Georgia State University

Childhood verbal abuse by adults costs society an estimated $300 billion a year globally, show recent findings. Childhood verbal abuse by adults costs society an estimated $300 billion (£239 billion) a year globally, show findings presented at the first international conference on childhood verbal abuse, hosted by UCL, Words Matter and the World Health Organization (WHO). The Words Matter: Impact and Prevention of Childhood Verbal Abuse conference marks the first time that experts from around the world have come together to focus attention on the lifetime damage of childhood verbal abuse and the need to develop solutions. Childhood verbal abuse involves behaviours that can be detrimental to a child's wellbeing, such as belittling, shouting and threatening language. The new study, led by Professor Xiangming Fang (China Agricultural University and Georgia State University) used data from the US Centers for Disease Control and Prevention's Violence Against Children Surveys, in four countries: Cambodia (1212 participants), Kenya (1099 participants), Colombia (1415 participants) and Moldova (906 participants), to analyse the effects of childhood verbal abuse on selected health outcomes, including mental distress, self-harm, drug use and problem drinking. The study then estimated the Disability-Adjusted Life Years (DALY) lost (the total amount of healthy life years lost due to people dying prematurely or living with a disability caused by a common disease or health problem in the community) due to health outcomes attributed to childhood verbal abuse to estimate its economic burden. These DALY losses were then converted into monetary value -- assuming that one DALY was equal to the country's per-capita Gross Domestic Product (GDP). The mean economic burden of childhood verbal abuse across the four countries was found to be 0.34% of GDP. When this figure was applied to global GDP, it equated to approximately $300 billion every year. Meanwhile, the DALY losses for outcomes attributed to childhood verbal abuse were significantly great than corresponding estimates for breast cancer and liver cancer in the four countries studied, and similar to the Disability-Adjusted Life Years lost to hypertensive heart disease. Conference Chair, Professor Peter Fonagy (UCL Psychology & Language Sciences), said: "Verbal abuse of children by adults is all too common, but is one of the most significant modifiable causes of life-long mental health disorders. "Tackling it gives us a powerful lever to prevent mental health disorders and their enormous cost to both the UK and global economy. "I am delighted that with the Words Matter charity, we have an organisation finally focusing on this problem. Bringing greater awareness to childhood verbal abuse has the potential to dramatically reduce the economic and psychological burden of psychiatric disorders." Previous research from experts at UCL and Wingate University* found that childhood verbal abuse can be as harmful as other forms of abuse and have significant adverse impacts on children's mental and physical health and development -- leading to anxiety, depression, eating disorders, self-harm, substance abuse and even suicide. Professor Xiangming Fang said: "The economic burden of childhood verbal abuse by adults that we have quantified clearly highlights the shocking hidden cost of the damage it causes to children throughout their lifetime. However, this is likely a considerable underestimate given the impact of childhood verbal abuse on several outcomes including healthcare utilisation costs and legal system expenses, which were not included in the analysis due to data unavailability. "There is clearly a significant opportunity for economic growth by ending childhood verbal abuse, and by revealing these figures, we hope this form of childhood maltreatment will be given the attention it deserves. Vital now is undertaking more research and devoting funds and resources to preventing it, so the cost to society can be reduced." Jessica Bondy, Founder of Words Matter, said: "For too long, childhood verbal abuse by adults has gone under the radar, yet it is all around us. We hope this conference helps put the issue firmly on the map and galvanises action. It is possible to bring an end to childhood verbal abuse with greater awareness, understanding and collaboration across the globe to devise solutions. We must act now, given the lifelong impact on children's mental and physical health and wellbeing and the monumental cost to society. Let's build children up, not knock them down, and create a better future for children." Tim Loughton MP, Chair of the All-Party Parliamentary Group for Children and former Children's Minister said: "By convening this conference, the work of Words Matter and its expert advisers is filling a gap in understanding the harms that can be inflicted on children from the way adults communicate with them and the routes for prevention. Whilst we are all too familiar with the damage done to children as a result of physical violence, verbal abuse is more insidious and pervasive, impacting so many whose mental health has already been deeply affected due to the Covid pandemic. "We all have a duty of care to treat children with respect and that includes the words and language we use with them. This conference highlights how much words really do matter and how if used poorly, they can have lasting implications for children and our economy." Former Health Minister and Chief Executive of the NHS Confederation and currently Opposition Whip, Lord Philip Hunt of Kings Heath said: "All children deserve to grow up happy and healthy, but millions are suffering verbal abuse by adults which has for far too long been hidden in the shadows. Thanks to the work of Words Matter, we now know that this is not only impacting children's mental health and development but is also, as