PubMed Health⌕ Search

Biomedical subjects

Cesar G Victora

Publications and source records attributed to Cesar G Victora.

At least 19 recordsLinked to original sources
PubMed2006

Size at birth and blood pressure in early adolescence: a prospective birth cohort study.

Previous studies have suggested that birth size may influence blood pressure in later life. Most of these reported inverse associations only became evident after weight or body mass index at some later age was included in the regression model. In a prospective birth cohort study in Brazil, the effect of birth size on blood pressure at age 11 years was explored. Of the 5,249 cohort members, 4,452 were interviewed. Mean systolic and diastolic blood pressures were 101.9 mmHg (standard deviation, 12.3) and 63.4 mmHg (standard deviation, 9.9), respectively. Birth weight was positively associated with blood pressure in the crude analysis, but this effect was no longer significant after adjustment for confounders. When current body mass index-a possible mediating variable-was added to the model, the association between birth weight and blood pressure tended to become negative, though not quite significant. Birth length showed a positive effect on later blood pressure regardless of the adjustments made. Head circumference, gestational age, and ponderal index were not associated with blood pressure. Children born small for gestational age had lower blood pressure values. The postulated inverse association between birth weight and later blood pressure was not confirmed in this cohort. Instead, a positive effect of birth length was detected.

Adolescent↗
PubMed2006

Countdown to 2015: tracking intervention coverage for child survival.

BACKGROUND: The fourth Millennium Development Goal (MDG) calls for a two-thirds' reduction between 1990 and 2015 in deaths of children younger than five years; achieving this will require widespread use of effective interventions, especially in poor countries. We present the first report of the Child Survival Countdown, a worldwide effort to monitor coverage of key child-survival interventions in 60 countries with the world's highest numbers or rates of child mortality. METHODS: In 2005, we developed a profile for each of the 60 countries to summarise information on coverage with essential child survival interventions. The profiles also present information on demographics, nutritional status, major causes of death in children under 5 years of age, and the status of selected health policies. Progress toward the fourth MDG is summarised by comparing the average annual rate of reduction in under-5 mortality in each country with that needed to achieve the goal. The profiles also include a comparison of the proportions of children in the poorest and richest quintiles of the population who received six or more essential prevention interventions. Each country's progress (as measured by defined indicators of intervention coverage) was put into one of three groups created on the basis of international targets: "on track"; "watch and act"; and "high alert". For indicators without targets, arbitrary thresholds for high, middle, and low performance across the 60 countries were used as a basis for categorisation. FINDINGS: Only seven countries are on track to met MDG-4, 39 countries are making some progress, although they need to accelerate the speed, and 14 countries are cause for serious concern. Coverage of the key child survival interventions remains critically low, although some countries have made substantial improvements in increasing the proportion of mothers and children with access to life saving interventions by as much as ten percentage points in 2 years. Children from the poorest families were less likely than those from wealthier families to have received at least six essential prevention interventions. INTERPRETATION: Our results show that tremendous efforts are urgently needed to achieve the MDG for child survival. Profiles for each country show where efforts need to be intensified, and highlight the extent to which prevention interventions are being delivered equitably and reaching poor families. This first report also shows country-specific improvements in coverage and highlights missed opportunities. The "Countdown to 2015" will report on progress every 2 years as a strategy for increasing accountability worldwide for progress in child survival.

Child Mortality↗
PubMed2006

[The 2004 Pelotas birth cohort: methods and description].

OBJECTIVE: To describe a birth cohort which started in 2004, aiming to assess pre and perinatal conditions of the newborns, infant morbimortality, early life characteristics and outcomes, and access, use and financing of health care. METHODS: All children born in the urban area of Pelotas and Capão do Leão municipalities (Southern Brazil) in 2004 were identified and their mothers invited to join the study. In the first year of the study the children were seen at birth, at three and 12 months of age. These visits involved the application of a questionnaire to the mothers including questions on health; life style; use of health services; socioeconomic situation; estimation of gestational age; anthropometric measurements on the newborn (weight, length, head, chest and abdominal circumferences); anthropometric measurements on the mother (weight and height) and assessment of infant development. RESULTS: Out of the eligible infants (4,558), more than 99% were recruited to the study at birth. Follow-up rates were 96% at three months and 94% at 12 months of age. Among the initial results we highlight the following. Infant mortality rate was 19.7 per thousand, with 66% of infant deaths occurring in the neonatal period. There were frequencies of 15% premature babies and 10% low birthweight. Cesarean sections represented 45% of deliveries. CONCLUSIONS: The third Pelotas birth cohort showed an infant mortality rate similar to that of 11 years ago, with most deaths occurring in the neonatal period. The rates of prematurity and cesarean sections increased substantially.

