Declaración de la Sociedad Argentina de Pediatría sobre la prevención de enfermedades no transmisibles: la necesidad de fortalecer conocimientos y reforzar estrategias / Statement of the Sociedad Argentina de Pediatría on the prevention of noncommunicable diseases: the need to strengthen knowledge and reinforce strategies

Investigaciones de las últimas décadas revelaron que un ambiente adverso en la etapa de desarrollo puede producir una mayor susceptibilidad hacia fenotipos relacionados con enfermedad cardiovascular, diabetes, hipertensión, trastornos neuroconductuales y otras enfermedades crónicas no transmisibles. Estas enfermedades, cuyo aumento ocurre especialmente en países con alta vulnerabilidad social, provocan muertes prematuras y constituyen la primera causa de muerte en la vida adulta, además de un elevado costo para la salud pública. Consciente de la necesidad de prevenir estas enfermedades desde los primeros mil días de vida, la Sociedad Argentina de Pediatría creó la Subcomisión DOHaD y formuló una declaración para la prevención de enfermedades no transmisibles a la que adhirieron otros países de Latinoamérica. La aplicación de las estrategias declaradas con acciones interdisciplinarias e intersectoriales sostenidas en el tiempo contribuirá a construir salud, a disminuir la carga de enfermedades crónicas no transmisibles y al mayor bienestar y productividad para los pueblos.

Research in recent decades has revealed that an adverse environment in the developmental stage can produce a greater susceptibility to phenotypes related to cardiovascular disease, diabetes, hypertension, or neurobehavioral disorders, among other chronic noncommunicable diseases. These diseases, whose tendency is increasing especially in countries with high social vulnerability, cause premature deaths and constitute the first cause of death in adult life as well as a great cost to public health. Aware of the need to prevent these diseases from the first thousand days of life, the Sociedad Argentina de Pediatría created the DOHaD Committee and formulated a statement for the prevention of NCDs, to which Latin American countries also adhered. We believe that the application of the declared strategies with interdisciplinary and intersectoral actions sustained over time will contribute to building health, reducing the burden of NCDs, and to greater wellbeing and productivity for the people

Trayectorias de fragilidad y factores relacionados en la población de adultos mayores en México / Trajectories of frailty and related factors of elderly people in Mexico

Resumen Introducción: la fragilidad es un indicador del estado de salud en la vejez y un síndrome clínico común en adultos mayores; conlleva un elevado riesgo de resultados deficientes de salud que incluyen caídas, incidentes de discapacidad, hospitalización y mortalidad. Este estudio tuvo como objetivo identificar las diferentes trayectorias de la fragilidad y los factores relacionados con esta entre adultos mayores mexicanos a lo largo del tiempo. Metodología: los datos provienen de un panel de cuatro rondas compuesto por adultos mayores mexicanos y desarrollado de 2001 a 2015 por el Estudio Nacional de Salud y Envejecimiento en México (ENASEM). La fragilidad es la acumulación de déficits a partir de un índice de fragilidad. Se aplicó un análisis multinivel, utilizando modelos jerárquicos para conocer los cambios de trayectorias de fragilidad y qué factores se relacionan con ella. Resultados: ser mujer mayor, viuda y tener un bajo nivel educativo fueron factores de riesgo para un índice de fragilidad alto y una menor satisfacción financiera o realizar actividades en el hogar tienen efectos adversos. Conclusiones: se halló una prevalencia de la fragilidad según la proporción de déficits que poseen los individuos y sus primordiales componentes asociados. Se requiere mejorar las condiciones socioeconómicas de salud en fases previas a la vejez con miras a evitar la presencia de fragilidad en el futuro.

Abstract Introduction: Frailty is an indicator of health status in old age and a common clinical syndrome in older adults that carries an increased risk of poor health outcomes, including falls, incidents of disability, hospitalization, and mortality. This study aimed to identify the different trajectories of frailty and the factors related to frailty among Mexican older adults over time. Methods: Data are from a four-wave panel composed of older Mexican adults from 2001 to 2015 of the Mexican Health and Aging Study (MHAS). Frailty is the accumulation of deficits using a frailty index. A multilevel analysis, using hierarchical models, was applied to know the changes of frailty trajectories and what factors are related to it. Results: Being female, older, being widowhood, and having a lower level of education were risk factors for having a high frailty index and lower financial satisfaction doing activities at home have adverse effects. Conclusion: The findings of this work present information about the prevalence of frailty considering the proportion of deficits that individuals possess and their main associated components in older Mexican adults. It is necessary to improve socioeconomic health conditions in phases before old age to avoid developing frailty in the future.

