抗原变异可使得多种致病微生物易于逃避宿主免疫应答。表达在感染红细胞表面的恶性疟原虫红细胞表面蛋白1（PfPMP1）与感染红细胞、内皮细胞、树突状细胞以及胎盘的单个或多个受体作用，在黏附及免疫逃避中起关键的作用。每个单倍体基因组var基因家族编码约60种成员，通过启动转录不同的var基因变异体为抗原变异提供了分子基础。

疟原虫var基因转换速率变化导致抗原变异[英]／Paul H, Robert P, Christodoulou Z, et al//Proc Natl Acad Sci U S A

Statistical method for testing the neutral mutation hypothesis by DNA polymorphism.

The psychological impact of quarantine and how to reduce it: rapid review of the evidence.

世界経済・社会統計 = World development indicators

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61690-6.pdf

Closing the gap in a generation: health equity through action on the social determinants of health

In its 1988 landmark report and again in 2003 in an updated report,1,2 the Institute of Medicine defined public health as "what we as a society do to collectively assure the conditions in which people can be healthy." The literature describing the relationship between conditions needed for health and health outcomes is as old as the public health endeavor itself and continues to grow, now almost exponentially. That certain conditions commonly referred to as social determinants—including access to affordable healthy food, potable water, safe housing, and supportive social networks—are linked to health outcomes is something on which most of us . . .

Addressing Social Determinants of Health Inequities: Learning From Doing

A growing body of evidence suggests that the experience of being diagnosed with breast cancer, a potentially life-threatening event, is associated with substantial psychological distress (1–3). Posttraumatic stress disorder (PTSD) is a psychiatric diagnosis characterized by the development of re-experiencing, avoidance, and increased arousal symptoms after exposure to a traumatic event (4). In 1994, the trauma criteria for PTSD in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were expanded to include life-threatening illnesses, such as cancer (4). Since that time, PTSD has been investigated in a number of studies of breast cancer survivors; these typically small-scale studies have yielded estimates of prevalence ranging from 0% (5,6) to 32% (7,8).

A number of studies have identified risk factors for PTSD after a diagnosis of cancer, including demographic, social, psychosocial, and clinical characteristics, such as socioeconomic status (9–11), less education (10,11), poor social support (12–15), prior individual psychological disturbances (10), younger age at diagnosis (9,11,12,16–19), type of surgery (10,15), lymph node involvement (10,15), stage of disease (12), and less time since treatment (13).

Racial disparities have been a concern in breast cancer, generally focused on differences in survival outcomes (20), but some studies have also suggested that the risk of PTSD may also be different across racial/ethnic groups (21,22). For example, Roberts and colleagues (22) found that the risk of PTSD after being exposed to various life traumas among blacks was 1.22 (95% confidence interval [CI] = 1.02 to 1.43), whereas among Asian women the risk was lower (odds ratio [OR] = 0.67, 95% CI = 0.45 to 0.99) in comparison with whites in their sample of more than 34 000 individuals representative of the US noninstitutionalized, civilian population aged 18 years and older. After a cancer diagnosis as the traumatic event, a higher rate of PTSD has been reported for blacks diagnosed with prostate cancer (23) and non-Hodgkins lymphoma (24) than for whites with the same diagnoses, but this issue has received little attention in breast cancer. Rates of PTSD after a diagnosis of breast cancer in Hispanic and Asian Americans have also received little research attention, although there is some evidence of generally lower emotional well-being among women in these minority groups compared with whites (25).

In this study, we investigate PTSD in data collected from a large prospective cohort of racially diverse breast cancer patients over a 6-month period after diagnosis based on three time points and explore the impact of demographic and clinical characteristics on PTSD, with a particular emphasis on race.

/pdf/racial-disparities-in-posttraumatic-stress-after-diagnosis-26xi9fvdl2.pdf

Racial Disparities in Posttraumatic Stress After Diagnosis of Localized Breast Cancer: The BQUAL Study

/pdf/the-role-of-physicians-in-addressing-social-determinants-of-4w5x3qi3n3.pdf

The Role of Physicians in Addressing Social Determinants of Health.

A solution to get the problem off, have you found it? Really? What kind of solution do you resolve the problem? From what sources? Well, there are so many questions that we utter every day. No matter how you will get the solution, it will mean better. You can take the reference from some books. And the handbook of urban health is one book that we really recommend you to read, to get more solutions in solving this problem.

Handbook of urban health

Objectives. We evaluated the contribution of neighborhood-level factors indicative of social disorganization, including educational and occupational attainment, immigrant concentration, physical disorder, and social cohesion, to the likelihood of intimate partner femicide (IPF) while taking into account known neighborhood- and individual-level IPF risk factors. Methods. We used medical examiner data on 1861 femicide victims between 1990 and 1999 and archival information on 59 neighborhoods in New York City to conduct a multilevel case‐control analysis. Results. After controlling for neighborhood-level income, we found that no neighborhood factors were significantly associated with IPF risk, as compared with risk of non‐IPF and risk of femicide from unknown perpetrators, above and beyond the contributions of individual-level factors. The strongest predictors of IPF were foreign country of birth and young age. Conclusions. IPF victims were nearly twice as likely as non-IPF victims to be foreign born; by contrast, there was little neighborhood-level heterogeneity with respect to IPF risk. Further research is needed to identify neighborhood characteristics that uniquely influence risk of IPF to guide community-level interventions. (Am J Public Health. 2008;98:1473‐1479. doi:10.2105/AJPH.2007.112813)

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2007.112813

Sandro Galea

Papers

Addressing Social Determinants of Health Inequities: Learning From Doing

Racial Disparities in Posttraumatic Stress After Diagnosis of Localized Breast Cancer: The BQUAL Study

The Role of Physicians in Addressing Social Determinants of Health.

Handbook of urban health

The Role of Neighborhood Environment and Risk of Intimate Partner Femicide in a Large Urban Area