this new study shows, having a huge cost on society as a whole. We all want children to develop armed with the tools to lead confident and productive adult lives and the words they hear from adults are so important in building self-esteem and confidence. By shining a light on this abuse, lives can and will be changed." Study limitations The $300 billion is likely a considerable underestimate given the impact of childhood verbal abuse on several outcomes, including healthcare utilisation costs and legal system expenses, which were not included in the analysis, due to data unavailability. Additionally, costs associated with chronic illnesses such as diabetes, heart disease, and cancer were not taken into account. Multiple risk factors can contribute to the occurrence of any disease. When attributing a disease to these factors the maximum attribution is capped at 100%. However, if multiple risk factors are involved and overlap, the sum of DALY estimates for all risk factors may exceed 100%. Failure to fully account for these inter-correlations could potentially result in overestimation of the figures instead. The field lacks reliable longitudinal data to assess the long-term repercussions of childhood verbal abuse. The absence of high-quality cohort studies that adopt a lifetime perspective in economic data estimation may lead to a substantial underestimation of the economic impact of childhood verbal abuse. Prioritising the collection of longitudinal data on the consequences of childhood verbal abuse should be a primary focus of future efforts.

A panel of healthcare and business policy researchers participates in a Q&A during the FTC's virtual workshop of private equity in healthcare. They echoed the testimonies of clinicians who described worsened care standards among healthcare organizations acquired by private equity firms. Federal regulators are weighing new safeguards against exploitative dealmaking by private equity firms within healthcare—and, so far, they aren't signaling any reprieve for the corporate investors experts say are behind withering care standards and preventable bankruptcies. Back in December, the Biden administration announced a sweeping, multiagency effort to clamp down on what it described as “corporate greed in healthcare.” That push was preceded by legal challenges against PE-backed physician roll-up schemes and ownership transparency requirements for several types of providers, and in recent months involves new data sharing between agencies as well as specific leadership roles focused on healthcare competition. The government went a step further on Tuesday as the Federal Trade Commission (FTC), the Department of Justice’s (DOJ's) Antitrust Division, and the U.S. Department of Health and Human Services (HHS) together issued a new request for information surrounding healthcare dealmaking. Specifically, the government said it wants to hear from the public on PE, health system, private payer or other healthcare-related asset manager deals that “may increase consolidation and generate profits for firms while threatening patients’ health, workers’ safety, quality of care, and affordable health care for patients and taxpayers.” They’re also seeking feedback on healthcare deals that potentially would not be noticed by regulators under the current premerger notification framework along with firsthand accounts from patients and workers who saw changes in their facilities following a merger or acquisition. The inquiry follows a multidecade uptick in PE involvement within the healthcare industry. A study published this week in Health Affairs, for instance, found that the number of PE-owned physician practice sites rose from 816 in 2012 to 5,779 in 2021 and that single PE firms had gained “significant” market share in dozens of metropolitan statistical areas thanks to their acquisitions. Regulators lay out enforcement priorities   The information gathering kicked off later that afternoon with a virtual public workshop on private equity in healthcare hosted by the FTC. It featured comments from FTC commissioners and DOJ and Centers for Medicare & Medicaid Services heads in addition to testimonies and Q&As from academic researchers, clinicians and other stakeholders. Both the policymakers and the public, near unanimously, painted PE as an exploitative and damaging force on care. In opening comments, FTC Chair Lina Khan said that PE healthcare acquisitions “has been top of mind” for the regulator and that it has heard “an outpouring of concern” within the last two years alone. Though she acknowledged that PE “can sometimes be an important source of capital” for small or midsized companies, and that “some” PE firms will take a long-term view of generating value, she pointed to a general trend in which increased financialization and pursuit of profits supplant clinicians’ medical judgement. Khan also drew attention to specific PE tactics—debt-financed strip-and-flip deals, market roll-ups via serial smaller acquisitions, and reducing competitive incentives among rivals through minority stake purchases or interlocking directorates—that she said regulators already have the tools to address. “Firms of all types should be on the notice that we’re on the lookout for these strategies and will continue to deploy the full scope of our authority to protect the American public from anti-competitive and unlawful tactics,” she said. Assistant Attorney General Jonathan Kanter, of the DOJ’s Antitrust Division, followed Khan by highlighting specific enforcement wins, including the resignation of 15 interlocking directors from 11 different corporate boards, and promised that “more than anything, we will stay laser-focused on the intermediaries that sit between you and your doctor.” Other officials from HHS outlined cases of healthcare fraud and warned that unchecked consolidation has increased Medicare costs and drives