Brazil↗
PubMed2006

Early determinants of physical activity in adolescence: prospective birth cohort study.

OBJECTIVE: To examine the effects of early social, anthropometric, and behavioural variables on physical activity in adolescence. DESIGN: Prospective birth cohort study. SETTING: Pelotas, southern Brazil. PARTICIPANTS: 4453 adolescents aged 10-12 years participating in the Pelotas 1993 birth cohort study (follow-up rate 87.5%). MAIN OUTCOME MEASURES: Sedentary lifestyle (< 300 minutes of physical activity per week) and median physical activity score (minutes per week). RESULTS: The prevalence of a sedentary lifestyle at age 10-12 years was 58.2% (95% confidence interval 56.7% to 59.7%). Risk factors for a sedentary lifestyle in adolescence were female sex, high family income at birth, high maternal education at birth, and low birth order. Weight gain variables at ages 0-1, 1-4, and 4-11 years and overweight at age 1 or 4 years were not significant predictors of physical activity. Levels of physical activity at age 4 years, based on maternal report, were inversely related to a sedentary lifestyle at age 10-12 years. CONCLUSIONS: Physical activity in adolescence does not seem to be programmed by physiological factors in infancy. A positive association between birth order and activity may be due to greater intensity of play in childhood and adolescence. Tracking of physical activity from age 4 to 10-12 years, however, suggests that genetic factors or early habit formation may be important.

Brazil↗
PubMed2006

Breastfeeding duration and blood pressure among Brazilian adolescents.

OBJECTIVE: To assess the relationship between breastfeeding duration and blood pressure in a large birth cohort of Brazilians followed from birth to adolescence. METHODS: All 5914 hospital births occurring in Pelotas in 1982 (over 99% of all deliveries) were studied prospectively. Detailed information on feeding practices was prospectively collected during childhood. In 1997 and 2001 we attempted to trace a sample of the cohort, whereas in 2000 we identified the male subjects when presenting for the army recruitment exam. Blood pressure measurements were taken in 1997 for both sexes, males in 2000 and females in 2001. RESULTS: Information on breastfeeding collected between 1983 and 1986 was available for 90.8% of the 5914 original cohort subjects. We managed to follow 1076, 2250 and 1031 subjects in 1997, 2000 and 2001, respectively. Total breastfeeding duration was not associated with systolic and diastolic blood pressure in adolescence. Diastolic blood pressure at the age of 15 y (1997) was higher among girls who had been predominantly breastfed for at least 4 mo. After controlling for confounding variables (family income, maternal education at birth and maternal BMI at birth, skin colour, birthweight, gestational age, maternal smoking during pregnancy, adolescent smoking and alcohol drinking), the strength of the association was reduced and the 95% confidence interval encompassed the other blood pressure estimates. Furthermore, such association was not replicated in the 2001 follow-up visit. CONCLUSION: Breastfeeding duration was not related to blood pressure in adolescence.

Adolescent↗
PubMed2006

Socio-economic and environmental factors influence energy utilization in Brazilian breast-fed infants.

