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Lifecourse and Chronic Disease Kathy Chapman, RN, MN April, 26, 2012

Lifecourse and Chronic Disease Kathy Chapman, RN, MN April, 26, 2012. Overview. Life Course Review Adverse Childhood Experience (ACE) Review ACEs as Health Risk Executive Function Application. Life Course-Basic Principles. Health at one stage affects health later.

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Lifecourse and Chronic Disease Kathy Chapman, RN, MN April, 26, 2012

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  1. Lifecourse and Chronic Disease Kathy Chapman, RN, MN April, 26, 2012

  2. Overview • Life Course Review • Adverse Childhood Experience (ACE) Review • ACEs as Health Risk • Executive Function • Application

  3. Life Course-Basic Principles • Health at one stage affects health later

  4. Life Course-Basic Principles • Health at one stage affects health later • Trajectory

  5. Life Course-Basic Principles • Health at one stage affects health later • Trajectory • Cumulative burden

  6. Life Course-Basic Principles • Health at one stage affects health later • Trajectory • Cumulative Burden • Sensitive or critical periods

  7. Critical Period • Positive and Adverse events and exposures can impact at any point in life • Impact is greatest at specific critical periods such as: • Pregnancy • Childhood • Adolescence

  8. Brain Development: Critical Period • In the first half pregnancy neurons are formed at an astonishing rate; 8,000 neurons per second • By birth all neurons are formed

  9. Brain Development in Childhood • In early childhood, 700 synapses formed per second • Pruning for efficiency – what is used stays

  10. Exposure during Critical Period • Adverse Child Events Study

  11. Pause

  12. Adverse Childhood Experiences (ACEs) • CDC study partnering with Kaiser • 17,000+ patients; middle class, employed, with insurance • Access to client charts • Asked questions about Early Childhood Experiences

  13. ACE Questions • Respondents were asked about experiences in their childhood • Abuse: emotional, physical, sexual • Neglect: emotional, physical • Household dysfunction: • Mother treated violently • Household substance abuse, mental illness • Parental separation or divorce • Incarcerated Parent

  14. ACE Scores in this middle class cohort • Zero 36% • One 26% • Two 16% • Three 9.5% • Four 12.5%

  15. Poor Health Outcomes“…as the number of ACE increase, the risk for the following health problems increases in a strong and graded fashion.” -- CDC • Alcoholism and alcohol abuse • Chronic obstructive pulmonary disease (COPD) • Depression • Fetal death • Health-related quality of life • Illicit drug use • Ischemic heart disease (IHD) • Liver disease • Risk for intimate partner violence • Multiple sex partners • Sexually transmitted diseases (STDs) • Smoking • Suicide attempts • Unintended pregnancies • Early initiation of smoking • Early initiation of sexual activity • Adolescent pregnancy

  16. Strong and Graded Fashion • The higher the ACE Score the higher the risk for health risk behaviors and for various chronic diseases

  17. Questions, Reflections

  18. Impact of ACE on Brain Development • Toxic Stress can lead to changes in brain structure and function. • One example: Executive Function

  19. Executive Function • Executive Functioning helps us translate knowledge into action; put into practice what we know.

  20. Executive Function • Helps us to function in 3 ways: • Inhibitory Control: filtering thoughts and impulses to resist temptation • Working memory: hold and manipulate information in our heads over a short period of time • Cognitive Flexibility: Adjust to changing demands, priorities and perspectives

  21. Executive Function • Develops over many years; • 2 periods of rapid development • Ages 3-5 years • Ages 12-25 years • Gives us the ability to keep plans in mind and act accordingly • Developmental Plasticity – responds to environment

  22. Focus on policy and practice • Executive Function • Risk Assessment

  23. Public Health Problem • Or Personal Coping mechanism?

  24. Executive Function Implications • How might issues with Executive Function impact interventions we use in chronic disease management or risk factor mitigation? • Smoking Cessation

  25. ACEs as Health Risk

  26. ACEs as Health Risk • We now know that a high Adverse Child Experience score puts a person at high risk for later physical and emotional illness. • It is time to shift our thinking – ACE as Health Risk • Screening questions • Provider education • Prevention and mitigation

  27. ACEs and the Prevention Framework • Primary prevention is easier than mitigation • Secondary Prevention: • Screening for ACEs and interventions to help improve executive function • Integrated approach to intervening with children with high ACE scores – often treatment for multiple family members. • Tertiary Prevention • Treat disease/risk behavior and address exec function issues (tobacco cessation)

  28. Questions, Reflections

  29. More information about ACE • http://www.cdc.gov/ace/index.htm • http://www.healthychild.ucla.edu/PUBLICATIONS/Documents/ZerotoThree.pdf • http://developingchild.harvard.edu/

  30. Other Resources • Jack P. Shonkoff, Lifelong Effects of Early Childhood Adversity and Toxic Stress http://pediatrics.aappublications.org/content/early/2011/12/21/peds.2011-2663 • http://pediatrics.aappublications.org/content/124/Supplement_3/S163.full

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