thousands of monthly complaints from beneficiaries. “For example … private Medicare managed care plans receive over $400 billion per year and cover over 50% of the Medicare population—and its growth has attracted more private investment,” Christi Grimm, HHS inspector general, said during the workshop. “It’s important that this investment supports well-run managed care plans that both comply with Medicare rules and ensure enrollees have access to cost effective, high-quality services for enrollees. … When investors’ conduct jeopardizes patient safety or crosses the line into fraud, [the Office of Inspector General] and our law enforcement partners are exploring the best ways to hold them accountable.” "The worst experience of my professional life"   More explicit criticisms of corporate ownership came during firsthand accounts on the “human impact” of PE in healthcare. In one testimony, a registered nurse and supervisor from a rural community hospital—who opted to testify anonymously “due to concerns about potential workplace retaliation”—said it was “evident” that their hospital had become “chronically understaffed” and unsafe since being acquired by a PE firm over a decade prior. They detailed an incident where a psychiatric patient being held in the ER escaped his bed and entered an adjacent room where he used his thumbs to “gouge out” the eye of another elderly patient, who later died of her wounds. The nurse said that there was no security guard on staff and that panic buttons hidden at nurses' desks “historically” haven’t led to responses within 15 minutes. “After that incident, ER nurses were given de-escalation training with the assumption that the handyman maintenance staff will act as security. Hiring a full-time security guard is simply too expensive,” they said before describing other incidents of sexual harassment and preventable patient deaths. Jonathan Jones, M.D., president of the American Academy for Emergency Medicine, said that he has worked in multiple hospitals and employment models over his career, “and I can definitively say that working under a PE-backed managed group has been the worst experience of my professional life. More importantly, it’s also been the worst possible experience for my patients.” He detailed a large community hospital he worked in where ED staffing had recently switched to a PE-controlled group, which led to staffing reductions “outside what is considered safe by any of the emergency medical specialty societies.” Physicians who said that changes were unsafe were told they “could stop complaining or we would be terminated,” he said. Jones eventually decided to leave, but, “given that the same PE that group staffed four other emergency departments in the city, and had a commanding share of the market in general, I had to leave my city as well.” In reaction to these and other provider testimonies, FTC Commissioner Alvaro Bedoya said it was clear PE was interfering with the goals of clinicians and healthcare. “I fear that PE threatens to turn the Hippocratic Oath on its head,” Bedoya said. “So many of the warnings and allegations that we’re hearing today … stem from situations where PE is taking control away from doctors and medical professionals.” "Heads, I win, tails, you lose"   Between breakdowns of the extensive body of academic data linking PE to worsened outcomes, healthcare and business policy researchers floated their ideas on how the administration should rein in exploitative investors. They noted that several practices outlined during the course of the day aren’t exclusive to PE. Rather, PE often moves more quickly than other types of for-profit businesses to exploit legal “loopholes” for the benefit of their investors, said Erin Fuse Brown, a law professor at Georgia State University. “When we think about crafting these policy responses … the polices themselves should be somewhat agnostic as to the type of owner,” she told regulators. “If it’s the same risk, it should apply equally no matter who is pulling the lever.” On the other hand, Brendan Ballou, an attorney, DOJ special counsel and author, said there are cases in which PE equity acquisitions are “qualitatively different” than those of traditional healthcare players. He said that it is “very hard” to hold PE firms conducting a roll-up strategy responsible for the portfolio companies it acquired. He also noted that PE firms' profit incentives aren’t always aligned with the goals of a healthcare company, and highlighted scenarios (akin to the now-scrutinized Steward Health Care) in which a transaction fee paid directly to a PE firm can justify a hospital’s decision to sell off its real estate and become saddled with regular rent payments to the new owner. “What that means is private equity firms often have a ‘heads, I win, tails, you lose’ sort of business model, where it makes sense, actually, for them to lever the company up and cut staffing in the hope of ambitious growth or increased profitability,” he said. “If things go well, that's great. But if things go poorly, often nothing bad will come [to the PE firm].” The expert panel said they were generally encouraged by regulators’ recent actions to address PE exploitation, including adjustments to premerger notification requirements that empower the FTC block “platform” companies from acquiring rivals should that lead to reduced competition. As for potential policy solutions, Brown described HHS’ moves to increase ownership transparency as “a fundamental starting point” that will act as the “bedrock principle” for future interventions. From there, she encouraged collective antitrust enforcement and competition policy across the agencies; fraud and abuse enforcement; new policies “to protect the clinical autonomy of the workforce,” such as physician noncompetes; and the closing of specific payment loopholes being “exploited by private equity to increase revenues.”

