Life course epidemiology

Scotland has higher mortality rates than the rest of Western Europe (rWE), with more cardiovascular disease and cancer among older adults; and alcohol-related and drug-related deaths, suicide and violence among younger adults. We obtained sex, age-specific and year-specific all-cause mortality rates for Scotland and other populations, and explored differences in mortality both visually and numerically. Scotland's age-specific mortality was higher than the rest of the UK (rUK) since 1950, and has increased. Between the 1950s and 2000s, 'excess deaths' by age 80 per 100 000 population associated with living in Scotland grew from 4341 to 7203 compared with rUK, and from 4132 to 8828 compared with rWE. UK-wide mortality risk compared with rWE also increased, from 240 'excess deaths' in the 1950s to 2320 in the 2000s. Cohorts born in the 1940s and 1950s throughout the UK including Scotland had lower mortality risk than comparable rWE populations, especially for males....

Data from many high- and low- or middle-income countries have linked exposures during key developmental periods (in particular pregnancy and infancy) to later health and disease. Africa faces substantial challenges with persisting infectious disease and now burgeoning non-communicable disease.This paper opens the debate to the value of strengthening the developmental origins of health and disease (DOHaD) research focus in Africa to tackle critical public health challenges across the life-course. We argue that the application of DOHaD science in Africa to advance life-course prevention programmes can aid the achievement of the Sustainable Development Goals, and assist in improving health across generations. To increase DOHaD research and its application in Africa, we need to mobilise multisectoral partners, utilise existing data and expertise on the continent, and foster a new generation of young African scientists engrossed in DOHaD.

The aim of this study was to investigate the association between early-life family income and dental pain experience from childhood to early adulthood. Data came from a 14-year prospective study (1991/1992-2005/2006) carried out in South Australia, which included children and adolescents aged 4-17 years (N = 9875) at baseline. The outcome was dental pain experience obtained at baseline, 14 years later in adulthood and at a middle point of time. The main explanatory variable was early-life family income collected at baseline. The prevalence of dental pain was 22.8% at baseline, 19.3% at 'middle time' and 39.3% at follow up. The proportion of people classified as 'poor' at baseline was 27.7%. Being poor early in life was significantly associated with dental pain at 14-year follow up (odds ratio = 1.45; 95% confidence interval = 1.27-1.66). Early-life relative poverty is associated with more frequent dental pain across the 14-year follow up and may be a key exposure var...

Background. The associations between cardiovascular disease (CVD) risk and later physical functioning have been observed, but few studies with follow-up into old age exist. We investigated the association between cardiovascular status in midlife and physical functioning trajectories in old age. . In the Helsinki Businessmen Study cohort (Caucasian men born in 1919-1934) three CVD status groups were formed based on clinical measurements carried out in 1974: signs of CVD (diagnosed clinically or with changes in ECG, chronic disease present or used medication, n=563); healthy and low CVD risk (n=593) and high CVD risk (n= 1222). Of them, 1560 men had data on physical functioning from at least one of four data collection waves between 2000-2010. Ten questions from the RAND-36 (SF-36) survey were used to construct physical functioning trajectories with latent class growth mixture models. Mortality was accounted for in competing risk models. A five-class solution provided the optimal number of trajectories: 'intact', 'high stable', 'high and declining', 'intermediate and declining' and 'consistently low' functioning. Compared to low CVD risk, high CVD risk in midlife decreased the risk of being classified into the 'intact' (fully adjusted β -3.98, SE 2.0, p=0.046) relative to 'consistently low' physical functioning trajectory. Compared to low CVD risk, those with signs of CVD were less likely to follow the 'intact', 'high stable' or 'high and declining' relative to the 'consistently low' trajectory (all p<0.018). Conclusions. Among businessmen, a more favorable CVD profile in midlife was associated with better development of physical functioning in old age.