Prácticas alimentarias, un fenómeno multinivel

RESUMEN El presente ensayo tiene como propósito posicionar el entender las prácticas alimentarias de las personas y de las poblaciones desde la perspectiva de curso de vida como tema relevante para generar conocimientos desde perspectivas interdisciplinarias. Así, se expondrán a las prácticas alimentarias desde una perspectiva sociohistórica, posicionándonos desde una visión que integre los diferentes niveles, dominios y temporalidades, con el fin de ampliar la perspectiva de un fenómeno esencialmente interdisciplinario. De esta manera, se abren las preguntas sobre qué niveles y dominios de la vida de las personas y las poblaciones se encuentran involucrados y cuáles son las formas temporales que se manejan en la interconexión de los diferentes elementos. Se busca posicionar a las prácticas alimentarias desde una perspectiva holística que pueda orientar la planificación e interpretación de investigaciones aplicadas para afrontar los desafíos de salud pública en el presente.

ABSTRACT The purpose of this essay is to position the understanding of food practices of individuals and populations from a life course perspective as relevant to focus in producing knowledge from an interdisciplinary perspective. So, here I discuss food practices as a sociohistorical phenomenon, acquiring a point of view that integrates different levels, domains and temporalities, with the purpose of broaden the perspective of a essentially multidisciplinary phenomenon. This opens questions about what levels and domains of the life of individuals and societies are involved, as well as what temporal forms are handled in the interconnection of the different elements. Thus, this essay seeks to position food practices from a wide perspective that can guide interpretation in empirical research necessary to face public health challenges that appear in the present.

Association between life-course leisure-time physical activity and prostate cancer / Actividad física a lo largo de la vida y su asociación con cáncer de próstata

Abstract: Objective: To evaluate the association between life-course leisure-time physical activity (PA) and prostate cancer (PC) among males living in Mexico City. Materials and methods: Information from 394 incident PC cases and 794 population controls matched by age (± 5 years), was analyzed. Using leisure-time PA information at different life stages, life-course PA patterns were constructed. The association between PA and PC was estimated using an unconditional logistic regression model. Results: Three life-course PA patterns were identified: low PA (71.0%), moderate PA (22.0%), and high PA (7.0%); this last pattern was characterized by higher levels and consistent PA practice. Compared with inactive males, those in the high PA pattern (OR: 0.50; 95%CI: 0.26-0.93) had significantly lower PC odds. Conclusion: Intense and regular PA could reduce the possibility of PC. These results are in accordance with PA World Health Organization recommendations.

Resumen: Objetivo: Evaluar la asociación entre la actividad física (AF) en la vida y el cáncer de próstata (CP) en hombres. Material y métodos: Se analizó la AF de 394 casos incidentes de CP y 794 controles poblacionales pareados por edad (± 5 años). Se utilizó la información de AF en diferentes etapas para generar los patrones de AF a lo largo de la vida. La asociación entre AF y CP se estimó mediante regresión logística no condicionada. Resultados: Se identificaron tres patrones de AF: baja (71.0%), moderada (22.0%) y alta (7.0%); este último patrón se caracterizó por una AF consistentemente mayor a lo largo de la vida. Comparado con los hombres inactivos, aquéllos en el patrón de alta AF (RM= 0.50; IC95% = 0.26-0.93) presentaron menos posibilidades de tener CP. Conclusión: El papel protector de la AF parece estar en función de la intensidad y regularidad de su práctica y apoyan las recomendaciones de la OMS.

Addressing the Double Burden of Malnutrition using the Life Course Perspective

@#The double burden of malnutrition refers to the coexistence of undernutrition which is typically characterised by stunting and wasting, alongside overnutrition at all levels of the population. The objective of this article is to review the current issues in addressing the double burden of malnutrition using the life course approach. Studies addressing life course approach in DBM were identified through PubMed & EMBASE databases. Relevant studies were critically appraised. The challenges, opportunities and way forward in addressing DBM through the life course concept were discussed. The review showed that the DBM dilemma could be addressed via a holistic perspective through a life course concept as nutrition plays an important role in influencing health from pre-conception to old age. The life course concept proposes that environmental exposures, including biological, physical, social, and behavioral factors, including life experiences, throughout life, influence health outcomes in current generations and their offspring.

