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Preterm delivery remains a major cause of morbidity and mortality in the United States, with African Americans bearing a disproportionate share of this adverse outcome. In 1997, urban mothers of African-American infants, compared with mothers of non-Hispanic white infants were 145% more likely to experience the death of a baby before the infant’s first birthday. Most of these deaths occur among infants of very low birthweight (VLBW), that is, at weights below 1,500 g. Almost all such births are preterm, and they occur almost three times more frequently among African-American women than their white counterparts for reasons that are still incompletely understood.
Known risk factors for VLBW include unwanted conceptions, poor nutrition, and insufficient prenatal care. Other implicated risk factors are maternal age less than 20 years, single marital status, low income, and not having graduated from high school. Research over several years comparing racial groups while attempting to control for socioeconomic status resulted in the paradoxical finding of a wider black-white gap among women in birth outcomes with fewer risk factors. For example, Kleinman and Kessel reported that the black-white relative risk for VLBW was 3.4 among low-risk women, compared to 1.7 among high-risk mothers.
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The failure of the socioeconomic model to eliminate observed racial disparities has led some researchers to suggest a possible genetic mechanism for these differences. However, theoretical and empirical studies of the genetic theory of racial disparities in health and birthweight have largely discredited that approach.
Comparing women of different races while controlling for socioeconomic status is not logically possible if race is acknowledged to be a social construct rather than a genetic category. Race designation is more appropriately seen as an integral part of the person’s social status. Thus, researchers have begun to move beyond the traditional socioeconomic and genetic models to more contextual analyses in order to explain the black-white gap in preterm birth. Preliminary studies support the view that the greater risk of preterm delivery among African-American women is embedded in their social context.
In response to this understanding we have undertaken an investigation of several social factors in African-American women and their role in the delivery of VLBW infants. The primary focus of the larger project of which the present report is a part was the impact of perceived racial discrimination on black VLBW risk. Results have been reported elsewhere. In the present study, we explored various indicators of social support to determine whether such support offers a protective effect to African-American women experiencing psychosocial stress. We also evaluated possible direct effects of social support on the pregnancy outcome under study, since prior work has indicated such an effect in other populations.
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