机体对呼吸道病毒感染（RVIs）的易感性在不同个体之间差异很大，近日，一篇发表在国际杂志Cell Host & Microbe上题为“Intestinal microbiota programming of alveolar macrophages influences severity of respiratory viral infection”的研究报告中，来自乔治亚州立大学等机构的科学家们通过研究发现，肠道中所发现的微生物群落的组成或许会影响小鼠对呼吸道病毒感染的易感性以及这些感染的严重程度。文章中，研究者发现，在肠道中所发现的分节丝状菌（segmented filamentous bacteria），无论是自然获得还是人工给予，其都能保护小鼠免于流感病毒的感染。这种能抵御感染的保护作用也适用于呼吸道合胞病毒（RSV）和引起COVID-19的SARS-CoV-2病毒，为了维持这种保护作用，研究者表示，分节丝状菌就需要肺部中的免疫细胞，即基底驻留肺泡巨噬细胞（basally resident alveolar macrophages）。这项研究中，研究人员调查了特定微生物群落的差异如何影响呼吸道病毒感染的结局，以及其是如何影响的，这在此前并未得到很好地阐释，研究人员对具有离散微生物组差异的小鼠和仅存在或不存在分节丝状菌的小鼠进行研究，当小鼠被感染后几天，研究人员对其肺部中的病毒滴度进行测定，而根据不同动物组机体微生物组的性质，其肺部中病毒滴度能发生显著变化。分节丝状菌 (SFB) 在肠道中定植可保护小鼠免受流感病毒感染图片来源：Cell Host & Microbe (2024). DOI:10.1016/j.chom.2024.01.002研究者Andrew Gewirtz说道，这些研究发现揭示了复杂的相互作用，这些相互作用能将肠道微生物与基本定植在肺泡巨噬细胞的功能以及呼吸道病毒感染的严重性机械地联系起来。他们发现，在分节丝状菌阴性的小鼠中，随着呼吸道病毒感染的进展，基底驻留肺泡巨噬细胞能迅速耗尽，然而，在分节丝状菌定植的小鼠中，基底驻留肺泡巨噬细胞则会被改变从而抵御流感病毒的耗尽和炎性信号。这些基底常驻肺泡巨噬细胞能让流感病毒失活，这在很大程度上是通过激活免疫系统中称之为补体系统的组成部分所致。研究人员发现，在栖息在小鼠肠道中数千种不同的微生物群落中存在一种常见的细菌群落，其会对呼吸道病毒感染模型产生强烈的影响，这种影响在很大程度上归咎于基底驻留肺泡巨噬细胞。综上，本文研究结果揭示了一种能将肠道微生物群落与肺泡巨噬细胞和呼吸道病毒感染机械性关联起来的复杂相互作用。参考文献：Vu L Ngo, Carolin M Lieber, Hae-Ji Kang, et al. Intestinal microbiota programming of alveolar macrophages influences severity of respiratory viral infection, Cell Host & Microbe (2024). DOI: 10.1016/j.chom.2024.01.002本文仅用于学术分享，转载请注明出处。若有侵权，请联系微信：bioonSir 删除或修改！