Soledad, envejecimiento y viudez en el curso de la vida. Un estudio de casos en personas viudas de Argentina / Loneliness, aging and widowhood throughout the life course. A case study in widowed people in Argentina 172

Resumen El presente trabajo indaga sobre formas de afrontar la viudez en el curso de vida. Se analizan diferencias de cohorte y género sobre el sentimiento subjetivo de soledad. Se estudian las actividades que se abandonaron, transformaron e iniciaron pos viudez y los tipos de apoyo social percibido. A partir de una estrategia metodológica cualitativa se realizaron entrevistas en profundidad a personas viudas del Área Metropolitana de Buenos Aires, Argentina. El análisis permitió reconstruir diferencias según cohorte, posición y género frente a la viudez, así como dimensiones espaciales y temporales referidas al sentimiento de soledad. Se evidencia que las mujeres cuentan con variados recursos y mayor apoyo emocional para afrontar la soledad, a diferencia de los viudos. La división sexual de tareas es notable en los viudos(as) nacidos entre 1930 y 1959 mientras que las cohortes posteriores a 1960 registran menor rigidez en este punto.

Abstract This article explores ways of coping with widowhood throughout life course. Cohort and gender differences on the subjective feeling of loneliness are analyzed. The activities abandoned, changed and initiated after widowhood and the types of perceived social support are studied. Based on a qualitative methodological strategy, in-depth interviews were conducted with widowed people in the Buenos Aires Metropolitan Area (Área Metropolitana de Buenos Aires), Argentina. The analysis allowed us to reconstruct differences according to cohort, position and gender in relation to widowhood, as well as spatial and temporal dimensions related to the feeling of loneliness. It is evident that women have a variety of resources and greater emotional support to cope with loneliness, unlike widowers. Sexual division of labor is significant among widowed people born between 1930 and 1959, while the cohorts born after 1960 show more flexibility in this regard.

Geriatric Medicine concepts: Trajectory of illness, Life course approach and comprehensive Geriatric assessment

@#Globally, there is an increase in older people. Clinicians, particularly primary care physicians, will need to equip themselves with knowledge and have a general approach for management of older people. In this paper, the following geriatric principles and concepts are covered: the trajectory of illness and the life course approach, multifactorial diagnoses and attributable risk, and comprehensive geriatric assessment. The illness trajectory concept enables clinicians to recognize where the patient is at, predict their likely prognosis and offer appropriate treatment decisions, balanced between aggressive curative intent and symptomatic management. The life course approach provides a model for planning intervention, which usually needs cooperation with other specialties. It is a worthwhile reminder for clinicians that older people tend to present with atypical symptoms, with multiple contributing factors towards their illness. Comprehensive geriatric assessment enables the clinician to gather sufficient information to complete clinical decision making for older people.

O Luxo do Futuro. Idosos LGBT, teleologias heteronormativas e futuros viáveis / El Lujo de un Futuro. Ancianos LGBT, teleologías heteronormativas y futuros viables / The Luxury of a Future. LGBT elderly, heteronormative teleologies and viable futures

Resumo Analiso neste texto as narrativas de um interlocutor - Maurício, 62 anos, gay, negro, cisgênero, classe média-baixa - sobre os impactos do surgimento no Brasil das noções de "idosos LGBT" e "velhice LGBT" em suas expectativas (individual e coletiva) de futuro e concepções sobre o curso da vida. Tal exame, retomando a noção de teleologias heteronormativas, lança luz sobre dinâmicas mais amplas relacionadas a transformações contemporâneas na velhice, à produção de subjetividades e ao processo de constituição biopolítica de populações envelhecidas. Nesse sentido, desenvolvo um exame antropológico do modo como meu interlocutor dava sentido a uma existência marcada por um intenso imediatismo e uma dificuldade de vislumbrar o futuro (a ideia de "futuro como luxo" e um privilégio de poucos); e uma espécie de normatividade, em termos de gênero e sexualidade, sobre os modos de compreender e alcançar uma "vida plena", "realizada" e "feliz". O pano de fundo da análise se dá, por fim, a partir de um novo modo de politização do envelhecimento no contemporâneo - sobretudo através da crítica ao apagamento da diversidade sexual e de gênero na velhice - o qual abre espaço para reconfigurar esse momento da vida e o futuro como sítios em que a existência de pessoas LGBT se torna potencialmente viável.