Background: Adolescent childbirth and elevated parity are relatively common in middle and low-income countries and they may be related to the higher prevalence and earlier onset of physical decline documented in these settings, especially in women. The aim of this paper is to investigate whether reproductive history is associated with physical function in middle-aged women from Northeast Brazil. Methods: The relationship between poor physical performance (grip strength, gait speed and chair stand), early maternal age at first birth (<18 years old), and multiparity (≥3 children) was evaluated in a community sample of 473 women living in Parnamirim (Northeast Brazil). Linear regression models were used to examine the relationship of interest; in addition, mediation analyses were employed to assess indirect effects of obesity and family income. Results: Women who gave birth at less than 18 years of age took approximately 0.50 s longer to complete the chair stand test compared to women who gave birth at 18 years or older. Moreover, women who gave birth to < 3 children completed the chair stand test 0.42 s faster compared to those who had ≥ 3 children. The relation between reproductive history and physical performance was mediated by BMI. Reproductive history was not associated with performance in gait speed. Conclusions: This study provides evidence that adolescent childbirth and multiparity are related to worse physical performance in middle-aged women from a low income setting. Reproductive history may partially account for earlier physical decline and greater disability in women from lower income settings.

Background: A growing literature suggests that low birth weight increases the risk of poor health outcomes in adulthood. We tested this hypothesis among young adults living in São Paulo State, Brazil. Methods and Findings: To identify the effects of low birth weight on young adulthood outcomes, a medical assessment of 297 individuals born between 1977 and 1989 was conducted at a primary care unit in São Paulo State, Brazil. We analyzed body mass index (BMI), waist-hip ratio, blood pressure, fasting glucose and total cholesterol levels using linear and logistic regressions. Low birth was negatively associated with BMI (b = 22.0, 95% CI: 23.69, 20.27, p = 0.02), fasting glucose levels (b = 21.9, 95% CI: 23.9, 20.07, p = 0.05), waist-hip ratio (b = 20.03, 95% CI: 20.07, 20.01, p = 0.10), systolic blood pressure (b = 23.32, 95% CI: 27.60, 0.96, p = 0.12), and total cholesterol levels (b = 23.19, 95% CI: 216.43, 10.05, p = 0.636). Low birth weight was also associated with lower odds of young adults being overweight and obese, but neither association was statistically significant. Weight gain in the first 12 months of life was associated with higher adult BMI (b = 0.79, 95% CI: 20.0455, 1.623, p = 0.064) and blood pressure (b = 2.79, 95% CI: 0.22, 5.35, p = 0.034). No associations were found between low birth weight and early life (catch-up) growth. Conclusions: Low birth weight was not associated with poor health outcomes among young adults in Brazil. These results appear inconsistent with the original Barker hypothesis, but will need to be corroborated in larger samples with longer follow-ups to allow a more general evaluation of the validity of the hypothesis in low and middle income countries.

Latar belakang: Stunting adalah gangguan pertumbuhan linier yang ditunjukkan dengan nilai Z-score tinggi badan menurut usia (TB/U) kurang dari -2 standar deviasi (SD) berdasarkan standar World Health Organization (WHO). Stunting tetap menjadi salah satu masalah gizi utama di dunia dan mencerminkan efek kumulatif dari malnutrisi kronis selama 1.000 hari pertama kehidupan. Penelitian ini bertujuan mengetahui perbedaan kejadian stunting pada penyakit akut dan kronis pada pasien rawat inap di RSUD Klungkung. Metode: Desain penelitian analitik cross sectional. Pengumpulan data melalui rekam medik anak yang di rawat di RSUD Klungkung periode 1 Januari sampai 31 Desember 2018 dengan metode total sampling yang dipilih berdasarkan kriteria inklusi dan eksklusi yaitu anak usia 0-60 bulan. Data dianalisis univariat dan bivariat menggunakan uji chi square. Hasil: Selama periode penelitian tercatat 404 orang anak dirawat di RSUD Klungkung dengan 356 anak (88,1%) menderita penyakit akut dan 48 an...

Objectives Little is known about how employment and work outcomes among young adults are influenced by their life-course history of mental health problems. Therefore, the aims of this study were to (i) identify trajectories of mental health problems from childhood to young adulthood and (ii) investigate the association between these trajectories and employment and work outcomes among young adults. Methods Data were used from 360 participants of the Tracking Adolescents&#39; Individual Lives Survey (TRAILS), a Dutch prospective cohort study, with 12-year follow-up. Trajectories of externalizing and internalizing problems were identified with latent class growth models. Employment conditions and work outcomes (ie, psychosocial work characteristics) were measured at age 22. We assessed the association between mental health trajectories and employment conditions and work outcomes. Results Four trajectories of mental health problems were identified: high-stable, decreasing, moderate-stab...

