Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
2Activity
0 of .
Results for:
No results containing your search query
P. 1
The Pelotas Birth Cohort Study, 1982 - 2001

The Pelotas Birth Cohort Study, 1982 - 2001

Ratings:

4.67

(3)
|Views: 198|Likes:
Published by notarazi
The Pelotas Birth Cohort Study, 1982 - 2001
The Pelotas Birth Cohort Study, 1982 - 2001

More info:

Published by: notarazi on Oct 18, 2008
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

09/07/2012

pdf

text

original

 
1241
Cad. Saúde Pública, Rio de Janeiro, 19(5):1241-1256, set-out, 2003
REVISÃO
REVIEW
The Pelotas Birth Cohort Study,Rio Grande do Sul, Brazil, 1982-2001
Estudo de coorte de nascimentos em Pelotas,Rio Grande do Sul, Brasil, 1982-2001
1Faculdade de Medicina,Universidade Federal de Pelotas.C.P.464,Pelotas,RS 96001-970,Brasil.cvictora@terra.com.br  2 Centro Latinoamericanode Perinatología y Desarrollo Humano.Casilla de Correo 627,11000, Montevideo,Uruguay.3London School of Hygiene & Tropical Medicine.Keppel Street,London WC1E 7HT,UK.4Escola de Medicina,Universidade Católicade Pelotas.Rua Félix daCunha 412,Pelotas,RS 96010-000,Brasil.
Cesar G.Victora
1
Fernando C.Barros 
1,2 
Rosângela C.Lima
1
Dominique P.Behague 
1,3
Helen Gonçalves 
1
Bernardo L.Horta
1,4
Denise P.Gigante 
1
 J.Patrick Vaughan
3
Abstract
Given the growing recognition of the importance of the life course approach for the determination of chronic diseases,birth cohort studies are becoming increasingly important.This paper describes the methods used in the 1982 Pelotas (Brazil) birth cohort study,one of the largest and longest studies of this type in developing countries.All 5,914 hospital births occur-ring in Pelotas in 1982 (over 99% of all deliveries) were studied prospectively.The main stages of the study took place in 1983,1984,1986,1995,1997,2000,and 2001.More than two thousand variables are available for each subject who participated in all stages of the study.Recent phases of the study included the examination of 2,250 males when presenting for the army recruitment exam in 2000,the study of a 27% sample of men and women in 2001 through household visits,and the study of over 400 children born to the cohort women.Follow-up rates in the recent stages of the cohort were 78.9% for the army examination and 69.0% for the household visits.Ethno- graphic and oral health studies were conducted in sub-samples.Some recent results on blood pressure,adolescent pregnancy,and asthma are presented as examples of utilization of the data.Suggestions on lessons learned for other cohort studies are proposed.
Key words
Cohort Studies;Growth;Life Cycle Stages;Adolescent;Chil
Resumo
Em função do reconhecimento crescente do enfoque do ciclo vital na determinação de doenças crônicas,estudos de coorte de nascimentos são cada vez mais importantes.Este artigodescreve a metodologia do estudo de coorte de nascidos em Pelotas,em 1982,um dos maiores e mais longos estudos de coorte em países em desenvolvimento.Todos os 5.914 nascimentos hospi-talares (mais de 99% de todos os nascimentos) ocorridos em 1982 foram estudados prospectiva-mente.As principais fases do estudo foram realizadas em 1983,1984,1986,1995,1997,2000 e  2001.Mais de duas mil variáveis estão disponíveis para sujeitos incluídos em todas as fases doestudo.As fases recentes incluíram o exame de 2.250 homens durante o exame médico de Alista-mento Militar no ano 2000,o estudo de uma subamostra de ambos os sexos em 2001,e o estudode mais de 400 crianças nascidas para as mulheres da coorte.As taxas de seguimento nas fases recentes do estudo foram de 78,9% para os recrutas e de 69,0% na visita domiciliar de 2001.Di-versos estudos complementares foram realizados em subamostras,inclusive investigações etno- gráficas e de saúde bucal.Sugestões metodológicas para novos estudos de coorte,baseados na ex-periência adquirida,são propostos.
Palavras-chave
Estudos de Coortes;Crescimento;Fases do Ciclo da Vida;Adolescente;Criança
 