Energy intake recommendations for infants are based on data from industrialized countries. FAO/WHO/UNU expressed the need for studies on total energy expenditure (TEE) and basal metabolic rate from developing countries covering current and changing lifestyles. For this observational study, 65 infants of differing socioeconomic status (SES) (n = 32 middle SES, n = 33 low SES) were selected in Pelotas, southern Brazil, aiming to: 1) compare TEE, minimum observable energy expenditure (MOEE), activity energy expenditure (AEE) between breast-fed infants 8.7 mo of age from middle and low SES; and 2) investigate the effect of potential mediating factors on TEE and AEE. TEE and total body water were measured with doubly labeled water, MOEE with respiration calorimetry, breast milk intake using the dose-to-the-mother deuterium-oxide turnover method, food intake using 1-d food weighing, and prevalence of overweight using BMI Z-scores. TEE adjusted for ethnicity was 257 (95% CI 232-281) kJ/(kg . d) in middle SES infants vs. 318 (95%CI 294-342) kJ/(kg . d) in low SES infants (P = 0.001). MOEE did not differ between groups and the difference in TEE was therefore attributed to AEE (P = 0.008). The effect of SES on AEE was mediated by the number of persons per bedroom (crowding). Prevalence of overweight tended to be higher in middle SES infants (P = 0.054) than in low SES infants. The difference in TEE and AEE between SES groups emphasizes the importance of an accurate description of the SES of any population in which TEE is studied and questions the extent to which TEE data from middle-class infants in transitional countries should be considered normative.

Breast Feeding↗
PubMed2006

Early life factors are determinants of female height at age 19 years in a population-based birth cohort (Pelotas, Brazil).

The purpose of this study was to investigate the influence of biological and social background on height of adolescent girls at age 19 y in the city of Pelotas, Southern Brazil. In 2001, a sample of the urban census tracts was visited and adolescent girls who were part of the Pelotas 1982 Birth Cohort Study were located. Standardized questionnaires were administered to the adolescents and their mothers. Height was measured using locally manufactured stadiometers; standardized protocols were employed. The information obtained in 2001 was combined with data collected in earlier phases of the study. The follow-up rate was 69% and 473 girls were studied in 2001. Multiple linear regressions were used to analyze the determinants of height. The height of the 19-y-old adolescents was 161.2+/-6.3 cm. The significant determinants of height were family income, maternal pre-gestational weight, maternal height, smoking during pregnancy, birth weight, height gain, and age at menarche. Birth weight was a more important predictor than weight gain during infancy or height gain between the ages of 2 and 4 y. Each 100 g in birth weight was associated with an increase of approximately 0.2 cm in the adolescent's height (P=0.001). The current findings reinforce the importance of early life factors in the determination of adult height.

Adult↗
PubMed2006

Breast feeding and blood lipid concentrations in male Brazilian adolescents.

OBJECTIVE: To assess the association between breast feeding and blood lipid levels in adolescence. DESIGN: Population based prospective birth cohort study. SETTING: City of Pelotas, Brazil. SUBJECTS: All hospital births taking place in 1982; 79% of all males (n = 2250) were followed up for 18 years, and 2089 blood samples were available. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Total cholesterol and fractions (very low density lipoprotein cholesterol (VLDL), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL)), LDL/HDL ratio, serum triglycerides. RESULTS: Three breast feeding variables were studied: total duration of breast feeding, duration of exclusive or predominant breast feeding, and ever compared with never breast fed. Adjusted analyses were controlled for family income, household assets index, maternal education, maternal pre-pregnancy body mass index (BMI), skin colour, birth weight, gestational age, maternal smoking during pregnancy, and adolescent BMI, and behavioural variables (fat content of diet, physical activity, smoking, and alcohol drinking). Only one association reached borderline significance (p = 0.05): LDL cholesterol was slightly higher among never (mean 41.0 mg/dl; 95% CI 39.4 to 42.7) than among ever breast fed men (38.6 mg/dl; 95% CI 38.6 to 40.3), in the adjusted analyses. All other associations were not significant (p> or =0.09). There was no evidence of effect modification according to preterm status, intrauterine growth retardation, socioeconomic level, growth velocity in the first two years of life, or nutritional status at 2 years of age. CONCLUSIONS: There was no clear association between breast feeding duration and serum lipid concentrations at the age of 18 years in this sample of Brazilian men.

Adolescent↗
PubMed2006

[North-South relations in scientific publications: editorial racism?].