Background The fetal origins hypothesis suggests that an adverse prenatal environment, indexed by low birthweight (LBW), may increase the risk of developing later disease. Recently the hypothesis has been extended to psychological outcomes, especially depression. The aim of this analysis was to test, for the first time in a developing country setting, the association between LBW and psychological symptoms, in Soweto, South Africa.

Scotland has higher mortality rates than the rest of Western Europe (rWE), with more cardiovascular disease and cancer among older adults; and alcohol-related and drug-related deaths, suicide and violence among younger adults. We obtained sex, age-specific and year-specific all-cause mortality rates for Scotland and other populations, and explored differences in mortality both visually and numerically. Scotland&#39;s age-specific mortality was higher than the rest of the UK (rUK) since 1950, and has increased. Between the 1950s and 2000s, &#39;excess deaths&#39; by age 80 per 100 000 population associated with living in Scotland grew from 4341 to 7203 compared with rUK, and from 4132 to 8828 compared with rWE. UK-wide mortality risk compared with rWE also increased, from 240 &#39;excess deaths&#39; in the 1950s to 2320 in the 2000s. Cohorts born in the 1940s and 1950s throughout the UK including Scotland had lower mortality risk than comparable rWE populations, especially for males....

Background: The Child and Adolescent Twin Study in Sweden (CATSS) is an ongoing , large population-based longitudinal twin study. We aimed (1) to investigate the reliability of two different versions (125-items and 238-items) of Cloninger's Temperament and Character Inventory (TCI) used in the CATSS and the validity of extracting the short version from the long version, (2) to compare these personality dimensions between twins and adolescents from the general population, and (3) to investigate the genetic structure of Cloninger's model. Method: Reliability and correlation analyses were conducted for both TCI versions, 2,714 CATSS-twins were compared to 631 adolescents from the general population, and the genetic structure was investigated through univariate genetic analyses, using a model-fitting approach with structural equation-modeling techniques based on same-sex twin pairs from the CATSS (423 monozygotic and 408 dizygotic pairs). Results: The TCI scores from the short and long versions showed comparable reliability coefficients and were strongly correlated. Twins scored about half a standard deviation higher in the character scales. Three of the four temperament dimensions (Novelty Seeking, Harm Avoidance, and Persistence) had strong genetic and non-shared environmental effects, while Reward Dependence and the three character dimensions had moderate genetic effects, and both shared and nonshared environmental effects. Conclusions: Twins showed higher scores in character dimensions compared to adolescents from the general population. At least among adolescents there is a shared environmental influence for all of the character dimensions, but only for one of the temperament dimensions (i.e., Reward Dependence). This specific finding regarding the existence of shared environmental factors behind the character dimensions in adolescence, together with earlier findings showing a small shared environmental effects on character among young adults and no shared environmental effects on character among adults, suggest that there is a shift in type of environmental influence from adolescence to adulthood regarding character.

Latar belakang: Stunting adalah gangguan pertumbuhan linier yang ditunjukkan dengan nilai Z-score tinggi badan menurut usia (TB/U) kurang dari -2 standar deviasi (SD) berdasarkan standar World Health Organization (WHO). Stunting tetap menjadi salah satu masalah gizi utama di dunia dan mencerminkan efek kumulatif dari malnutrisi kronis selama 1.000 hari pertama kehidupan. Penelitian ini bertujuan mengetahui perbedaan kejadian stunting pada penyakit akut dan kronis pada pasien rawat inap di RSUD Klungkung. Metode: Desain penelitian analitik cross sectional. Pengumpulan data melalui rekam medik anak yang di rawat di RSUD Klungkung periode 1 Januari sampai 31 Desember 2018 dengan metode total sampling yang dipilih berdasarkan kriteria inklusi dan eksklusi yaitu anak usia 0-60 bulan. Data dianalisis univariat dan bivariat menggunakan uji chi square. Hasil: Selama periode penelitian tercatat 404 orang anak dirawat di RSUD Klungkung dengan 356 anak (88,1%) menderita penyakit akut dan 48 an...