 VICTORA, C. G. et al.
1242
Cad. Saúde Pública, Rio de Janeiro, 19(5):1241-1256, set-out, 2003
Introduction
Birth cohort studies from developed countrieshave contributed enormously to the under-standing of the long-term consequences of con-ditions in early life. The first prospective na-tional birth cohort study was started in theUnited Kingdom in 1946 (Wadsworth, 1991),and new cohorts were started in 1958, 1970, and2000 (Smith & Joshi, 2002). In the United States,a large birth cohort will be started in 2004 (seehttp://www.nichd.nih.gov/despr/cohort).However, large birth cohort studies are rareoutside developed countries. Harpham et al.(in press) have recently reviewed longitudinalstudies from developing countries with samplesof 1,000 or more children. Of these, only threebirth cohorts were followed for 10 years ormore. In chronological order, these include the1982 Pelotas (Brazil) cohort of approximately 6,000 births; the 1983-1984 Cebu (Philippines)study with approximately 3,000 newborns(CHLNS, 2002); and the 1990 Johannesburg (South Africa)
Birth to Ten Study 
of some 4,000births (Richter et al., 1995). With the exceptionof the Cebu study – terminated in 1999 – theother two cohorts are still being followed. A smaller study is being conducted in Guatema-la, where about 400 subjects born from 1969 to1977 are still being followed (Stein et al., 2002).In this paper we provide an update on the
Pelotas and Birth Cohort Study 
, with emphasison the design and methods used in recentphases of the study. The importance of birthcohort studies and their main methodologicalchallenges are highlighted. Special attention isgiven to the issue of losses to follow-up, possi-ble strategies for improving response rates incohort studies, and integration of longitudinalepidemiological and ethnographic methods.
Methods
The study was carried out in the Brazilian city of Pelotas, Rio Grande do Sul State. The urbanpopulation grew from 214,000 in 1982 to 320,000in 2000. This is a relatively affluent area of Brazil, near the Southern border with Uruguay and Argentina, with a per capita gross domes-tic product of US$ 2,700 (Klering, 1992) in the1990s. The population descends mostly fromPortuguese and Spanish settlers, Amerindians,and Africans brought as slaves; German immi-grants are also represented. Inter-racial mar-riages are common. The main economic activi-ties are agriculture (mostly rice farming andcattle-raising), commerce, and education (thecity is home to two large universities). Over90% of the households are connected to thepublic water supply and half to the sewage dis-posal network. When the study began, the in-fant mortality rate in the city was some 40deaths per thousand live births. There is onephysician for each 260 inhabitants, health carebeing provided free of charge at 32 basic healthfacilities, five specialized health centers, andfive general hospitals.
Early phases of the study: 1982-1986
The methods used in the early phases of thecohort have been described elsewhere (Barroset al., 1990, 2001; Victora et al., 1992). The study began as a perinatal health survey (Barros,1986) including all 6,011 infants born in threematernity hospitals (accounting for 99.2% of allbirths in the city). The 5,914 live-born infants were weighed with regularly calibrated pedi-atric scales (Filizolla, Brazil) to the nearest 10g.Birth length was not recorded. Mothers were weighed and measured and answered a shortquestionnaire on socioeconomic, demograph-ic, and health-related variables.The cohort children were followed up atseveral points in time(Table 1). Initially, thoseborn from January to April 1982 were targetedin the
1983 Follow-up Study 
through the ad-dresses obtained during the hospital interview, when they were aged 8-16 months (mean age11.3 months).To calculate the proportion of children lo-cated in each follow-up visit, those known tohave died were added to those examined. In1983, 66 of the 1,919 children born from Janu-ary to April 1982 were know to have died; addedto the 1,457 whose mothers or caretakers wereinterviewed, these accounted for 79.3% of thechildren who were targeted. Address errors were the main reason for non-response. Non-response rates quoted in the present paper areslightly different from those presented in earli-er publications (Barros et al., 1990), since they did not fully account for children who haddied.The subsequent phases included the
1984Follow-up Study 
(January-April 1984), whenthe mean age was 19.4 months (range 12-29),and the
1986 Follow-up Study 
(December 1985-May 1986) (mean age 43.1 months; range 35-53). To minimize losses to follow-up, in eachround the approximately 70,000 urban house-holds were visited in search of children born in1982. After the census was completed, children who still had not been located were searchedfor at their last known address. This approach
 