Resumen En este texto, analizo las narrativas de un interlocutor - Maurício, 62 años, gay, negro, cisgénero, clase media baja - sobre los impactos del surgimiento en Brasil de las no ciones de "ancianos LGBT" y "vejez LGBT" sobre sus expectativas (individual y colectiva) de futuro y concepciones sobre el curso de la vida. Tal examen, retomando la noción de teleologías heteronormativas, arroja luz sobre dinámicas más amplias relacionadas con las transformaciones contemporáneas en la vejez, la producción de subjetividades y el proceso de constitución biopolítica de poblaciones envejecidas. En este sentido, desarrollo un examen antropológico de la forma en que mi interlocutor dio sentido a una existencia marcada por una intensa inmediatez y una dificultad para vislumbrar el futuro (la idea del "futuro como un lujo" y privilegio de unos pocos); y una especie de normatividad, en términos de género y sexualidad, sobre las formas de entender y lograr una vida "plena" y "feliz". El trasfondo de este análisis se fundamenta, finalmente, en el surgimiento de una nueva forma de politizar el envejecimiento en el contemporáneo - sobre todo a través de la crítica al borradura de la diversidad sexual y de género en la vejez - que abre espacios para reconfigurar este momento de la vida y el futuro como sitios en que la existencia de personas LGBT se vuelve potencialmente viable.

Abstract In this text, I analyze the narratives of an interlocutor - Maurício, 62 years old, gay, black, cisgender, lower-middle class - about the impacts of the emergence in Brazil of the notions of "LGBT elderly" and "LGBT old age" on his (individual and collective) expectations of the future and conceptions about the life course. Such an examination, taking up the notion of heteronormative teleologies, sheds light on broader dynamics related to contemporary transformations in old age, the production of subjectivities and the process of biopolitical constitution of aging populations. In this sense, I develop an anthropological examination of the way in which my interlocutor gave meaning to an existence marked by intense immediacy and a difficulty in envisioning the future (the idea of "future as a luxury" and the privilege of a few); and a kind of normativity, in terms of gender and sexuality, on the ways of understanding and achieving a "fulfilled" and "happy" life. The background of this analysis is, finally, based on the rising of a new way of politicizing aging in the contemporary - above all through the criticism of the erasure of sexual and gender diversity in old age - which opens space to reconfigure this moment in life and the future as sites where the existence of LGBT people becomes potentially viable.

Reto de los primeros 1000 días de vida / Challenge of the first 1000 days of life

Los primeros mil días de vida son parte del Curso de Vida, al tomar en consideración la Epigenética, término postulado por Waddington en 1942: modifica la expresión genética SIN cambiar la secuencia de las bases de ADN. El proyecto internacional llamado DOHaD (Developmental Origins of Health and Disease) u ODSE (Orígenes del Desarrollo de la Salud y Enfermedad), está inserto dentro de la Transición Alimentaria y Nutricional (TAN), que, en países en desarrollo­ocurre en forma muy rápida ­produce tanto la malnutrición por déficit como por exceso; es decir la doble carga nutricional. La TAN es producto en nuestro país, de una urbanización acelerada y anárquica, y de cambios socioculturales, como la incorporación de la mujer al mercado de trabajo con menos tiempo para cocinar; está acompañada de una transición epidemiológica con la emergencia y prevalencia de la obesidad y de las enfermedades crónicas como morbiletalidad. Esta doble carga nutricional se modificó, por la situación país, y prevalece más el déficit que el exceso. Se presenta el PROYECTO FUNDACIÓN BENGOA ­ SVPP ­ SOGV ­ CANIA, cuya meta es: Elaborar una agenda preventiva común contra la malnutrición tanto por déficit como por exceso y sus comorbilidades, bajo el enfoque de los primeros mil días de vida y su efecto sobre todo el curso de vida. Se realizó el diseño y aplicación de tres cuestionarios digitales, que se utilizaran para la elaboración de esta meta. Se consolidó un CONSENSO NACIONAL formado por profesionales de la salud involucrados en los primeros mil días de vida(AU)

The first 1000 days of life is the new paradigm that determines health and nutrition during the life course, based on epidemiological models that incorporate the concept of Epigenetics, term introduced by Waddington, that refers to changes that affect the genetic expression without changing the DNA sequence, within the international program DOHaD/ODSE as well as the Food and Nutrition Transition(FNT). This FNT, product of an accelerated and anarchic urbanization that led to sedentary activities, plus the incorporation of women to the work media, with less time for cooking, with the substitution of the traditional diet for one much more practical and efficient in time and effort. It is accompanied by demographic and epidemiologic changes and transitions. The Double Burden of Nutrition in VENEZUELA has changed due to the effect of the recent crisis with a rise in malnutrition and a fall in obesity/overweight. The current project: Fundación Bengoa- Pediatric Society Venezuela (SVPP) ­ CANIA - Obstetric Society of Venezuela (SOGV) is called Developmental Origins of Health and Disease in Venezuela (DOHaD Venezuela): and by means of a national consensus of medical societies and institutions, its goal is "To elaborate a Preventive Agenda both for Malnutrition and for Overweight and Obesity and its comorbidities, considering the First 1000 Days of life and its effect over the life course"

