Brazilian cohorts with potential for life-course studies: a scoping review.

OBJECTIVE To identify the Brazilian cohorts that started either in the prenatal period or at birth, to describe their characteristics and the explored variables, and to map the cohorts with potential for studies on early determinants on health and the risk of falling ill on later stages of the life cycle. METHODS A scoping review was carried out. The articles were searched in the electronic databases PubMed and Virtual Health Library (VHL). The descriptors used were [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND (Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. The inclusion criteria were Brazilian cohorts that started the baseline in the prenatal period or at birth and with at least two follow-ups with the participants. In order to meet the concept of LCE, we excluded those cohorts whose follow-ups were restricted to the first year of life, as well as those that did not address biological, behavioral and psychosocial aspects, and cohorts with data collection of a single stage of the life cycle. RESULTS The search step identified 5,010 articles. Eighteen cohorts were selected for descriptive synthesis. The median number of baseline participants was 2,000 individuals and the median age at the last follow-up was 9 years. Sample loss at the last follow-up ranged from 9.2 to 87.5%. Most cohorts monitored two phases of the life cycle (the perinatal period and childhood). The Southern region had the highest number of cohorts. The main variables collected were sociodemographic and environmental aspects of the family, morbidity aspects, nutritional practices and lifestyle. CONCLUSIONS We recommend the continuity of these cohorts, the approach to different social contexts and the performance of follow-ups with participants in different phases of the life cycle for the strengthening and expansion of life course epidemiology analyses in Brazil.

Brazilian cohorts with potential for life-course studies: a scoping review / Coortes no Brasil com potencial para estudos do ciclo vital: uma revisão de escopo

ABSTRACT OBJECTIVE To identify the Brazilian cohorts that started either in the prenatal period or at birth, to describe their characteristics and the explored variables, and to map the cohorts with potential for studies on early determinants on health and the risk of falling ill on later stages of the life cycle. METHODS A scoping review was carried out. The articles were searched in the electronic databases PubMed and Virtual Health Library (VHL). The descriptors used were [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND (Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. The inclusion criteria were Brazilian cohorts that started the baseline in the prenatal period or at birth and with at least two follow-ups with the participants. In order to meet the concept of LCE, we excluded those cohorts whose follow-ups were restricted to the first year of life, as well as those that did not address biological, behavioral and psychosocial aspects, and cohorts with data collection of a single stage of the life cycle. RESULTS The search step identified 5,010 articles. Eighteen cohorts were selected for descriptive synthesis. The median number of baseline participants was 2,000 individuals and the median age at the last follow-up was 9 years. Sample loss at the last follow-up ranged from 9.2 to 87.5%. Most cohorts monitored two phases of the life cycle (the perinatal period and childhood). The Southern region had the highest number of cohorts. The main variables collected were sociodemographic and environmental aspects of the family, morbidity aspects, nutritional practices and lifestyle. CONCLUSIONS We recommend the continuity of these cohorts, the approach to different social contexts and the performance of follow-ups with participants in different phases of the life cycle for the strengthening and expansion of life course epidemiology analyses in Brazil.

RESUMO OBJETIVO Identificar as coortes brasileiras iniciadas no período pré-natal ou no nascimento, descrever suas características e as variáveis exploradas, além de mapear as coortes com potencial para se estudar os determinantes precoces de saúde e doença e o risco de adoecer em etapas posteriores do ciclo vital. MÉTODOS Realizou-se uma revisão de escopo. A busca dos artigos foi realizada nas bases de dados PubMed e Biblioteca Virtual em Saúde em 16 de junho de 2018. Os descritores utilizados foram [((("Child" OR "Child, Preschool" OR "Infant" OR "Infant, Newborn") AND ("Cohort Studies" OR "Longitudinal Studies")) AND "Brazil")]. Os critérios de inclusão foram coortes brasileiras que iniciaram a linha de base no período pré-natal ou no nascimento e com pelo menos dois acompanhamentos com os participantes. Foram excluídas as coortes cujos acompanhamentos foram restritos ao primeiro ano de vida, as que não abordaram aspectos biológicos, comportamentais e psicossociais e também aquelas com coleta de informações em um único estágio do ciclo vital. RESULTADOS A etapa de busca identificou 5.010 artigos. Foram selecionadas 18 coortes para a síntese descritiva. A mediana do número de participantes na linha de base foi 2.000 indivíduos e a mediana de idade no último acompanhamento foi 9 anos. A perda amostral no último acompanhamento variou de 9,2 a 87,5%. A maioria das coortes realizou acompanhamentos em duas fases do ciclo vital (período perinatal e infância). A região Sul contemplou o maior número de coortes. As principais variáveis coletadas foram sociodemográficas e ambientais da família, aspectos de morbidade, práticas alimentares e estilo de vida dos participantes. CONCLUSÕES Recomenda-se a continuidade dessas coortes, a abordagem de diferentes contextos sociais e a realização de acompanhamentos com os participantes em diferentes fases do ciclo vital para o fortalecimento e ampliação das análises de epidemiologia do ciclo vital no Brasil.

Brazil's unified health system: the first 30 years and prospects for the future.

In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility. Progress towards universal health coverage in Brazil has been achieved through a unified health system (Sistema Único de Saúde [SUS]), created in 1990. With successes and setbacks in the implementation of health programmes and the organisation of its health system, Brazil has achieved nearly universal access to health-care services for the population. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale universal health coverage in a highly unequal country with relatively low resources allocated to health-care services by the government compared with that in middle-income and high-income countries. Analysis of the past 30 years since the inception of the SUS shows that innovations extend beyond the development of new models of care and highlights the importance of establishing political, legal, organisational, and management-related structures, with clearly defined roles for both the federal and local governments in the governance, planning, financing, and provision of health-care services. The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration. Fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all.