Kunci tahapan dalam kehidupan masyarakat mempunyai relevansi khusus dengan kesehatannya. Life Course Approach dapat kita telusuri sehingga etiologi, risiko penyakit kronis dan kematian dini dapat dijelaskan pada Life Course Approach (siklus kehidupan) ini. Life Course Epidemiology dapat menelusuri efek jangka panjang dari paparan fisik dan sosial selama kehamilan, masa kanak-kanak, remaja, dewasa muda, sampai dengan kehidupan dewasa dihubungkan dengan kesehatan dan risiko penyakitnya di kemudian hari mencakup faktor biologis, perilaku, dan psikososial.
Kuh D, Shlomo YB. Introduction. In: A life course approach to chronic disease epidemiology Oxford University Press; 2004.

Background: Investigations of the structure of psychological well-being items are useful for advancing knowledge of what dimensions define psychological well-being in practice. Ryff has proposed a multidimensional model of psychological well-being and her questionnaire items are widely used but their latent structure and factorial validity remains contentious. Methods: We applied latent variable models for factor analysis of ordinal/categorical data to a 42item version of Ryff's psychological well-being scales administered to women aged 52 in a UK birth cohort study (n = 1,179). Construct (predictive) validity was examined against a measure of mental health recorded one year later. Results: Inter-factor correlations among four of the first-order psychological well-being constructs were sufficiently high (> 0.80) to warrant a parsimonious representation as a secondorder general well-being dimension. Method factors for questions reflecting positive and negative item content, orthogonal to the construct factors and assumed independent of each other, improved model fit by removing nuisance variance. Predictive validity correlations between psychological well-being and a multidimensional measure of psychological distress were dominated by the contribution of environmental mastery, in keeping with earlier findings from cross-sectional studies that have correlated well-being and severity of depression. Conclusion: Our preferred model included a single second-order factor, loaded by four of the six first-order factors, two method factors, and two more distinct first-order factors. Psychological well-being is negatively associated with dimensions of mental health. Further investigation of precision of measurement across the health continuum is required.

Data from many high- and low- or middle-income countries have linked exposures during key developmental periods (in particular pregnancy and infancy) to later health and disease. Africa faces substantial challenges with persisting infectious disease and now burgeoning non-communicable disease.This paper opens the debate to the value of strengthening the developmental origins of health and disease (DOHaD) research focus in Africa to tackle critical public health challenges across the life-course. We argue that the application of DOHaD science in Africa to advance life-course prevention programmes can aid the achievement of the Sustainable Development Goals, and assist in improving health across generations. To increase DOHaD research and its application in Africa, we need to mobilise multisectoral partners, utilise existing data and expertise on the continent, and foster a new generation of young African scientists engrossed in DOHaD.

Background: A growing literature suggests that low birth weight increases the risk of poor health outcomes in adulthood. We tested this hypothesis among young adults living in São Paulo State, Brazil. Methods and Findings: To identify the effects of low birth weight on young adulthood outcomes, a medical assessment of 297 individuals born between 1977 and 1989 was conducted at a primary care unit in São Paulo State, Brazil. We analyzed body mass index (BMI), waist-hip ratio, blood pressure, fasting glucose and total cholesterol levels using linear and logistic regressions. Low birth was negatively associated with BMI (b = 22.0, 95% CI: 23.69, 20.27, p = 0.02), fasting glucose levels (b = 21.9, 95% CI: 23.9, 20.07, p = 0.05), waist-hip ratio (b = 20.03, 95% CI: 20.07, 20.01, p = 0.10), systolic blood pressure (b = 23.32, 95% CI: 27.60, 0.96, p = 0.12), and total cholesterol levels (b = 23.19, 95% CI: 216.43, 10.05, p = 0.636). Low birth weight was also associated with lower odds of young adults being overweight and obese, but neither association was statistically significant. Weight gain in the first 12 months of life was associated with higher adult BMI (b = 0.79, 95% CI: 20.0455, 1.623, p = 0.064) and blood pressure (b = 2.79, 95% CI: 0.22, 5.35, p = 0.034). No associations were found between low birth weight and early life (catch-up) growth. Conclusions: Low birth weight was not associated with poor health outcomes among young adults in Brazil. These results appear inconsistent with the original Barker hypothesis, but will need to be corroborated in larger samples with longer follow-ups to allow a more general evaluation of the validity of the hypothesis in low and middle income countries.

