https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)60074-4.pdf

Epidemiology and causes of preterm birth

Given the functional interdependencies between the molecular components in a human cell, a disease is rarely a consequence of an abnormality in a single gene, but reflects the perturbations of the complex intracellular and intercellular network that links tissue and organ systems. The emerging tools of network medicine offer a platform to explore systematically not only the molecular complexity of a particular disease, leading to the identification of disease modules and pathways, but also the molecular relationships among apparently distinct (patho)phenotypes. Advances in this direction are essential for identifying new disease genes, for uncovering the biological significance of disease-associated mutations identified by genome-wide association studies and full-genome sequencing, and for identifying drug targets and biomarkers for complex diseases.

Network Medicine: A Network-Based Approach to Human Disease

Features of neighborhoods or residential environments may affect health and contribute to social and race/ethnic inequalities in health. The study of neighborhood health effects has grown exponentially over the past 15 years. This chapter summarizes key work in this area with a particular focus on chronic disease outcomes (specifically obesity and related risk factors) and mental health (specifically depression and depressive symptoms). Empirical work is classified into two main eras: studies that use census proxies and studies that directly measure neighborhood attributes using a variety of approaches. Key conceptual and methodological challenges in studying neighborhood health effects are reviewed. Existing gaps in knowledge and promising new directions in the field are highlighted.

/pdf/neighborhoods-and-health-4576uxzkt2.pdf

Neighborhoods and health.

In this article a conceptual model for the study of child development in minority populations in the United States is proposed. In support of the proposed model, this article includes (a) a delineation and critical analysis of mainstream theoretical frameworks in relation to their attention and applicability to the understanding of developmental processes in children of color and of issues at the intersection of social class, culture, ethnicity, and race, and (b) a description and evaluation of the conceptual frameworks that have guided the extant literature on minority children and families. Based on the above considerations, an integrative conceptual model of child development is presented, anchored within social stratification theory, emphasizing the importance of racism, prejudice, discrimination, oppression, and segregation on the development of minority children and families.

An Integrative Model for the Study of Developmental Competencies in Minority Children

This article presents an introduction to the Health Belief Model (HBM). The HBM states that the perception of a personal health behavior threat is influenced by at least three factors: general health values, interest and concern about health; specific beliefs about vulnerability to a particular health threat; and beliefs about the consequences of the health problem. Once an individual perceives a threat to his health and is simultaneously cued to action, if his perceived benefits outweighs his perceived costs, then the individual is most likely to undertake the recommended preventive health action. Key words: health promotion, health belief model, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy. Content available only in Romanian.

Health Belief Model

ContextLittle is known about genetic susceptibility to cigarette smoke in relation
to adverse pregnancy outcomes.ObjectiveTo investigate whether the association between maternal cigarette smoking
and infant birth weight differs by polymorphisms of 2 maternal metabolic genes: CYP1A1 and GSTT1.Design, Setting, and ParticipantsCase-control study conducted in 1998-2000 among 741 mothers (174 ever
smokers and 567 never smokers) who delivered singleton live births at Boston
Medical Center. A total of 207 cases were preterm or low-birth-weight infants
and 534 were non–low-birth-weight, full-term infants (control).Main Outcome MeasureBirth weight, gestation, fetal growth by smoking status and CYP1A1 MspI (AA vs Aa
and aa, where Aa and aa were combined because of small numbers of aa and similar results), and GSTT1 (present
vs absent) genotypes.ResultsWithout consideration of genotype, continuous maternal smoking during
pregnancy was associated with a mean reduction of 377 g (SE, 89 g) in birth
weight (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.7). When CYP1A1 genotype was considered, the estimated reduction
in birth weight was 252 g (SE, 111 g) for the AA
genotype group (n = 75; OR, 1.3; 95% CI, 0.6-2.6), but was 520 g (SE, 124
g) for the Aa/aa genotype
group (n = 43 for Aa, n = 6 for aa; OR, 3.2; 95% CI, 1.6-6.4). When GSTT1
genotype was considered, the estimated reduction in birth weight was 285 g
(SE, 99 g) (OR, 1.7; 95% CI, 0.9-3.2) and 642 g (SE, 154 g) (OR, 3.5; 95%
CI, 1.5-8.3) for the present and absent genotype groups, respectively. When
both CYP1A1 and GSTT1 genotypes
were considered, the greatest reduction in birth weight was found among smoking
mothers with the CYP1A1 Aa/aa and GSTT1 absent genotypes (−1285 g; SE, 234 g; P<.001). Among never smokers, genotype did not independently confer
an adverse effect. A similar pattern emerged in analyses stratified by maternal
ethnicity and in analyses for gestation.ConclusionsIn our study, maternal CYP1A1 and GSTT1 genotypes modified the association between maternal cigarette
smoking and infant birth weight, suggesting an interaction between metabolic
genes and cigarette smoking.

https://jamanetwork.com/journals/jama/articlepdf/194545/JOC10264.pdf

Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight.

