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Adverse childhood experiences (ACEs) are prevalent and associated with common problems among adults with substance use disorders (SUDs), including posttraumatic stress disorder (PTSD) symptoms and compulsive behaviors. Most studies consider cumulative ACEs when examining their associations with health and behavioral outcomes. We tested whether patterns of ACEs related to SUD symptoms, PTSD symptoms, and compulsive behaviors among adults receiving treatment for substance use. We identified latent classes of ACEs using medical record data from 721 patients in residential SUD treatment and conducted Wald chi-square tests to assess whether these latent classes differed in alcohol and drug use disorder symptoms, PTSD symptoms, compulsive sexual behavior, and compulsive gambling. We identified four latent classes: high ACEs (15.1%), maltreatment (12.4%), household problems (22.3%), and low ACEs (49.1%). There were significant differences across latent classes in drug use disorder symptoms, PTSD symptoms, and compulsive sexual behavior, χ 2 (1, N = 721) = 37.42-107.07, ps < .001. Participants in the high ACEs and household problems classes had more drug use disorder symptoms than those in the low ACEs class. Relative to all other classes, individuals in the low ACEs class had the lowest PTSD symptoms and those in the high ACEs class had the highest PTSD symptoms. Findings indicate that adults with SUDs who have more ACEs have the highest risk for PTSD symptoms and compulsive sexual behavior. Screening for ACEs while considering ACE patterns and frequency may benefit treatment planning for SUD patients with comorbid concerns such as PTSD symptoms and compulsive sexual behavior., (© 2024 International Society for Traumatic Stress Studies.)

Background: Latin America and the Caribbean (LAC) is among the most unequal regions in the world in terms of wealth and household income. Such inequalities have been shown to influence different outcomes during the COVID-19 pandemic, including the disruption of routine health services. The aim of this paper is to examine socioeconomic inequalities in household experiences of healthcare disruption in LAC countries from mid-2020 to late 2021., Methods: We used household-level data from the COVID-19 High Frequency Phone Surveys (HFPS), conducted in 14 LAC countries in one round in 2020 and 24 countries in two rounds in 2021. Ordinary least square and Logit multivariate regressions were conducted to examine the correlation between reported healthcare disruptions with household characteristics for 2020 and 2021. Since household income levels were not directly collected in the HPFS, we created an index of inequality and estimated the relative index of inequality., Results: When analyzing 2020-2021 together, reported healthcare disruptions were lower if the respondent was employed or did not report lack of food in the last month; if the household had more people aged 65 or older or more rooms to sleep in. When analyzed separately in 2020 and 2021, having more people aged 65 or older or not experiencing food insecurity remained stable factors for lower odds of disruption in both years. In addition, being employed was associated with lower odds of disruption in 2020, while being male or having more rooms to sleep in were associated with lower odds of disruption in 2021. Regarding wealth differences in 2021 (it was not possible to compute it for 2020), households with the lowest wealth were 27.3% more likely to report a care disruption than households with the highest wealth., Conclusions: The socioeconomic status of households in LAC was a relevant factor in explaining the disruption of healthcare during the COVID19 pandemic, with a clear social gradient where the wealthier a household, the less likely it was to experience disruption of care. Food security, employment, and gender policies should be integral to preparing for and responding to future shocks such as pandemics. Prioritizing the most affected populations, like the elderly during COVID-19, can enhance the health system effectiveness., Competing Interests: Declarations. Human ethics and consent to participate declarations: As secondary data analysis, this study did not constitute human subjects research and ethical approval was not required. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

In addition to the direct health effects of the Coronavirus disease (COVID-19) pandemic, the pandemic has increased the risks of foregone non-COVID-19 healthcare. Likely, these risks are greatest in low- and middle-income countries (LMICs), where health systems are less resilient and economies more fragile. However, there are no published studies on the prevalence of foregone healthcare in LMICs during the pandemic. We used pooled data from phone surveys conducted between April and August 2020, covering 73 638 households in 39 LMICs. We estimated the prevalence of foregone care and the relative importance of various reported reasons for foregoing care, disaggregated by country income group and region. In the sample, 18.8% (95% CI 17.8-19.8%) of households reported not being able to access healthcare when needed. Financial barriers were the most-commonly self-reported reason for foregoing care, cited by 31.4% (28.6-34.3%) of households. More households in wealthier countries reported foregoing care for reasons related to COVID-19 [27.2% (22.5-31.8%) in upper-middle-income countries compared to 8.0% (4.7-11.3%) in low-income countries]; more households in poorer countries reported foregoing care due to financial reasons [65.6% (59.9-71.2%)] compared to 17.4% (13.1-21.6%) in upper-middle-income countries. A substantial proportion of households in LMICs had to forgo healthcare in the early months of the pandemic. While in richer countries this was largely due to fear of contracting COVID-19 or lockdowns, in poorer countries foregone care was due to financial constraints., (© The Author(s) 2022. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Childhood stunting, being short for one's age, has life-long consequences for health, human capital and economic growth. Being stunted in early childhood is associated with slower cognitive development, reduced schooling attainment and adult incomes decreased by 5-53%. The World Health Assembly has endorsed global nutrition targets including one to reduce the number of stunted children under five by 40% by 2025. The target has been included in the Sustainable Development Goals (SDG target 2.2). This paper estimates the cost of achieving this target and develops scenarios for generating the necessary financing. We focus on a key intervention package for stunting (KIPS) with strong evidence of effectiveness. Annual scale-up costs for the period of 2016-25 were estimated for a sample of 37 high burden countries and extrapolated to all low and middle income countries. The Lives Saved Tool was used to model the impact of the scale-up on stunting prevalence. We analysed data on KIPS budget allocations and expenditure by governments, donors and households to derive a global baseline financing estimate. We modelled two financing scenarios, a 'business as usual', which extends the current trends in domestic and international financing for nutrition through 2025, and another that proposes increases in financing from all sources under a set of burden-sharing rules. The 10-year financial need to scale up KIPS is US$49.5 billion. Under 'business as usual', this financial need is not met and the global stunting target is not reached. To reach the target, current financing will have to increase from US$2.6 billion to US$7.4 billion a year on average. Reaching the stunting target is feasible but will require large coordinated investments in KIPS and a supportive enabling environment. The example of HIV scale-up over 2001-11 is instructive in identifying the factors that could drive such a global response to childhood stunting., (© The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

There is an urgent need for global action to increase the rates of exclusive breastfeeding. In 2012, the World Health Assembly (WHA) set a global target to increase the rate of exclusive breastfeeding in the first 6 months up to at least 50% by 2025. However, current investment levels are insufficient to drive the kind of progress that is needed to meet the target. Reaching the global nutrition target of increasing exclusive breastfeeding to 50% will require an average annual investment of $570 million over 10 years in addition to what is currently being spent. This investment is projected to result in an additional 105 million children being exclusively breastfed and at least 520,000 child deaths prevented over the next 10 years. This analysis was part of an investment framework developed by the World Bank, Results for Development Institute, and 1,000 Days to provide policy makers with a roadmap for how to reach four of the six WHA global nutrition targets: decreasing childhood stunting, decreasing childhood wasting, decreasing rates of anemia in women of reproductive age, and increasing exclusive breastfeeding in the first 6 months.