Catálogo de publicaciones - libros

Given the very high cost of hanging somebody in chains, why was it ever carried out? It was intended to make a deterrent impression on potential criminals and to demonstrate the power and order of the State. However, the many and variable responses to hanging in chains meant that the practice did not always have the intended effect. Gibbetings were infrequent and memorable and served to make the names and histories of those so treated memorable and enduring. Even the very last occasions of hanging in chains were massively popular events, so the distaste expressed by some newspaper commentators was not universally shared.

A critical mass of research linking early life events, experiences, and exposures with adult health conditions is delineating the developmental origins of many common chronic diseases. This emerging body of life course health development (LCHD) research specifies the complex adaptive processes by which both adversity and opportunity are integrated into developing biobehavioral systems. It is also challenging long-held views about origins and etiology of health and disease. There is a growing momentum among practitioners and policymakers to “connect the dots” between this rapidly expanding evidence base and the related practices and policies that are implemented within the fields of medicine, public health, nursing, mental health, education, urban planning, community development, social welfare, and others. At the same time, there is a strong impetus among LCHD researchers to continue to fill the substantial gaps in our knowledge and to ensure that research findings are appropriately synthesized and translated before being applied in clinical, public health, or public policy contexts. Comprised of 26 chapters that grew out of the 2013 Maternal and Child Health (MCH) Life Course Research Agenda-Setting Meeting that was organized by the MCH Life Course Research Network (LCRN) and funded by Health Resources and Services Administration-Maternal and Child Health Bureau (HRSA-MCHB), this volume assesses what has been learned as the LCHD field has emerged, takes stock of what we know and do not know about how health and disease develop, provides some initial guidance regarding the kinds of interventions and efforts that can be beneficial, and lays the foundation for a research agenda that identifies high-priority areas for basic, clinical, population, and translational investigations in order to strategically target resources and efforts and advance the life course health sciences. In this introductory chapter, we begin by providing a rationale for the publication of this volume, including an historical overview that traces the emergence of the LCHD field and provides evidence of a significant, but as yet incomplete, transformation in how we think about and promote health. We go on to describe the purpose, structure, and content of the volume and examine some of the challenges the evolving field must consider as it adaptively moves forward. Finally, we provide readers with information about each section and chapter in this volume, including the impressive backgrounds of the various experts who contributed substantial amounts of both time and original thinking in their roles as authors.

Concepts of what constitutes health, and theories about how health is produced and optimized, are constantly evolving in response to myriad social and cultural expectations shaped by our contemporary worldview, scientific advances, improvements in health interventions, and the changing capacity of the health system. Stimulated originally by a series of studies demonstrating how growth during early life is related to chronic health conditions that emerge many decades later, new research is demonstrating how complex developmental processes integrate a range of biological, behavioral, social, and environmental influences that modify gene expression, modulate physiologic and behavioral function, and dynamically shape different pathways of health production. These empirical findings are highlighting the limitations of the more mechanistic biomedical and biopsychosocial models of health, which fail to offer comprehensive explanations about such phenomena as the developmental origins of health, how stress affects current and future health, and the consequences of dynamic interactions between individuals and their environments over time. The comfort and certainty of simple, linear, and deterministic causal pathways are giving way to the uncomfortable uncertainty of nonlinear causal clusters that are networked together into complex, multilevel, interactive, and relational systems. Informed by new theoretical perspectives emerging from such fields of study as developmental psychology, systems biology, epigenetics, the developmental origins of chronic disease, and evolutionary developmental biology, a coherent transdisciplinary framework is emerging which we call Life Course Health Development (LCHD) and which is presented in this chapter as a set of seven principles: (1) health development, (2) unfolding, (3) complexity, (4) timing, (5) plasticity, (6) thriving, and (7) harmony. LCHD offers a new perspective that will guide future scientific inquiry on health development and facilitate synthesis of medicine and public health that links treatment, prevention, and health promotion and catalyzes more integrated and networked strategies for designing, organizing, and implementing multilevel health interventions that transcend individual and population dichotomies. We hope that the LCHD framework presented here, coupled with our explanatory narrative, will encourage theory building and testing, inspire innovative transdisciplinary research, and mature the framework into a scientific model with descriptive, explanatory, and predictive utility. Furthermore, we hope that LCHD will shine a light on the conundrum of how little attributable risk is explained in many studies of chronic disease, how early experience conditions future biological response patterns, and how these early experiences play through complex, environmentally influenced, and developmentally plastic health development pathways.

The prenatal period is a critical developmental stage for obesity and metabolic outcomes. In light of the global obesity and type 2 diabetes (T2DM) epidemic and growing evidence of early life origins of obesity and diabetes, early identification of individuals at high risk and early prevention of obesity and metabolic syndrome are a key to achieve primary prevention and reverse the trends of the obesity and T2DM epidemics. This chapter will discuss the impact of important preconceptional and prenatal factors, including maternal obesity and/or diabetes, gestational weight gain, and maternal micronutrient status, on in utero and lifelong metabolic outcomes and the possible gene–environment interactions and epigenetic mechanisms underlying early life origins of metabolic risk. Finally, it will provide perspectives on current knowledge gaps and recommendations to advance the field.

