Background An increasing number of studies are identifying associations between adverse childhood experiences (ACEs) and ill health throughout the life course. We aimed to calculate the proportions of major risk factors for and causes of ill health that are attributable to one or multiple types of ACE and the associated financial costs. Methods In this systematic review and meta-analysis, we searched for studies in which risk data in individuals withACEs were compared with these data in those without ACEs. We searched six electronic databases (MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Databases, and the Education Resources Information Center) for quantitative studies published between Jan 1, 1990, and July 11, 2018, that reported risks of health-related behaviours and causes of ill health in adults that were associated with cumulative measures of ACEs (ie, number of ACEs). We included studies in adults in populations that did not have a high risk of ACEs, that had sample sizes of at least 1000 people, and that provided ACE prevalence data. We calculated the pooled RR for risk factors (harmful alcohol use, illicit drug use, smoking, and obesity) and causes of ill health (cancer, diabetes, cardiovascular disease, respiratory disease, anxiety, and depression) associated with ACEs. RRs were used to estimate the population-attributable fractions (PAFs) of risk attributable to ACEs and the disability-adjusted life-years (DALYs) and financial costs associated with ACEs. This study was prospectively registered in PROSPERO (CRD42018090356). FindingsOf 4387 unique articles found following our initial search, after review of the titles (and abstracts, when the title was relevant), we assessed 880 (20%) full-text articles. We considered 221 (25%) full-text articles for inclusion, of which 23 (10%) articles met all selection criteria for our meta-analysis. We found a pooled prevalence of 23·5% of individuals (95% CI 18·7-28·5) with one ACE and 18·7% (14·7-23·2) with two or more ACEs in Europe (from ten studies) and of 23·4% of individuals (22·0-24·8) with one ACE and 35·0% (31·6-38·4) with two or more ACEs in north America (from nine studies). Illicit drug use had the highest PAFs associated with ACEs of all the risk factors assessed in both regions (34·1% in Europe; 41·1% in north America). In both regions, PAFs of causes of ill health were highest for mental illness outcomes: ACEs were attributed to about 30% of cases of anxiety and 40% of cases of depression in north America and more than a quarter of both conditions in Europe. Costs of cardiovascular disease attributable to ACEs were substantially higher than for most other causes of ill health because of higher DALYs for this condition. Total annual costs attributable to ACEs were estimated to be US$581 billion in Europe and $748 billion in north America. More than 75% of these costs arose in individuals with two or more ACEs.Interpretation Millions of adults across Europe and north America live with a legacy of ACEs. Our fi...

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Objective: To estimate the incidence and severity of invasive group A streptococcal infection in Victoria, Australia. Design: Prospective active surveillance study. Setting: Public and private laboratories, hospitals and general practitioners throughout Victoria. Patients: People in Victoria diagnosed with group A streptococcal disease notified to the surveillance system between 1 March 2002 and 31 August 2004. Main outcome measure: Confirmed invasive group A streptococcal disease. Results: We identified 333 confirmed cases: an average annualised incidence rate of 2.7 (95% CI, 2.3–3.2) per 100 000 population per year. Rates were highest in people aged 65 years and older and those younger than 5 years. The case‐fatality rate was 7.8%. Streptococcal toxic shock syndrome occurred in 48 patients (14.4%), with a case‐fatality rate of 23%. Thirty cases of necrotising fasciitis were reported; five (17%) of these patients died. Type 1 (23%) was the most frequently identified emm sequence type in all age groups. All tested isolates were susceptible to penicillin and clindamycin. Two isolates (4%) were resistant to erythromycin. Conclusion: The incidence of invasive group A streptococcal disease in temperate Australia is greater than previously appreciated and warrants greater public health attention, including its designation as a notifiable disease.

Aims To study the impact of alcohol control policy measures (i.e. increases in taxation, restrictions on availability, including minimum purchasing age regulations, legislation on drink driving and advertisement bans) on alcohol‐related traffic harm in Lithuania between January 2004 and February 2019. Design Analyses of trend data on the proportion of alcohol‐related collisions and crashes, injury and mortality, adjusting for secular trends, seasonality, periods of alcohol control measure implementation and economic development. Generalized additive mixed models were used. Multiple sensitivity analyses were conducted. Setting Lithuania. Cases Monthly number of alcohol‐related cases of traffic collisions and crashes, injuries and deaths. Interventions and comparators Periods of time during which new alcohol control measures were implemented and/or augmented compared to periods when they were not. Measurements Monthly data for 2004 to 2019 from routine statistics of the Lithuanian Road Police Service. Findings All indicators decreased consistently and significantly after the implementation of alcohol control measures, including increased taxation, reduction of availability and a ban on advertisement, starting in 2014. On average, each implemented policy measure permanently reduced the proportion of alcohol‐attributable crashes by 0.55% [95% confidence interval (CI) = 0.21–0.90%; P = 0.002], the proportion of alcohol‐attributable injuries by 0.60% (95% CI = 0.24–0.97%; P = 0.001) and the proportion of alcohol‐attributable deaths by 0.13% (95% CI = 0.10–0.15%; P < 0.001). Conclusions Alcohol control policy measures, including measures to reduce overall level of alcohol consumption, were associated with a marked decrease in alcohol‐related traffic harm.

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