Objective To examine the association of state income inequality and individual household income with the mental and physical health of women with young children. Design Cross sectional study. Individual level data (outcomes, income, and other sociodemographic covariates) from a 1991 follow up survey of a birth cohort established in 1988. State level income inequality calculated from the income distribution of each state from 1990 US census. Setting United States, 1991. Participants Nationally representative stratified random sample of 8060 women who gave birth in 1988 and were successfully contacted (89%) in 1991. Main outcome measures Depressive symptoms (Center for Epidemiologic Studies depression score > 15) and self rated health Results 19% of women reported depressive symptoms, and 7.5% reported fair or poor health. Compared with women in the highest fifth of distribution of household income, women in the lowest fifth were more likely to report depressive symptoms (33% v 9%, P < 0.001) and fair or poor health (15% v 2%, P < 0.001). Compared with low income women in states with low income inequality, low income women in states with high income inequality had a higher risk of depressive symptoms (odds ratio 1.6, 95% confidence interval 1.0 to 2.6) and fair or poor health (1.8, 0.9 to 3.5). Conclusions High income inequality confers an increased risk of poor mental and physical health, particularly among the poorest women. Both income inequality and household income are important for health in this population.

/pdf/state-income-inequality-household-income-and-maternal-mental-1bzx5pt8g6.pdf

State income inequality, household income, and maternal mental and physical health: cross sectional national survey

We examined racial and income-related patterns of mortality from birth through adolescence in Boston, where residents have high access to tertiary medical care. Childhood mortality was significantly higher among black children (odds ratio, 1.24; P less than 0.05) and low-income children (odds ratio, 1.47; P less than 0.001). Socioeconomic effects varied for different age groups and causes of death. The largest relative disparity occurred in the neonatal and postneonatal periods, and the smallest in adolescence. Of the total racial differential in neonatal mortality (6.88 deaths per 1000 live births), 51.2 per cent occurred in premature infants, 13.4 per cent in term infants who were small for their gestational age, and 25.9 per cent in neonates who were both premature and small for their age. Black neonatal mortality was elevated at all income levels. Beyond the neonatal period, mortality from respiratory disease, fire, and homicide had strong inverse relationships with income, and mortality from injuries to the occupants of motor vehicles was directly related to income. These data suggest that despite access to tertiary medical services, substantial social differentiation in mortality may exist throughout childhood. Equity in childhood survival will probably require policies that emphasize preventive goals.

Racial and socioeconomic disparities in childhood mortality in Boston.

OBJECTIVE: The war in Bosnia has had a tremendous impact on civilians. Little is known about the impact of modern warfare on children. This survey documents the nature and frequency of war-related experiences among Bosnian children and describes their manifestations of selected psychological sequelae. METHODS: A cross-sectional survey of 364 internally displaced 6- to 12-year-old children and their parents living in central Bosnian collectives was conducted during the war. Parents were surveyed for their children's war experiences; the children were surveyed for war-related distress symptoms. RESULTS: The children were exposed to virtually all of the surveyed war-related experiences. The majority had faced separations from family, bereavement, close contact with war and combat, and extreme deprivation. The prevalence and severity of experiences were not significantly related to a child's gender, wealth, or age, but were related to their region of residence, with children from the region of Sarajevo having the highest prevalence of experiences. Almost 94% of the children met Diagnostic and Statistical Manual of Mental Disorders, 4th ed, criteria for posttraumatic stress disorder. Significant life activity affecting sadness and anxiety were reported by 90.6% and 95.5% of the children, respectively. High levels of other symptoms surveyed were also found. Children with greater symptoms had witnessed the death, injury, or torture of a member of their nuclear family, were older, and came from a large city. CONCLUSIONS: The war-related experiences of the children studied were both varied and severe, and were associated with a variety of psychological sequelae. This experience underscores the vulnerability of civilians in areas of conflict and the need to address the effects of war on the mental health of children. Language: en

War experiences and distress symptoms of Bosnian children.

Infant mortality has long been viewed as a synoptic indicator of the health and social condition of a population. In this article we examine critically the structure of this reflective capacity with a particular emphasis on how new health care technologies may have altered traditional pathways of social influence. The infant mortality rate is a composite of a series of component rates, each with its own relationship to social factors. Advances in health care have reduced dramatically the risk of mortality for the critically ill newborn, thereby elevating the importance of access to this care in shaping absolute and disparate infant mortality rates. These advances in health services technology have also had the effect of concentrating infant mortality among extremely premature and low birth-weight infants, a group tied directly to social factors operating through maternal influences and the general well-being of women. In this manner, current patterns of infant mortality in the United States provide a usef...

Paul H. Wise

Papers

Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight.

State income inequality, household income, and maternal mental and physical health: cross sectional national survey

Racial and socioeconomic disparities in childhood mortality in Boston.

War experiences and distress symptoms of Bosnian children.

The first injustice: socioeconomic disparities, health services technology, and infant mortality.