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Ask when--not just whether--it's a risk: How regional context influences local causes of diarrheal disease.

ABSTRACT: Contemporary epidemiology is enriched when it incorporates ecological concepts about systems and dependencies. With regard to diarrheal disease, the causes of which are many and interacting, the dynamics of within- and between-community disease transmission have distinct components but are also linked in important ways. However, few investigators have studied how regional-scale disease dynamics affect local patterns of diarrheal disease transmission. Characterizing this dependence is important for identifying local- and regional-level transmission pathways. We used data from active surveillance of diarrheal disease prevalence gathered from February 2004 through July 2007 in 21 neighboring Ecuadorian villages to estimate how disease prevalence in spatially and temporally proximate villages modulates the influences of village-level risk and protective factors. We found that the impact of local, village-level interventions such as improved latrines and water treatment can be quite different under conditions of high and low regional disease prevalence. In particular, water treatment was effective only when regional disease prevalence was low, suggesting that person-to-person spread, not waterborne spread, is probably responsible for most between-village transmission in this region. Additional regional-scale data could enhance our understanding of how regional-scale transmission affects local-scale dynamics.

SUBMITTER: Goldstick JE

PROVIDER: S-EPMC4010187 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Ask when--not just whether--it's a risk: How regional context influences local causes of diarrheal disease.

Goldstick Jason E JE Trostle James J Eisenberg Joseph N S JN

American journal of epidemiology 20140415 10

Contemporary epidemiology is enriched when it incorporates ecological concepts about systems and dependencies. With regard to diarrheal disease, the causes of which are many and interacting, the dynamics of within- and between-community disease transmission have distinct components but are also linked in important ways. However, few investigators have studied how regional-scale disease dynamics affect local patterns of diarrheal disease transmission. Characterizing this dependence is important f ...[more]

PMID: 24740889

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Project description:Depression is known to be influenced by psychosocial stressors. For mothers with recurrent depressive illness, the presence of psychopathology in their children may have important effects on their own mental health. Although the impact of maternal depression on child mental health is well-established, no study to date, as far as we are aware, has examined the extent to which offspring psychopathology influences the course of depression in mothers with a history of recurrent depressive illness, what types of child psychopathology impact maternal mental health, or whether risks vary by child gender. Aims were to (a) Use a longitudinal design to examine whether adolescent psychopathology (depression, disruptive behavior disorder; DBD) predicts recurrence of a depressive episode and depression symptom course in women with a history of recurrent depression; and (b) To test if observed effects vary by child gender. 299 mothers with recurrent major depressive disorder and their adolescent offspring were assessed on 2 occasions, 29 months apart. Maternal depression and offspring psychopathology were assessed using semistructured interview measures. Cross-generational links across time were assessed using structural equation modeling. Analyses were adjusted for past severity of maternal depression. Offspring depression symptoms but not DBD symptoms at baseline predicted future episode recurrence in mothers. Depression symptoms in daughters (β = .16, p = .039) but not sons (β = -.07, p = .461), predicted an increase in maternal depression symptoms across time. Psychopathology in daughters is associated with long-term depressive symptoms in women (mothers) with a history of recurrent depression. Findings highlight the importance of careful assessment and management of mental health problems in adolescents for more effective management of maternal depression. This study suggests that offspring symptoms of depression may be important for the recurrence of maternal depression episodes. Girls' symptoms of depression may be a particularly important psychosocial stressor for the development of depressive symptoms in mothers with a history of recurrent depression.

Dataset Information

Ask when--not just whether--it's a risk: How regional context influences local causes of diarrheal disease.

Publications

Ask when--not just whether--it's a risk: How regional context influences local causes of diarrheal disease.

Similar Datasets

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