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Where Is MCH In Relation to the Life-Course Perspective? Michael C. Lu, MD, MPH Associate Professor Department of Obstetrics & Gynecology David Geffen School of Medicine at UCLA Department of Community Health Sciences UCLA School of Public Health National MCH Life Course Meeting Oakland, CA June 9, 2008 Major Disconnects in MCH Longitudinal Disconnect Contextual Disconnect Methodological Disconnect Longitudinal Disconnect Life Course Perspective Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J. 2003;7:13-30. Developmental Programming Programming The process whereby a stimulus or insult, at a sensitive or ‘critical’ period, has lasting or lifelong impact on health or function. Barker DJP. Mothers, babies and health in later life. Edinburgh: Churchill Livingstone. 1998. Prenatal Programming of Childhood Obesity Prenatal Programming of Childhood Obesity Maternal Diabetes & Intrauterine Hyperglycemia Intrauterine Hyperinsulinemia (Fetal Pancreatic β Cells) Preadipocyte Differentiation Adipocyte Hyperplasia Prenatal& Postnatal Hyperleptinemia Programmed Insulin Resistance Postnatal Hyperinsulinemia Hypothalamic Leptin Resistance Pancreatic βCell Leptin Resistance Hyperphagia Hyperinsulinism Adipogenesis Epigenetics Epigenetics Same Genome, Different Epigenome R.A. Waterland, R.A. Jirtle, "Transposable elements: targets for early nutritional effects on epigenetic gene regulation," Mol Cell Biol, 23:5293-300, 2003. Reprinted in the New Scientist 2004 Allostasis: Maintain Stability through Change McEwen BS. Protective and damaging effects of stress mediators. N Eng J Med. 1998;338:171-9. Allostastic Load: Wear and Tear from Chronic Stress McEwen BS. Protective and damaging effects of stress mediators. N Eng J Med. 1998;338:171-9. Stressed vs. Stressed Out Stressed Stressed Out Increased cardiac output Hypertension & cardiovascular diseases Increased available glucose Glucose intolerance & insulin resistance Enhanced immune functions Infection & inflammation Growth of neurons in hippocampus & prefrontal cortex Atrophy & death of neurons in hippocampus & prefrontal cortex Allostasis & Allostatic Load McEwen BS, Lasley EN. The end of stress: As we know it. Washington DC: John Henry Press. 2002 “Weathering” The effects of social inequality on the health of populations may compound with age, leading to growing gaps in health status through young and middle adulthood that can affect fetal health. Geronimus AT (1996) Contextual Disconnect Epidemiological Model Environment Host Agent (Parasite) Multiple Determinants Evans RG, Stoddart GL. Producing health, consuming health care. Soc Sci Med. 1990;31:1347-63. Ecological Model Bronfenbrenner U. Ecology of Human Development: Experiments by Nature and Design. Cambridge MA: Harvard University Press. 1979. Toxic Environments Methodological Disconnect Transdisciplinary Research Multidisciplinary Research Interdisciplinary Research researchers from different fields work independently or sequentially, each from his or her own disciplinary perspective, to address a particular research topic entails greater sharing of information and closer coordination among researchers from various fields than occurs in multidisciplinary projects, yet the participants remain anchored in their respective disciplinary models and methodologies Transdisciplinary Research researchers work together to develop a shared conceptual framework that integrates and extends discipline-based concepts, theories, and methods to address a common research topic. Transdisciplinary research collaborations are intended to achieve the highest levels of intellectual integration across multiple fields and yield shared conceptual formulations that move beyond the disciplinary perspectives represented by team members. Stokols D. Toward a science of transdisciplinary action research. Am J Community Psychol. 2006 Sep;38(1-2):63 Community-Based Participatory Research (CBPR) A collaborative process that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities Minkler M, Wallerstein N, eds. Community Based Participatory Research for Health. San Francisco, Calif: Jossey-Bass Publishers; 2003 Praxis Integration of theory and practice Now What? Integration Integration Longitudinal Integration Measurements Data Infrastructure Longitudinal modeling Contextual Integration Measurements Bias & confounding Multilevel modeling Data linkages Longitudinal studies National Children’s Study Interactions Gene-environment Cumulative risks Methodological Integration Transdisciplinary Research Community-Based Participatory Research Praxis Integrated Science of MCH Life Course Theory Research Practice Policy Education