Life Course Theory Flashcards
Life course theory
body of theoretical models that attempt to explain how life contexts shape health, bx, dev
- experience and exposures are cumulative
- early life contexts (incl fetal period) may cause profound shifts in bio and bx into old age
- across phys, bio, social, genetic contexts
Barker hypothesis
Adverse fetal life context leads to inc risk of adult disease thru epigenetic changes
- maternal undernut–>fetal growth restriction–>struc chx w/i organs, poor child growth, and met/endo dysfxn–>disease later–>grandchildren affected too
Physiological focus of Barker hypothesis
Intrauterine growth restriction, LBW, preterm births
Health consequences of IUGR
inc risk CVD, metabolic sx, DM2, renal fail, asthma, hyperchol, autoimmune disease
Recent research shift in Barker hypothesis
Shift in metabolic processes are attempt to adapt fetal body to nutrient poor fetal enviro
- body prioritizes survival over long-term health
Dutch hunger winter
- 1944 food cut off to W Holland by Nazis
- restrict to 400-800kcal/d and over 10k died (cold and starve)
Outcomes of Dutch Hunger Winter
- 2nd/3rd tri babies had LBW
- babies exp during 1st tri had normal BW but worse adult disease like inc obese, CVD, cog dec than those born before/after war
intergenerational transmission
- females born with all eggs so gametes directly expose to intra acute condx
- epigen markers inherited almost exclusively from women
- placental fxn controls every aspect of fetal exp and can prime or program the fetal tissues to adapt to the perceived extra-ute enviro
Public health interventions for intergenerational transmission
- improve health of child-bearing ppl via nut, dec stress, exercise, better overall health
- intervene with high risk pop
- intervene for LBW OR ind exposure to extreme low nut in early preg
What requires special urgency for public health
Transgenerational factors
Stress
body’s response to changing fx w/i yourself or the enviro
- int and ext stressors
What can responses to acute stress do?
inc survival and be adaptive
allostasis
body’s adaptation to predictable and unpredictable change in enviro
- acute and shorter pd of exposure
Allostatic load
cost of chronic exp to inc endo/neural response (inc epi, nor) resulting from chronic or repeated challenges (stress)
Effects of chronic stress
- wear and tear on bod reg system
- weathering or gradual decline in health
Stressed
Positive or tolerable stress
- inc CO
- inc available glucose
- enhanced immune fxn
- grown neurons in hippo and PFC
Stressed out
Toxic stress
- HTN and CVD
- gluc intol and ins resistance
- infx and inflam
- atrophy and neuron death in PFC and hippo
Toxic stress
- poverty and adverse childhood events that can explain dev in kids (bio, eco, dec)
3 domains of stress response
- positive–>growth
- tolerable–>short lived and no long-term harm
- toxic–>severe/chronic and can lead to toxic fx on brain, bx, maladaptive responses; often from ACEs or poverty
ACEs
traumatic life experiences before the age of 18 that a person can recall as an adult
- incl neglect, abuse, violence, imprisonment, sub use
Lasting fx of ACEs on health
- obese, CVD, COPD, broken bones, STDs, suicide
ACEs can lead to bx including
smoke, AUD/SUD, poor coping mech, prob for pt, delayed grad, academic achievement, lost timeframe
As ACES inc, so do…
negative outcomes
First step in addressing ACES
dec stigma
Nurse interventions for ACEs
- PREVENT
- replace maladaptive with adaptive (exercise and self-care)
- enhance social support
- address trauma source in therapy
- public health crisi
- edu HCW on ACES
- inc system capacity
- create policies to coor foster care coor
- foster multidisciplinary care
- resilience
- ID rf
What kind of care is especially good for ACES?
Trauma-informed care