The aim of the present study was to comment on the possible existence of editorial prejudice among the editors of scientific journals from Northern countries against Southern authors. We highlight that a study using bibliometric methods documented an important imbalance in terms of the international scientific production of health researchers from high-income countries (the "North") and those from low and middle-income countries (the "South"). In a survey of Brazilian researchers, three in every four blamed this imbalance, at least in part, on prejudice among international editors. This is supported by the fact that a very small percentage of editorial board members of international journals come from the South. Although prejudice can explain part of the imbalance, there are also specific measures that may increase the likelihood of a paper from the South being accepted in international journals. These include the need to invest in the quality of the written text, and to show empathy with editors and readers, emphasizing the contribution of the manuscript to the international literature. Finally, we discuss whether research carried out in the South should be published in national or international journals, and suggest that there are at least six dimensions to this choice. These include language and target audience; type of contribution to knowledge; generalizability; citation index; speed of publication; and open access. The rapid growth in the number of Brazilian contributions to the international health literature shows that editorial prejudice, although often present, can be effectively offset by research with solid methodology and good-quality presentation.

Bibliometrics↗
PubMed2006

Adolescent physical activity and health: a systematic review.

Physical activity in adolescence may contribute to the development of healthy adult lifestyles, helping reduce chronic disease incidence. However, definition of the optimal amount of physical activity in adolescence requires addressing a number of scientific challenges. This article reviews the evidence on short- and long-term health effects of adolescent physical activity. Systematic reviews of the literature were undertaken using a reference period between 2000 and 2004, based primarily on the MEDLINE/PubMed database. Relevant studies were identified by examination of titles, abstracts and full papers, according to inclusion criteria defined a priori. A conceptual framework is proposed to outline how adolescent physical activity may contribute to adult health, including the following pathways: (i) pathway A--tracking of physical activity from adolescence to adulthood; (ii) pathway B--direct influence of adolescent physical activity on adult morbidity; (iii) pathway C--role of physical activity in treating adolescent morbidity; and (iv) pathway D - short-term benefits of physical activity in adolescence on health. The literature reviews showed consistent evidence supporting pathway 'A', although the magnitude of the association appears to be moderate. Thus, there is an indirect effect on all health benefits resulting from adult physical activity. Regarding pathway 'B', adolescent physical activity seems to provide long-term benefits on bone health, breast cancer and sedentary behaviours. In terms of pathway 'C', water physical activities in adolescence are effective in the treatment of asthma, and exercise is recommended in the treatment of cystic fibrosis. Self-esteem is also positively affected by adolescent physical activity. Regarding pathway 'D', adolescent physical activity provides short-term benefits; the strongest evidence refers to bone and mental health. Appreciation of different mechanisms through which adolescent physical activity may influence adult health is essential for drawing recommendations; however, the amount of exercise needed for achieving different benefits may vary. Physical activity promotion must start in early life; although the 'how much' remains unknown and needs further research, the lifelong benefits of adolescent physical activity on adult health are unequivocal.

Adolescent↗
PubMed2005

Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study.

BACKGROUND: Both the prevalence and mortality attributable to chronic obstructive pulmonary disease (COPD) seem to be increasing in low-income and middle-income countries, but few data are available. The aim of the PLATINO study, launched in 2002, was to describe the epidemiology of COPD in five major Latin American cities: São Paulo (Brazil), Santiago (Chile), Mexico City (Mexico), Montevideo (Uruguay), and Caracas (Venezuela). METHODS: A two-stage sampling strategy was used in the five areas to obtain probability samples of adults aged 40 years or older. These individuals were invited to answer a questionnaire and undergo anthropometry, followed by prebronchodilator and postbronchodilator spirometry. We defined COPD as a ratio less than 0.7 of postbronchodilator forced expiratory volume in the first second over forced vital capacity. FINDINGS: Complete information, including spirometry, was obtained from 963 people in São Paulo, 1173 in Santiago, 1000 in Mexico City, 885 in Montevideo, and 1294 in Caracas. Crude rates of COPD ranged from 7.8% (78 of 1000; 95% CI 5.9-9.7) in Mexico City to 19.7% (174 of 885; 17.2-22.2) in Montevideo. After adjustment for key risk factors, the prevalence of COPD in Mexico City remained significantly lower than that in other cities. INTERPRETATION: These results suggest that COPD is a greater health problem in Latin America than previously realised. Altitude may explain part of the difference in prevalence. Given the high rates of tobacco use in the region, increasing public awareness of the burden of COPD is important.

