and established treatment and practical approaches for child and adolescent psychiatrists, psychotherapists and allied (mental health) professionals worldwide. First published in 2012, the updated and revised version was launched in 2015. The aim of this commentary is to review and disseminate the usefulness and practicability of content and further material included in the new version of the textbook.

Review: Overall, the textbook contains ten sections divided into 59 chapters, with a total of 1435 pages. The original version of the textbook was written in English. The revised version contains translations of 49 chapters into different languages (to date French, Spanish, Hebrew, Arabic, Portuguese, Russian, Norwegian and/or Japanese), with additional material for knowledge dissemination and self-directed learning (e.g. videos and quizzes) for several chapters. The textbook and the add-on materials for dissemination are of high quality and convey a great introduction to important topics concerning mental health. Apart from knowledge transfer, there is a pragmatic focus on clinical practice and on regional and cultural differences.

Conclusion: The textbook is a new and unique opportunity for professionals all over the world to improve their knowledge, skills and expertise in CAMH. High-quality, up-to-date and freely accessible materials in the field of CAMH are combined with the opportunity to share insights with colleagues.
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http://dx.doi.org/10.1186/s13034-018-0220-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816398PMC
February 2018

Knowledge transfer: a worldwide challenge in child mental health: a recommendation to the readership of CAPMH concerning the revised version of the IACAPAP Textbook of Child and Adolescent Mental Health.

Child Adolesc Psychiatry Ment Health 2018 17;12:14. Epub 2018 Feb 17.

Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany.

Background: Transfer of knowledge is an important issue throughout all scientific disciplines, especially in the medical and psycho-social field. The issue of worldwide knowledge transfer in child mental health is one of the aims and goals of the journal (CAPMH). The demand for mental health training is high worldwide, and especially in low- to lower-middle income countries, where inadequate access to knowledge resources in the field of child and adolescent mental health (CAMH) is prevalent. At the same time, many of these countries are showing an increased risk for mental health issues in children and adolescents. The International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) counters this problem. It is an open-access e-textbook aiming to provide an overview of current and established treatment and practical approaches for child and adolescent psychiatrists, psychotherapists and allied (mental health) professionals worldwide. First published in 2012, the updated and revised version was launched in 2015. The aim of this commentary is to review and disseminate the usefulness and practicability of content and further material included in the new version of the textbook.

Review: Overall, the textbook contains ten sections divided into 59 chapters, with a total of 1435 pages. The original version of the textbook was written in English. The revised version contains translations of 49 chapters into different languages (to date French, Spanish, Hebrew, Arabic, Portuguese, Russian, Norwegian and/or Japanese), with additional material for knowledge dissemination and self-directed learning (e.g. videos and quizzes) for several chapters. The textbook and the add-on materials for dissemination are of high quality and convey a great introduction to important topics concerning mental health. Apart from knowledge transfer, there is a pragmatic focus on clinical practice and on regional and cultural differences.

Conclusion: The textbook is a new and unique opportunity for professionals all over the world to improve their knowledge, skills and expertise in CAMH. High-quality, up-to-date and freely accessible materials in the field of CAMH are combined with the opportunity to share insights with colleagues.
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http://dx.doi.org/10.1186/s13034-018-0220-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816398PMC
February 2018

Child maltreatment in Germany: prevalence rates in the general population.

Child Adolesc Psychiatry Ment Health 2017 29;11:47. Epub 2017 Sep 29.

Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany.

Background: Child maltreatment and its consequences are considered a major public health problem. So far, there is only one study from Germany reporting prevalence rates on different types of maltreatment.

Methods: A representative sample of the German general population was examined for experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ) between September and November 2016. A total of 2510 (53.3% female) participants between 14 and 94 years (M = 48.8 years) were enrolled. Besides the CTQ, a range of sociodemographic information was collected. The interrelatedness of different types of maltreatment was examined using configuration analysis and predictors for maltreatment were identified by performing binary logistic regression analyses.

Results: Overall, 2.6% (f: 3.9%, m: 1.2%) of all participants reported severe emotional abuse, 3.3% (f: 3.4%, m: 3.3%) severe physical abuse, 2.3% (f: 3.7%, m: 0.7%) severe sexual abuse, 7.1% (f: 8.1%, m: 5.9%) severe emotional neglect and 9% (f: 9.2%, m: 8.9%) severe physical neglect. Women were more likely to report at least moderate sexual and emotional abuse than men. The largest difference between age groups was reported for physical neglect, with participants aged over 70 years reporting the highest rates. Participants who reported childhood maltreatment were more likely to be unemployed or have lower educational outcomes. The most common combination of maltreatment types were physical and emotional neglect, all five types of maltreatment combined and physical and emotional neglect and physical abuse combined.

