643 research outputs found
CESAR VICTORA, médico epidemiologista: uma vida de liderança científica mundial a serviço da sobrevivência de milhões de crianças.
No full textO médico epidemiologista Cesar G. Victora, Professor Emérito da Universidade Federal de Pelotas, com doutorado em Epidemiologia da Assistência Médica pela Escola de Higiene e Medicina Tropical da Universidade de Londres, realizou extensas pesquisas em diversos estados brasileiros e atuou como pesquisador ou consultor em mais de 40 países, assessorando a Organização Mundial da Saúde (OMS) e o UNICEF. Suas principais contribuições científicas incluem a documentação da importância do aleitamento materno exclusivo para prevenir a mortalidade infantil e a construção de curvas de crescimento infantil atualmente adotadas em mais de 140 países. É Professor Visitante das Universidades de Harvard, Oxford, Londres e Johns Hopkins. Recebeu inúmeras condecorações internacionais, entre elas, mais recentemente, em 2017, o Canada Gairdner Global Health Award. Por meio de suas pesquisas, é responsável direto pela sobrevivência de milhões de crianças ao redor do mundo. A promoção da amamentação exclusiva e o monitoramento adequado do crescimento, dois dos legados deixados pelos estudos liderados pelo Prof. Cesar, evitaram e seguem evitando que milhões de crianças percam a vida precocemente
Measuring Socioeconomic Inequalities With Predicted Absolute Incomes Rather Than Wealth Quintiles: A Comparative Assessment Using Child Stunting Data From National Surveys
No full text Objectives. To compare the predictive power of synthetic absolute income measures with that of asset-based wealth quintiles in low- and middle-income countries (LMICs) using child stunting as an outcome. Methods. We pooled data from 239 nationally representative household surveys from LMICs and computed absolute incomes in US dollars based on households’ asset rank as well as data on national consumption and inequality levels. We used multivariable regression models to compare the predictive power of the created income measure with the predictive power of existing asset indicator measures. Results. In cross-country analysis, log absolute income predicted 54.5% of stunting variation observed, compared with 20% of variation explained by wealth quintiles. For within-survey analysis, we also found absolute income gaps to be predictive of the gaps between stunting in the wealthiest and poorest households (P < .001). Conclusions. Our results suggest that absolute income levels can greatly improve the prediction of stunting levels across and within countries over time, compared with models that rely solely on relative wealth quintiles. </jats:p
Maternal and child undernutrition: consequences for adult health and human capital
No full textIn this paper we review the associations between maternal and child undernutrition with human capital and risk of adult diseases in low-income and middle-income countries. We analysed data from five long-standing prospective cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa and noted that indices of maternal and child undernutrition (maternal height, birthweight, intrauterine growth restriction, and weight, height, and body-mass index at 2 years according to the new WHO growth standards) were related to adult outcomes (height, schooling, income or assets, offspring birthweight, body-mass index, glucose concentrations, blood pressure). We undertook systematic reviews of studies from low-income and middle-income countries for these outcomes and for indicators related to blood lipids, cardiovascular disease, lung and immune function, cancers, osteoporosis, and mental illness. Undernutrition was strongly associated, both in the review of published work and in new analyses, with shorter adult height, less schooling, reduced economic productivity, and--for women--lower offspring birthweight. Associations with adult disease indicators were not so clear-cut. Increased size at birth and in childhood were positively associated with adult body-mass index and to a lesser extent with blood pressure values, but not with blood glucose concentrations. In our new analyses and in published work, lower birthweight and undernutrition in childhood were risk factors for high glucose concentrations, blood pressure, and harmful lipid profiles once adult body-mass index and height were adjusted for, suggesting that rapid postnatal weight gain--especially after infancy--is linked to these conditions. The review of published works indicates that there is insufficient information about long-term changes in immune function, blood lipids, or osteoporosis indicators. Birthweight is positively associated with lung function and with the incidence of some cancers, and undernutrition could be associated with mental illness. We noted that height-for-age at 2 years was the best predictor of human capital and that undernutrition is associated with lower human capital. We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations. Its prevention will probably bring about important health, educational, and economic benefits. Chronic diseases are especially common in undernourished children who experience rapid weight gain after infancy
Effect of breastfeeding on malocclusions: a systematic review and meta-analysis
No full textAIM: The objective of this systematic review was to investigate if breastfeeding decreases the risk of malocclusions. METHODS: Six databases were systematically searched to the end of October 2014. Observational and interventional studies were included. Breastfeeding was evaluated in three categories: a) ever versus never; b) exclusive versus absence of exclusive; c) longer periods versus shorter periods. All types of malocclusion were considered as the outcome. Pooled adjusted odds ratio and its 95% confidence interval (95%CI) were obtained from meta-analyses. Heterogeneity was assessed with both the Q-test and the I-square. Funnel plots and Egger's test were employed to assess publication bias. RESULTS: Forty-eight studies were included in the systematic review and 41 were included in the overall meta-analysis (n =27,023 participants). Subjects who were ever breastfed were less likely to develop malocclusions than those never breastfed (OR 0.34; 95% CI 0.24; 0.48), those who were exclusively breastfed presented lower risk to present malocclusion than those with absence of exclusive breastfeeding (OR 0.54; 95% CI 0.38; 0.77), and subjects longer breastfed were less likely to have malocclusions than those with shorter breastfed (OR 0.40; 95% CI 0.29; 0.54). CONCLUSION: Breastfeeding decreases the risk of malocclusions.Karen Glazer Peres, Andreia Morales Cascaes, Gustavo Giacomelli Nascimento, and Cesar Gomes Victor
Socioeconomic and racial/ethnic differentials of C-reactive protein levels: a systematic review of population-based studies
No full textBackground:Socioeconomic and racial/ethnic factors strongly influence cardiovascular disease outcomes and risk factors. C-reactive protein (CRP), a non-specific marker of inflammation, is associated with cardiovascular risk, and knowledge about its distribution in the population may help direct preventive efforts. A systematic review was undertaken to critically assess CRP levels according to socioeconomic and racial/ethnic factors.