Cad. Saúde Pública, Rio de Janeiro, 19(5):1241-1256, set-out, 2003
resulted in locating 87.2% and 84.1% of theoriginal cohort, respectively.During each visit, the mother or caretakeranswered pre-coded, standardized question-naires (see Table 2 for a list of the main vari-ables collected). Children were weighed withportable spring scales (CMS, United Kingdom)and were measured with locally made AHRTAGstadiometers (Barros & Victora, 1998). Standard weighing and measuring methods were used(Jelliffe, 1966), and the interviewers were ex-tensively trained before fieldwork. Quality-con-trol measures included repeating some 5% of the interviews and measurements by a field- work supervisor, standardization sessions, anddouble data entry.Two sub-studies were also performed. The
Psychomotor Development Study 
(Victora et al.,1990) was performed on a random sub-sample
THE PELOTAS BIRTH COHORT STUDY, 1982-2001
1243
of 360 children born from January to April 1982 who had been seen at all follow-up visits. At themean age of 4.5 years, they were tested with theGriffiths’s scales in six areas of development (lo-comotor, personal-social, hearing and speech,eye-hand coordination, performance, and prac-tical reasoning).The
 Mortality Study 
entailed the identifica-tion of all deaths occurring among cohort chil-dren. All hospitals, cemeteries, civil records of-fices, and the Regional Secretariat of Health were regularly visited from 1982 to 1982 to de-tect deaths of children and adolescents belong-ing to the 1982 cohort; from 1987 onwards, itbecame clear that civil records offices were de-tecting all deaths, and thus other sources wereno longer monitored. Causes of death were in-vestigated by reviewing case notes from outpa-tient clinics and hospitals, in addition to inter-
Table 1Principal phases of the Pelotas Birth Cohort Study.
 YearTarget populationMain sampling strategyMean age Number of subjectsLosses to
DescriptionNumber
(range)
InterviewedDeceased*
follow-up (%)
*1982All hospital births in 5,914Daily visits to all 0 mo.5,9140the city from January-city hospitalsDecember 19821983All children born from 1,916Visit to addresses11.3 mo. (8-16)1,4576620.7January-April 1982obtained in hospital1984All cohort children5,914Census of all 70,000 19.4 mo. (12-29)4,93422712.8households in the city1986All cohort children5,914Census of all 80,000 43.1 mo. (35.4-53.0)4,74223715.9households in the city199520% of cohort 1,100Visits to households based13.1 yr. (12.5-13.7)7154730.1adolescentson the addresses collectedin previous visits199727% of cohort 1,749Visits to all households in 14.7 yr. (14.0-15.6)1,0767028,2adolescentsa systematic sample of 27%of the city’s census tracts1997-Ethnographic studyStratified sub-sample of 8 15-19 yr.962001census tracts from thosevisited in 1997; random sampleof 12 subjects in each tract2000All male cohort 3,037Identification of adolescents 18.2 yr. (17.6-19.1)2,25014321.1adolescentsattending the compulsoryArmy recruitment examination200127% of cohort 1,749Visits to all households in18.9 yr. (18.1-19.9)1,0317131.0adolescentsa systematic sample of 27%of the city’s census tracts* This includes those known to be dead at the time of the 1983, 1984, 1986, and 2000 visits, and 27%of those known to be dead at the time of the 1997 and 2001 visits.

Activity (2)

You've already reviewed this. Edit your review.
1 thousand reads
1 hundred reads

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->