br Trauma and ACEs screening
Trauma and ACEs screening: the past, present, and future Traditionally, allopathy’s biomedical model has utilized an etic perspective; the outsiders’ view of the problem. Development of diagnostic screening tools requires an etic approach, which relies heavily on a completely objective perspective. Therein lies the quandary for the current way in which healthcare is practiced. ACEs screening raises concerns about overly diagnosing patients without sufficient understanding about what to do. On the other hand, the emic perspective provides a view of health through the eyes of the patient. The emic perspective can also provide a better understanding about the contribution of life experiences to the health and well-being of multi-generational patient populations (Murphy et al., 2014, Murphy et al., 2016). Presently, we have a public health crisis. There are no vaccinations against trauma and trauma cannot be treated with antibiotics. Yet, trauma and stress are highly prevalent in our society and culture. Public health action often requires a rapid, yet careful response with the available evidence (Public Health Leadership Society, 2002). In the case of ACEs, the real threat is not taking action, given the known short-term and long-term consequences of childhood trauma. While it fasudil australia is true that research is needed to identify evidence-based interventions to address and prevent ACEs, it may take time to realize. That is why researchers and practitioners in multiple disciplines take the needed action of collecting and cautiously utilizing data on ACEs. In summary, we are at a critical juncture to pragmatically address and prevent ACEs. First, it will be imperative that ACEs science be incorporated into medical and allied health training to better prepare future generations of practitioners. Second, we need to conceptualize universal ACEs screening not as a diagnostic tool, but as a powerful surveillance tool that can transform the healthcare culture to be more trauma-informed. Thus, ACEs data can increase recognition that trauma is widespread and associated with numerous health problems across different clinical settings and patient populations. Third, ACEs assessment can increase provider understanding of health from the patient’s perspective. Healthcare providers are in a position to promote true patient-centered care and the human body’s capacity for healing. Within the context of ACEs, this is best accomplished by ensuring that the collection and use of data is non-diagnostic, multi-generational, trauma-informed, and includes assessment of patient resiliency. Ethically speaking, we really cannot afford to wait another twenty years to take the needed action for addressing and preventing ACEs. In effect, we are witnessing the cautious movement towards this endeavor.
Introduction Depression is one of the most prevalent psychiatric disorders, yet despite considerable advances in clinical practice, case detection remains relatively poor at all ages. In older persons, untreated depression has been furthermore associated with both high rates of functional impairment and comorbidity, notably cardiovascular disease (CVD) (Alexopoulos, 2005). One of the principal factors contributing to poor case identification is insufficient knowledge of the mechanisms underlying disease onset, and in particular the causes of variations in clinical presentation and treatment response. Development of specific biomarkers would significantly contribute to a better understanding of disease etiology and heterogeneity, as well as improving case detection and monitoring. Growing evidence suggests that depression results from complex interactions between genetic and environmental factors (Caspi et al., 2003, Booij et al., 2013). Epigenetic mechanisms such as DNA methylation may play an important role due to their ability to respond to both genetic and environmental influences to potentiate changes in gene activity (Tsankova et al., 2007). Whilst depression is a brain-based disorder, the effects on an individual are more wide-spread, and physiological changes in peripheral tissues have been observed (O'Donovan et al., 2010, Thomson et al., 2014). Furthermore, brain tissue cannot be accessed in living humans, so human epigenetic marks have been predominantly studied in peripheral tissues including blood and buccal (mouth epithelial cells) (Lockwood et al., 2015), which offer an advantage of being easily accessible, thus contributing to their potential as biomarkers. Biomarkers do not always lie along causal pathways, but must robustly associate with the phenotype to ensure diagnostic utility.