Trayectorias y dinámicas alimentarias de adultos/as mayores: la alimentación como relato de vida / Trajectories and food dynamics of Elderly People: food as life story

Argentina atraviesa un proceso de transición demográfica avanzada, ya que los/as adultos mayores (AM) alcanzan el 15,1% de la población. Ello pone en tensión el lugar de las/os AM en la sociedad, sus condiciones de acceso y resolución de necesidades, entre ellas la alimentación. En este trabajo se postula que hablar de la alimentación, de los alimentos, es hablar de los/as AM, de la historia de vida de estas personas que se va escribiendo entre sustancias y circunstancias que hacen a actividades tan cotidianas como el cocinar y el comer. Así, se planteó como objetivo, indagar acerca de la categoría trayectorias y dinámicas alimentarias (TyDA) de los/as AM de la Ciudad de Córdoba-Argentina, para establecer diálogo(s) posible(s) entre alimentación y curso de vida. Se realizó una investigación con posicionamiento epistemológico mixto entre paradigma interpretativista y crítico; con triangulación metodológica cuali-cuantitativa. Etapa cuantitativa: muestra no probabilística por cuotas según nivel de instrucción (n=384); incluyendo a AM de Córdoba y gran Córdoba que integran espacios participativos. Se implementó un cuestionario semiestructurado. Etapa cualitativa: muestra intencional (n=10) a partir del muestro anterior. Se realizaron observaciones participantes, bitácora de campo y entrevistas. Participaron 384 AM, edad promedio de 72 años (DE=7), 79% mujeres y 21% varones. Las "TyDA", siguiendo una idea de proceso que se construye y reconstruye constantemente, fueron abordadas desde: a) Etapa de la vida b) Sistema Alimentario y c) Alimentos identificadores. Reconstruir la historia de la comida de los/as AM propicia el reencuentro con la propia historia (infancia, juventud, adultez, vejez). Esta matriz de sentido es una invitación a repensar los abordajes en materia de políticas públicas destinados a este grupo poblacional; que genera cambios demográficos tanto a nivel macrosocial (cultura, economía, mercado de trabajo, sistemas políticos) pero especialmente en la experiencia de vida de los y las AM.

Una introducción al enfoque del curso de vida y su uso en la investigación pediátrica: principales conceptos y principios metodológicos / An introduction to the life course approach and its use in pediatric research: main concepts and methodological principles

Resumen Desde su concepción, el enfoque del curso de vida se ha utilizado ampliamente en la investigación sociodemográfica y en los estudios sociológicos. El empleo de esta perspectiva se ha difundido desde hace algunos años en la investigación en salud. Sin embargo, su uso ha sido muy limitado en pediatría. Este trabajo presenta una exposición de los principales conceptos del enfoque del curso de vida y algunos principios metodológicos para el desarrollo de investigaciones desde esta perspectiva. Además, se incluyen una serie de proyectos de investigación que se han valido de este enfoque como fundamentación conceptual en su diseño e implementación y algunas fuentes de información que pueden ser utilizadas para el desarrollo de investigaciones desde esta conceptualización en México.

Abstract Since its inception, the life course approach has been widely used in the socio-demographic research and sociological studies. The use of this perspective in health research has spread for some years, although its use in pediatrics has been limited. This work presents the main concepts of the life course approach and some methodological principles for the development of research from this perspective. In addition, a series of research projects that have used this approach as a conceptual basis in their design and implementation are included, as well as some sources of information that can be used for the development of research since this conceptualization in Mexico.

Childhood BMI and Adult Obesity in a Chinese Sample: A 13-Year Follow-up Study / 生物医学与环境科学（英文）

OBJECTIVE@#Obesity is recognized as a significant risk factor for diabetes and hypertension. The present study aimed to examine the associations between adults'obesity risk and childhood and parental obesity.@*METHODS@#A total of 204 children aged 6-17 years were recruited in 2002 with an average follow-up period of 13.2 years. Height and body weight were measured by trained staffs. Overweight and obesity were defined based on the Chinese standard for children and adults. T-test, analysis of variance, and Chi-square analysis were used for single factor analysis. Multiple linear and logistic regression analyses were used to perform multifactor analysis.@*RESULTS@#The percentage of non-obese children who grew up to be non-obese adults was 62.6%, and that of obese children who grew up to be obese adults was 80.0%. There was a significant association between childhood body mass index (BMI) and adulthood BMI with a β regression coefficient of 3.76 [95% confidence interval (CI): 1.36-6.16], and between childhood obesity and adulthood obesity with an odds ratio of 5.76 (95% CI: 1.37-24.34). There was no statistical difference between parental obesity at baseline and children's adulthood obesity, after adjustment of confounders. Male participants and those aged 10.0-13.0 years had a higher risk of adulthood obesity with odds ratios of 2.50 (95% CI: 1.12-5.26) and 3.62 (95% CI: 1.17-11.24), respectively.@*CONCLUSION@#Childhood obesity is an important predictor of adulthood obesity.