Conclusions: Child maltreatment, especially physical neglect is common in the German population. Women seem to be at greater risk for sexual and emotional abuse than men. Knowledge about different types of maltreatment based on the Childhood Trauma Questionnaire (CTQ) can help to put findings of future studies into an epidemiological and societal context.
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http://dx.doi.org/10.1186/s13034-017-0185-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621113PMC
September 2017

Child maltreatment in Germany: prevalence rates in the general population.

Child Adolesc Psychiatry Ment Health 2017 29;11:47. Epub 2017 Sep 29.

Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany.

Background: Child maltreatment and its consequences are considered a major public health problem. So far, there is only one study from Germany reporting prevalence rates on different types of maltreatment.

Methods: A representative sample of the German general population was examined for experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ) between September and November 2016. A total of 2510 (53.3% female) participants between 14 and 94 years (M = 48.8 years) were enrolled. Besides the CTQ, a range of sociodemographic information was collected. The interrelatedness of different types of maltreatment was examined using configuration analysis and predictors for maltreatment were identified by performing binary logistic regression analyses.

Results: Overall, 2.6% (f: 3.9%, m: 1.2%) of all participants reported severe emotional abuse, 3.3% (f: 3.4%, m: 3.3%) severe physical abuse, 2.3% (f: 3.7%, m: 0.7%) severe sexual abuse, 7.1% (f: 8.1%, m: 5.9%) severe emotional neglect and 9% (f: 9.2%, m: 8.9%) severe physical neglect. Women were more likely to report at least moderate sexual and emotional abuse than men. The largest difference between age groups was reported for physical neglect, with participants aged over 70 years reporting the highest rates. Participants who reported childhood maltreatment were more likely to be unemployed or have lower educational outcomes. The most common combination of maltreatment types were physical and emotional neglect, all five types of maltreatment combined and physical and emotional neglect and physical abuse combined.

Conclusions: Child maltreatment, especially physical neglect is common in the German population. Women seem to be at greater risk for sexual and emotional abuse than men. Knowledge about different types of maltreatment based on the Childhood Trauma Questionnaire (CTQ) can help to put findings of future studies into an epidemiological and societal context.
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http://dx.doi.org/10.1186/s13034-017-0185-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621113PMC
September 2017

Child maltreatment in Germany: prevalence rates in the general population.

Child Adolesc Psychiatry Ment Health 2017 29;11:47. Epub 2017 Sep 29.

Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89073 Ulm, Germany.

Background: Child maltreatment and its consequences are considered a major public health problem. So far, there is only one study from Germany reporting prevalence rates on different types of maltreatment.

Methods: A representative sample of the German general population was examined for experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ) between September and November 2016. A total of 2510 (53.3% female) participants between 14 and 94 years (M = 48.8 years) were enrolled. Besides the CTQ, a range of sociodemographic information was collected. The interrelatedness of different types of maltreatment was examined using configuration analysis and predictors for maltreatment were identified by performing binary logistic regression analyses.

Results: Overall, 2.6% (f: 3.9%, m: 1.2%) of all participants reported severe emotional abuse, 3.3% (f: 3.4%, m: 3.3%) severe physical abuse, 2.3% (f: 3.7%, m: 0.7%) severe sexual abuse, 7.1% (f: 8.1%, m: 5.9%) severe emotional neglect and 9% (f: 9.2%, m: 8.9%) severe physical neglect. Women were more likely to report at least moderate sexual and emotional abuse than men. The largest difference between age groups was reported for physical neglect, with participants aged over 70 years reporting the highest rates. Participants who reported childhood maltreatment were more likely to be unemployed or have lower educational outcomes. The most common combination of maltreatment types were physical and emotional neglect, all five types of maltreatment combined and physical and emotional neglect and physical abuse combined.

Conclusions: Child maltreatment, especially physical neglect is common in the German population. Women seem to be at greater risk for sexual and emotional abuse than men. Knowledge about different types of maltreatment based on the Childhood Trauma Questionnaire (CTQ) can help to put findings of future studies into an epidemiological and societal context.
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http://dx.doi.org/10.1186/s13034-017-0185-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621113PMC
September 2017