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PERINATAL HEALTH RESEARCH

PERINATAL HEALTH RESEARCH. Michael C. Lu, MD, MPH UCLA Schools of Medicine & Public Health. Panel on “The Future Research Agenda for MCH” 2004 APHA Annual Meeting Washington DC, November 10, 2004. Objectives for Panel. What are the current key issues? What are the future questions?.

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PERINATAL HEALTH RESEARCH

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  1. PERINATAL HEALTH RESEARCH Michael C. Lu, MD, MPH UCLA Schools of Medicine & Public Health Panel on “The Future Research Agenda for MCH” 2004 APHA Annual Meeting Washington DC, November 10, 2004

  2. Objectives for Panel • What are the current key issues? • What are the future questions?

  3. Key Issues Integration

  4. Key Issues • Longitudinal disconnect • Contextual disconnect • Methodological disconnect

  5. Longitudinal Disconnect

  6. 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.

  7. Good health Risk Factors Poor Health Protective Factors 0 Life Course

  8. Future Direction • Longitudinal Integration • What are the life course influences on perinatal outcomes? • What are the perinatal influences over the life course? • What are the pre-disease pathways (not just risk factors) leading to poor outcomes (e.g. maternal allostatic load)? • What are the pathways leading to positive health and development? • References • Kotelchuck M. Building on a life-course perspective in maternal and child health.Matern Child Health J. 2003;7:5-11 • Wise P. Framework as metaphor: the promise and peril of MCH life-course perspectives. Matern Child Health J. 2003;7:151-6. • Misra DP, Guyer B, Allston A. Integrated perinatal health framework. A multiple determinants model with a life span approach. Am J Prev Med. 2003;25:65-75.

  9. Contextual Disconnect

  10. Multiple Determinants Evans RG, Stoddart GL. Producing health, consuming health care. Soc Sci Med. 1990;31:1347-63.

  11. Ecological Model Bronfenbrenner U. Ecology of Human Development: Experiments by Nature and Design. Cambridge MA: Harvard University Press. 1979.

  12. Integrated Perinatal Health Framework Misra DP, Guyer B, Allston A. Integrated perinatal health framework. A multiple determinants model with a life span approach. Am J Prev Med. 2003;25:65-75.

  13. Future Direction • Contextual Integration • Individual • How do contextual factors become embedded in pregnancy physiology or developmental biology (e.g. envrionmentally induced gene expression)? • Interpersonal • What personal ties are important to perinatal outcomes? • Where is the M in MCH (male involvement) • Neighborhood & community • What collective properties influence perinatal outcomes (e.g. social capital, neighborhood stressors)? • Population health • What macro-level factors (e.g. macro-economy or the healthcare system) influence perinatal outcomes?

  14. Methodological Disconnect

  15. Methodological Disconnect • Across academic disciplines • Between academia & community

  16. Future Direction • Methodological Integration • Integrative approach to perinatal research • What are the methodological issues (measurement techniques, study designs, levels of analyses)? • What infrastructure is needed to support an integrative approach? • How do we do better collaborative research between academia and community? Singer BH, Ryff CD. Eds. Nataional Research Council. New horizons in health: An integrative approach. Washington DC: Natioanl Academy Press. 2001

  17. Future DirectionSummary • Longitudinal integration • Contextual integration • Methodological integration

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