Dynamic path analysis on life course epidemiology / 中华流行病学杂志

In the studies of modem epidemiology,exposure in a short term cannot fully elaborate the mechanism of the development of diseases or health-related events.Thus,lights have been shed on to life course epidemiology,which studies the exposures in early life time and their effects related to the development of chronic diseases.When exploring the mechanism leading from one exposure to an outcome and its effects through other factors,due to the existence of time-variant effects,conventional statistic methods could not meet the needs of etiological analysis in life course epidemiology.This paper summarizes the dynamic path analysis model,including the model structure and significance,and its application in life course epidemiology.Meanwhile,the procedure of data processing and etiology analyzing were introduced.In conclusion,dynamic path analysis is a useful tool which can be used to better elucidate the mechanisms that underlie the etiology of chronic diseases.

Dynamic path analysis on life course epidemiology / 中华流行病学杂志

In the studies of modem epidemiology,exposure in a short term cannot fully elaborate the mechanism of the development of diseases or health-related events.Thus,lights have been shed on to life course epidemiology,which studies the exposures in early life time and their effects related to the development of chronic diseases.When exploring the mechanism leading from one exposure to an outcome and its effects through other factors,due to the existence of time-variant effects,conventional statistic methods could not meet the needs of etiological analysis in life course epidemiology.This paper summarizes the dynamic path analysis model,including the model structure and significance,and its application in life course epidemiology.Meanwhile,the procedure of data processing and etiology analyzing were introduced.In conclusion,dynamic path analysis is a useful tool which can be used to better elucidate the mechanisms that underlie the etiology of chronic diseases.

Application of the Real World Data for Pharmacoepidemiology Reserach / 薬剤疫学

Recently, medical real world data involving claims data, drug data, and electrical medical record database have been developed worldwide and can be utilized for the phrmacoepidemiology research.The results of the pharmacoepidemiology research with these database contribute not only to post-marketing safety research but also to the outcomes research and pharmacoeconomic evaluation. On the other hand, collaborating with a number of local governments, we have developed maternal and child health check-up and school health check-up database in Japan. The development of healthcare lifecourse data like this will contribute to the preventive medicine, the understanding of the rare diseases, and drug development.

<b>Application of the Real World Data for Pharmacoepidemiology Reserach </b> / 薬剤疫学

<p>Recently, medical real world data involving claims data, drug data, and electrical medical record database have been developed worldwide and can be utilized for the phrmacoepidemiology research.The results of the pharmacoepidemiology research with these database contribute not only to post-marketing safety research but also to the outcomes research and pharmacoeconomic evaluation. On the other hand, collaborating with a number of local governments, we have developed maternal and child health check-up and school health check-up database in Japan. The development of healthcare lifecourse data like this will contribute to the preventive medicine, the understanding of the rare diseases, and drug development.</p><p></p>

Destructive Divorce in the Family Life Cycle and its Implications: Criticisms of Parental Alienation / O Divórcio Destrutivo Inscrito no Ciclo de Vida Familiar e suas Implicações: Críticas à Alienação Parental

ABSTRACT Some difficulties may arise during the divorce process, taking the family into "destructive divorce". In such cases, some authors can see the rising of Parental Alienation (PA). This article aims to criticize PA, reflecting about the Family Life Cycle and divorce. Regarding this, a qualitative study was conducted with legal actors (judges, prosecutors, psychologists, social workers, lawyers) on the issues of divorce and PA and the results were built using the conceptions of Zones of Sense by Gonzalez Rey. The summary results are: (a) PA does not contextualize the conflict; (b) it does not consider the history of the relationships; (c) it pathologizes, medicates and criminalizes the phenomena of post-divorce and (d) PA underestimates the child in the conflict.