This chapter begins with an assertion that, beyond the cultural traditions that affirm childhood as a period of special and lasting importance, a new science of child development reveals an influence of the early years throughout the life course. Through processes of “biological embedding,” early developmental experiences and exposures become neurobiologically instantiated in the brain and genome, thereby affecting trajectories of health and development for the remainder of life. The socioeconomic maldistribution of exposures to adversities and misfortune allots a disproportionate share of physical and mental morbidities to those growing up in conditions of poverty and disadvantage. These outcomes now appear related to epigenetic interactions between aspects of allelic variation-based vulnerability and the assaultive or supportive conditions of early life. Future research should thus address how epigenetic regulation of gene expression is linked to the neurobiological processes underpinning developmental psychopathology and other maladaptive outcomes. Richer understanding of how early environments can amplify or diminish the impacts of adversity exposure will provide new insights to guide the construction of novel, effective, and early interventions.

Middle childhood—conventionally going from about 6–11 years of age—is a crucial yet underappreciated phase of human development. On the surface, middle childhood may appear like a slow-motion interlude between the spectacular transformations of infancy and early childhood and those of adolescence. In reality, this life stage is anything but static: the transition from early to middle childhood heralds a global shift in cognition, motivation, and social behavior, with profound and wide-ranging implications for the development of personality, sex differences, and even psychopathology.

In the last two decades, converging theories and findings from anthropology, primatology, evolutionary psychology, endocrinology, and behavior genetics have revolutionized our understanding of middle childhood. In this chapter, I show how these diverse contributions can be synthesized into an integrated evolutionary-developmental model of middle childhood. I begin by reviewing the main evolved functions of middle childhood and the cognitive, behavioral, and hormonal processes that characterize this life stage. Then, I introduce the idea that the transition to middle childhood works as a switch point in the development of life history strategies and discuss three insights in the nature of middle childhood that arise from an integrated approach.

The contemporary study of adolescent development emphasizes that the process of development involves mutually influential relations between the developing individual and the features of his or her complex and changing context. These relations are most often framed by models derived from a relational developmental systems metatheory, an approach to theory that is entirely consistent with the seven principles of life course health development. Concepts associated with these ideas are used to describe, explain, and optimize the course of development in the second decade of life and, as such, to frame applied research aimed at promoting health and positive development among diverse adolescents. Accordingly we discuss the relational developmental systems metatheory and the seven principles and illustrate how the ideas associated with both approaches to adolescent development can innovatively integrate and extend scholarship about transitions and transformations characterizing the adolescent period and, as well, afford optimism that relational changes linked to positive change in the health developmental system can be identified and used to promote thriving in adolescence.

Emerging adulthood, viewed through the lens of life course health development, has the potential to be a very positive developmental stage with postindustrial societies giving adolescents and emerging adults a greater opportunity for choice and exploration but also greater challenges with greater educational and social role requirements. The loss of supports and structures offered by schools, families, and child- and family-oriented health and social services means that the emerging adult must rely more on his/her own resources in a less structured environment. This increased agency in the context of less structure is occurring as the human brain is still developing higher-level capacities such as executive functioning. The person-context interactions during EA are many and complex, leading to multiple different pathways through emerging adulthood. Those with sufficient economic and adult supports as well as personal resources and maturity will be more likely to choose well and embark on a positive trajectory during EA. Those lacking these resources, or those with physical and mental health or intellectual disabilities, may struggle during this period and experience a negative trajectory in the spheres of education, vocation, relationships, and health status. The life course health science of EA requires more detailed and deeper analysis of the relationship between family, peers, and societal supports and personal internal resources in order to help promote successful developmental trajectories during EA.

Growing evidence indicates that women with a history of common pregnancy complications, including fetal growth restriction and preterm delivery (often combined as low birth weight), hypertensive disorders of pregnancy, and gestational diabetes are at increased risk for cardiovascular disease later in life. Here we review the associations of parity and these four pregnancy complications with cardiovascular morbidity and mortality and the role of cardiovascular risk factors before, during, and after pregnancy complications in explaining these associations. We explore the implications of these findings for research in life course health science and policy intended to avoid or mitigate these pregnancy-related effects. Findings suggest consistent and often strong associations of pregnancy complications with latent and future cardiovascular disease. Many pregnancy complications appear to be preceded by subclinical vascular and metabolic dysfunction, suggesting that the complications may be useful markers of latent high-risk cardiovascular trajectories. Pregnancy complications may be useful in identifying high-risk women, at a relatively early stage in their life course for screening, prevention, and treatment of cardiovascular disease, the leading cause of morbidity and mortality among women.

One of the reasons for the intractability of childhood obesity is the underappreciation of the complexity and interconnectedness of contributing factors across the life course. A multilevel approach for obesity prevention takes into account individual risk factors that operate “above water” (family, neighborhood, policies) and the interaction with biology and “underwater” influences (genetics, epigenetics, physiology) and recognizes that these factors also interact across the life course, starting before birth. We organize this chapter to reflect phases of life course health development, prenatally through adolescence, that appear to be most important for the development of obesity and present key examples to illustrate important risk factors, mechanisms, and gaps in research. One of the challenges to understanding influences on obesity risk is the extent to which associations described in observational studies are causal. We present alternative methodological approaches, including sibling-pair design, maternal versus paternal effects, Mendelian randomization, cohorts with different confounding structures, and randomized controlled trials, that can help disentangle causal associations. We conclude with recommendations for future work on methodology, research in emerging areas, and implications for practice and policy based on the current evidence.