Adult↗
PubMed2005

[A nationwide wealth score based on the 2000 Brazilian demographic census].

OBJECTIVE: To propose an asset based indicator of wealth for Brazil using variables present in the demographic census. METHODS: The indicator, named IEN (Indicador Econômico Nacional/ National Wealth Score), was developed using 12 assets and the schooling of the household head, through principal component analysis. Data from the 2000 Brazilian Demographic sample was used for deriving the score and for the calculation of decile cut-off points. RESULTS: The indicator, first component obtained from the analysis with the 13 variables, retained 38% of the total variability, and presented a Spearman correlation of 0,74 with total family income and of 0,67 with per capita income. The necessary scores to calculate the indicator are presented, as well as reference distributions for the 27 states and their capitals, the five major regions as for the whole country. An example of use of indicator is presented. CONCLUSIONS: Differently from other economic indicators, the Indicador Econômico Nacional has local reference distributions available, along with the national distribution. It is therefore possible to compare a study sample to the municipal, state or country distribution. The small number of variables allow investigators to calculate the Indicador Econômico Nacional in research studies where economic classification is of interest.

Brazil↗
PubMed2005

Who, when, and how much? Epidemiology of walking in a middle-income country.

BACKGROUND: Physical inactivity is one of the leading causes of morbidity and mortality worldwide. Walking, an inexpensive and accessible activity, is protective against unhealthy outcomes. Little data on walking practices are available outside developed countries. This study estimated the prevalence and correlates of compliance with physical activity recommendations through leisure-time and all-domain (combined leisure time, commuting, and work-related) walking in individuals aged > or =20 years in a southern Brazilian city. METHODS: Data from two population-based surveys carried out in 2002 and 2003 in Pelotas, Rio Grande do Sul, were compared and analyzed in 2004. Multistage sampling procedures were undertaken in both surveys. Compliance with physical activity recommendations was defined as > or =150 minutes/week of walking during the previous week, although other cut-off points were estimated. The International Physical Activity Questionnaire was used in both studies. RESULTS: Samples comprised 3182 (2002 study) and 3100 (2003 study) individuals. Nonresponse rates were 5.6% and 3.5%, respectively. Both prevalence and correlates of leisure-time and all-domains walking were markedly different. Compliance with physical activity guidelines (> or =150 minutes/week) through walking was 40.6% (all domains) and 15.0% (leisure time). Poor and uneducated participants had a lower likelihood of walking than higher-income and more educated people, particularly in leisure time. Walkers were also more likely to practice other vigorous and moderate-intensity activities. CONCLUSIONS: Although the results derive from a single Brazilian city, they are likely to be relevant to similar environments/locales in middle-income countries, where the obesity epidemic is rapidly increasing. Due to the low levels of walking detected, particularly during leisure time, healthcare professionals are encouraged to recommend walking to their patients.

Adult↗
PubMed2005

Breastfeeding and school achievement in Brazilian adolescents.

AIM: To assess the effect of breastfeeding duration on school achievement in a Brazilian cohort. METHODS: In a population-based birth cohort, we analysed the highest grade achieved in school of over 2,000 male 18-y-olds relative to breastfeeding information collected in early life. Analyses were adjusted for birthweight, family income, maternal and paternal schooling, household assets, number of siblings, social class, maternal smoking during pregnancy, and ethnicity. RESULTS: After adjustment for confounding variables, there was a highly significant trend in school achievement with increasing breastfeeding duration. Those breastfed for 9 mo or more were ahead by 0.5-0.8 school grades, relative to those breastfed for less than 1 mo. Data from a cross-sectional survey in the same population suggest that such a difference corresponds to a 10-15% difference in adult income levels. The duration of exclusive or predominant breastfeeding was also positively associated with schooling. CONCLUSION: Unlike studies from developed countries, there was no clear association between breastfeeding duration and either the family's socio-economic level or parental schooling in our sample and therefore residual confounding is improbable. These results suggest that the impact of breastfeeding on intellectual development may lead to sizeable differences in adult education and wage-earning performance.

Adolescent↗