Methods:Medline was searched through December 2006 for population-based studies examining CRP levels among adults with respect to indicators of socioeconomic position (SEP) and/or race/ethnicity. Bibliographies from located studies were scanned and 26 experts in the field were contacted for unpublished work.
Results:Thirty-two relevant articles were located. Cross-sectional (n = 20) and cohort studies (n = 11) were included, as was the control group of one trial. CRP levels were examined with respect to SEP and race/ethnicity in 25 and 15 analyses, respectively. Of 20 studies that were unadjusted or adjusted for demographic variables, 19 found inverse associations between CRP levels and SEP. Of 15 similar studies, 14 found differences between racial/ethnic groups such that whites had the lowest while blacks, Hispanics and South Asians had the highest CRP levels. Most studies also included adjustment for potential mediating variables in the causal chain between SEP or race/ethnicity and CRP. Most of these studies showed attenuated but still significant associations.
Conclusion: Increasing poverty and non-white race was associated with elevated CRP levels among adults. Most analyses in the literature are underestimating the true effects of racial/ethnic and socioeconomic factors due to adjustment for mediating factors
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Monitoring Health Inequities in Low-and-Middle-Income Countries: Who Is – and Is Not – Counted and Included in Government Health Statistics?
No full textThis dissertation examines which populations and places are excluded from health data in low- and middle-income countries (LMICs) and the implications of this invisibility on how population health inequities are understood and addressed.
The first study utilizes data from 173 Demographic Health Surveys and Multiple Indicator Cluster Surveys (MICS) to estimate changes in average birth registration coverage in 67 LMICs between 1999 and 2015 and examine whether absolute and relative wealth and urban/rural inequities in birth registration widened or narrowed. In the majority of countries which had not achieved complete birth registration, we find that average improvements in birth registration were not met with reductions in wealth and urban/rural inequities.
The second study combines semi-structured interviews with the staff of six population-based cancer registries (PBCRs) in India with a literature review of studies based on PBCR data to understand and document practices of registration, efforts to include rural populations in cancer registries, and efforts to collect, analyze and report data on social inequalities in cancer. Qualitative results suggest that PBCRs in India have developed additional approaches to cancer registration, including conducting village and home visits to interview cancer patients in rural areas. Results of the literature review indicate that few studies which utilize PBCR data are explicitly designed to use PBCR data to measure social inequities in cancer in India.
The third study is a mixed methods study which combines an analysis of the 2014 Nepal MICS survey and 18 key informant interviews with organizations in the child protection sector in Nepal to understand uses of child protection data, to highlight invisibilities in data, and to provide recommendations to improve data, including the possibility of a national monitoring system. We find the burden of violent discipline (82%), child labor (37%), child marriage (12%), and their co-occurrence, is high in Nepal. Respondents described using large-scale surveys, case data from the police and court system, newspapers, community consultations, and child participation to guide their work.
These studies underscore the importance of strengthening routine public health data to measure and monitor health inequities and demonstrate the benefits of monitoring equity in health outcomes instead of relying solely on averages in order to reduce health inequities which are unfair, unjust, and avoidable.Social and Behavioral Science
Adolescent blood pressure, body mass index and skin folds: sorting out the effects of early weight and length gains
No full textBackground Although there is longstanding evidence ofthe short-term benefits of promoting rapid growth foryoung children in low-income settings, more recentstudies suggest that early weight gain can also increasethe risk of chronic diseases in adults. This paperattempts to separate the effects of early life weight andlength/height gains on blood pressure, body mass index(BMI), sum of skin folds and subscapular/triceps skin foldratio at 14e15 years of age.Methods The sample comprised 833 members ofa prospective population-based birth cohort from Brazil.Conditional size (weight or height) analyses were used toexpress the difference between observed size at a givenage and expected size based on a regression, includingall previous measures of the same anthropometric index.A positive conditional weight or height indicates growingfaster than expected given prior size.Results Conditional weights at all age ranges werepositively associated with most outcomes; each z-scoreof conditional weight at 4 years was associated with anincrease of 6.1 mm in the sum of skin folds (95% CI 4.5to 7.6) in adolescence after adjustment for conditionallength/height. Associations of the outcomes withconditional length/height were mostly negative or nonsignificantdeachz-score was associated witha reduction of 2.4 mm (95% CI ?3.8 to ?1.1) in the sumof skin folds after adjustment for conditional weight. Noassociations were found with the skin fold ratio.Conclusion The promotion of rapid length/height gainwithout excessive weight gain seems to be beneficial forlong-term outcomes, but this requires confirmation fromother studies
Global child survival initiatives and their relevante to the Latin American and Caribbean Region [Iniciativas para mejorar la supervivencia infantil y su importancia en la Regi\uf3n de Am\ue9rica Latina y el Caribe
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