Stress and preterm delivery: a conceptual framework
Stress and preterm delivery: a conceptual framework
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DOI：
10.1046/j.1365-3016.2001.00006.x
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发表时间：
2001-07-01
影响因子：
2.8
通讯作者：
Hatch, MC
中科院分区：
文献类型：
--
作者：
Hogue, CJR;Hoffman, S;Hatch, MC
许多关于各种应激与早产的流行病学研究都得出了阴性或弱阳性的结果。这些不确定的发现可能是因为缺乏关联，或者是因为公认的方法学问题可能掩盖了关联。压力假说的生物学合理性为使用更好的研究设计继续进行压力研究提供了一个理论基础。为了进一步推进这一议程，我们提出了一个流行病学模型，基于经典的“主机，环境，代理”流行病学因果关系的三角形。主机是个别妇女，或多或少容易受到压力诱发的病理。环境包括作为持续压力源的社会和文化条件，以及压力的社会和文化调节因素，例如可能影响特定压力源如何体验或对它的身体反应的因素。代理人是需要她做出反应的直接情感或身体压力源。我们从最近的文献中，主要是自1990年以来出版的，来说明这个模型。这个流行病学模型假定，个体是否被压力源压倒不仅取决于代理的强度，而且取决于宿主对压力的易感性，以及急性，环境和背景压力源的背景水平，以及宿主的调节影响，处理压力的环境和背景资源。未来的研究需要基于压力假设，包括三角形的所有方面，充分捕捉相关的压力源和压力反应的数据收集工具，以及能够处理复杂的多层次关系的分析技术。
Numerous epidemiological studies of various kinds of stress and preterm delivery have produced either negative or weakly positive results. Those inconclusive findings could be either because of the absence of an association or because of recognised methodological problems that may have masked an association. The biological plausibility of the stress hypothesis provides one rationale for continuing stress research, using better study designs. To further this agenda, we propose an epidemiological model, based on the classic 'host, environment, agent' triangle of epidemiological causality. The host is the individual woman, more or less susceptible to stressor-induced pathology. The environment includes the social and cultural conditions that are ongoing stressors as well as social and cultural modifiers of stress e.g. those factors that may influence how a particular stressor is experienced or what the physical response to it may be. The agent is the immediate emotional or physical stressor requiring her response. We draw from recent literature, published principally since 1990, to illustrate this model.This epidemiological model posits that whether the individual is overwhelmed by stressors depends not only on the strength of the agents but also upon host susceptibility to stress, as well as the background level of acute, environmental and contextual stressors, and the moderating influence of host, environmental and contextual resources for handling stress. Future research needs to be based on stress hypotheses that include all sides of the triangle, data collection instruments that adequately capture relevant stressors and stress responses, and analytical techniques capable of handling complex, multilevel relationships.