RESUMO Algumas dificuldades podem surgir durante o processo de divórcio, levando a família ao "divórcio destrutivo". Nesses casos, alguns autores compreendem o surgimento da Alienação Parental (PA). Este artigo tem como objetivo criticar a PA, refletindo sobre o Ciclo Vital da Família e divórcio. A esse respeito, um estudo qualitativo foi realizado com atores legais (juízes, promotores, psicólogos, assistentes sociais, advogados) sobre as questões do divórcio e PA, e os resultados foram construídos com as concepções de Zonas de Sentido de Gonzalez Rey. O resumo dos resultados é: (a) PA não contextualiza o conflito; (b) não considera a história das relações; (c) patologiza, medica e criminaliza os fenômenos do pós-divórcio e (d) PA subestima a criança no conflito.

Escala de Macarthur de status social subjetivo: validade e associação com indicadores de posição socioeconômica no curso de vida - estudo longitudinal de saúde do adulto (ELSA-BRASIL) / Escala de Macarthur de status social subjetivo: validade e associação com indicadores de posição socioeconômica no curso de vida - estudo longitudinal de saúde do adulto (ELSA-BRASIL)

INTRODUCTION: The MacArthur scale of subjective social status (SSS), which combines verbal instruction and an image of a 10-steps ladder, aims to capture the common sense perception that an individual has about his/her own position in social hierarchies, in three different contexts: society, community and work. OBJECTIVE: To conduct a concurrent and face validity analysis of the MacArthur scale (Paper 1) and to investigate whether individuals who perceive themselves as having a low SSS in adult life, in the society context, were more exposed to low objective socioeconomic positions (SEP) in childhood and youth, after adjusting for current SEP. METHODS: The article 1 included 159 participants from the Longitudinal Study of Adult Health (ELSA-Brasil), from Minas Gerais Investigating Center, selected by convenience during the 2nd wave of interviews and examinations between 11/2012 and 02/2014. The MacArthur scale was compared with a Status scale, created for this study based on the cognitive metaphor theory, which used the same image of a ladder as an indicator of the status and a very similar but more direct instruction. The concurrent validity was examined by comparing the answers to both scales (MacArthur and Status) using weighted kappa statistics. The face validity was assessed by qualitative methods from corpus linguistics. Ordinal logistic regression was used to investigate whether sociodemographic factors were associated with differences of 1, or 2 or more steps in the choices made using the MacArthur and the Status ladders. In the paper 2, 15.105 participants from the base line of ELSA-Brasil (2008-2010) were included. Low SSS was in the society was defined by the choice of a step lower than 5 out of 10. Multivariate logistic regression analysis was used to investigate whether exposures to low objective indicators of SEP in the childhood (maternal education), youth (occupational social class of the household head; occupational social class of the first job; nature of occupation of household head; nature of occupation in the first job) and adult life (current occupational social class; current nature of occupation; current education) increased the chances of being at low SSS. RESULTS: Agreement between the answers to the MacArthur and Status scales moderated in the society context (kw=0,55) and good in the community (kw=0,60) and work (kw=0,67). Face validity analysis showed that MacArthur scale captures beyond the classic socioeconomic indicators, encompassing elements from collective health, as home, transport, health, leisure, merit etc. Although individuals without college education (in the society context) and women (in the community ambience) had greater chances of differing by 1, or 2 or more steps from those with college education or who were women, qualitative differences were not identified by the corpus linguistics, suggesting that the MacArthur scale has good face validity. In paper 2, after adjustments, low SSS in adult life remained statistically associated with low SEP in all stages of the life course, being the magnitude of the associations strong in adult life, moderate in youth and weak in childhood, showing dose response gradients in all associations. CONCLUSION: The MacArthur scale seems to be a valid instrument to measure the SSS in the Brazilian sociocultural context, thus they can be used in studies of social inequality in health. In addition, results suggest that the scale may capture a summary of exposures and experiences of present and past SEP, both intra and intergenerational, allowing to expand the interpretations of findings of health inequalities based on the MacArthur scale.

INTRODUCTION: The MacArthur scale of subjective social status (SSS), which combines verbal instruction and an image of a 10-steps ladder, aims to capture the common sense perception that an individual has about his/her own position in social hierarchies, in three different contexts: society, community and work. OBJECTIVE: To conduct a concurrent and face validity analysis of the MacArthur scale (Paper 1) and to investigate whether individuals who perceive themselves as having a low SSS in adult life, in the society context, were more exposed to low objective socioeconomic positions (SEP) in childhood and youth, after adjusting for current SEP. METHODS: The article 1 included 159 participants from the Longitudinal Study of Adult Health (ELSA-Brasil), from Minas Gerais Investigating Center, selected by convenience during the 2nd wave of interviews and examinations between 11/2012 and 02/2014. The MacArthur scale was compared with a Status scale, created for this study based on the cognitive metaphor theory, which used the same image of a ladder as an indicator of the status and a very similar but more direct instruction. The concurrent validity was examined by comparing the answers to both scales (MacArthur and Status) using weighted kappa statistics. The face validity was assessed by qualitative methods from corpus linguistics. Ordinal logistic regression was used to investigate whether sociodemographic factors were associated with differences of 1, or 2 or more steps in the choices made using the MacArthur and the Status ladders. In the paper 2, 15.105 participants from the base line of ELSA-Brasil (2008-2010) were included. Low SSS was in the society was defined by the choice of a step lower than 5 out of 10. Multivariate logistic regression analysis was used to investigate whether exposures to low objective indicators of SEP in the childhood (maternal education), youth (occupational social class of the household head; occupational social class of the first job; nature of occupation of household head; nature of occupation in the first job) and adult life (current occupational social class; current nature of occupation; current education) increased the chances of being at low SSS. RESULTS: Agreement between the answers to the MacArthur and Status scales moderated in the society context (kw=0,55) and good in the community (kw=0,60) and work (kw=0,67). Face validity analysis showed that MacArthur scale captures beyond the classic socioeconomic indicators, encompassing elements from collective health, as home, transport, health, leisure, merit etc. Although individuals without college education (in the society context) and women (in the community ambience) had greater chances of differing by 1, or 2 or more steps from those with college education or who were women, qualitative differences were not identified by the corpus linguistics, suggesting that the MacArthur scale has good face validity. In paper 2, after adjustments, low SSS in adult life remained statistically associated with low SEP in all stages of the life course, being the magnitude of the associations strong in adult life, moderate in youth and weak in childhood, showing dose response gradients in all associations. CONCLUSION: The MacArthur scale seems to be a valid instrument to measure the SSS in the Brazilian sociocultural context, thus they can be used in studies of social inequality in health. In addition, results suggest that the scale may capture a summary of exposures and experiences of present and past SEP, both intra and intergenerational, allowing to expand the interpretations of findings of health inequalities based on the MacArthur scale.

A life course approach to mortality in Mexico / Un enfoque de ciclo de vida para la mortalidad en México

Objective. Research on early life socioeconomic status (SES), education and mortality is less established in developing countries. This analysis aims to determine how SES and education are patterned across the life course and associated with adult mortality in Mexico. Materials and methods. Data comes from 2001-2012 Mexican Health & Aging Study (Mexican adults age 50+, n= 11 222). Cox proportional hazard models predict mortality using baseline covariates. Results. In unadjusted analyses, similar mortality was seen across levels of early life SES. Lower early life SES was associated with better survival after accounting for education in the younger cohort. Lower education was only associated with mortality in the younger cohort. Conclusions. Early life SES was associated with education but the relationship between education and mortality differed across cohorts in Mexico. Selective survival and differential returns to education may explain differences.

Objetivo. Determinar cómo el estatus socioeconómico (ES) en la vida temprana y la educación alcanzada están asociados con la mortalidad adulta en México. Material y métodos. Se usaron datos longitudinales del Estudio Nacional de Salud y Envejecimiento en México 2001-2012 sobre adultos de 50 años o más (n= 11 222), por cohortes de edad. Para predecir la mortalidad, se utilizaron modelos proporcionales de Cox con covariables en la encuesta basal. Resultados. Con datos no ajustados, la mortalidad resultó similar entre niveles de ES en la vida temprana. Después de ajustarlos por educación, se encontró que un bajo ES en la vida temprana está asociado con baja mortalidad y que la educación predice mortalidad solamente en las cohortes de edad joven. Conclusiones. El ES temprano está asociado con la educación alcanzada, pero la relación entre educación y mortalidad difiere por cohortes de adultos mayores en México. La selectividad en sobrevivencia y el beneficio diferencial de la educación pueden explicar las diferencias identificadas entre cohortes de edad.

Las emociones en el curso de la vida Un marco conceptual / Emotions over the life course: a conceptual frame

El objetivo de este artículo es revisar los principales estudios sobre las emociones, desde los estudios clásicos hasta las nuevas conceptualizaciones particularmente referidas al curso vital. Se focalizará sobre los cambios que se producen en el curso vital a nivel del desarrollo emocional y las teorías emergentes que analizan la complejidad de las emociones, la regulación y reactividad emocional, las demandas cognitivas a nivel del procesamiento y la incidencia a nivel cerebral.

The aim of this article is to review the main studies on emotions, from classical studies to new conceptualizations particularly relating to life course. It will focus on the changes that occur in the life course on the emotional development and the emerging theories that analyze the complexity of emotion, the regulation and emotional reactivity, the cognitive demands of processing level and the incidence in the brain.