The social gradient in smoking is well known, with higher rates among those in less advantaged socioeconomic position. Some recent research has reported that personality characteristics partly explain this gradient. However, the majority of existing work is limited by cross-sectional designs unsuitable to determine whether differences in conscientiousness are a predictor or a product of social inequalities. Adopting a life course perspective, we investigated in the current paper the influence of conscientiousness in early and mid-life on the social gradient in smoking and the role of potential confounding factors in a large longitudinal cohort study. Using data from the 1958 National Child Development Study, we examined the extent to which two measures of conscientiousness, one assessed with a personality questionnaire at age 50 and one derived from three related items at 16 years in childhood, explained the social gradient of smoking at age 50 by comparing nested logistic regressio...

Background Several mechanisms have been suggested to explain the association between adversities across life and dementia. This study aimed to investigate the association between indicators of socioeconomic disadvantages throughout the life-course and dementia among older adults in Sao Paulo, Brazil and to explore possible causal pathways. Methods We used baseline data from the SPAH study which involved participants aged 65 years and older (n ¼ 2005). The outcome of interest was prevalent dementia. Exposures included in the analyses were socioeconomic position (SEP) indicators in childhood (place of birth and literacy) and adulthood (occupation and income), anthropometric measurements as markers of intrauterine and childhood environment (head circumference and leg length), smoking, diabetes and hypertension. Logistic regression models were used to test the hypothesized pathways and to assess whether there was an association between cumulative adversities across the life course and prevalent dementia. Results Indicators of socioeconomic disadvantage in early life were associated with increased prevalence of dementia. This association was partially mediated through adulthood SEP. Head circumference and leg length were also clearly associated with dementia but there was no evidence that this association was mediated by early life socioeconomic disadvantage. There was an association between cumulative unfavourable conditions across the life course and dementia. Conclusions Early life disadvantages seem to operate through biological mechanisms associated with passive brain reserve and opportunities in life representing active cognitive reserve. Prevention of dementia should start early in life and continue through life span as seen with many other chronic diseases.

To investigate the association between mental disorders and substance misuse at 30 years of age with gender, socioeconomic position at birth, and family income trajectories. The 1982 Pelotas Birth Cohort was used; all 5914 children born alive at hospital were originally enrolled (99.2% of all city births). In 2012, 3701 subjects were located and interviewed (68% retention rate). Mental disorders and substance misuse were assessed, and their prevalence analysed according to gender, socioeconomic status at birth, and four different income trajectories: always poor, never poor, poor at birth/non-poor at age 30, and non-poor at birth/poor at age 30. While women presented higher prevalence of mental disorders, substance misuse was much more frequent among men. Individuals in the lowest income quintile at birth presented 2-5 times more mental disorders and substance misuse than those in the highest quintile. Young adults who were always poor or were not poor at birth but were poor at 30 y...

Background: Adolescent childbirth and elevated parity are relatively common in middle and low-income countries and they may be related to the higher prevalence and earlier onset of physical decline documented in these settings, especially in women. The aim of this paper is to investigate whether reproductive history is associated with physical function in middle-aged women from Northeast Brazil. Methods: The relationship between poor physical performance (grip strength, gait speed and chair stand), early maternal age at first birth (<18 years old), and multiparity (≥3 children) was evaluated in a community sample of 473 women living in Parnamirim (Northeast Brazil). Linear regression models were used to examine the relationship of interest; in addition, mediation analyses were employed to assess indirect effects of obesity and family income. Results: Women who gave birth at less than 18 years of age took approximately 0.50 s longer to complete the chair stand test compared to women who gave birth at 18 years or older. Moreover, women who gave birth to < 3 children completed the chair stand test 0.42 s faster compared to those who had ≥ 3 children. The relation between reproductive history and physical performance was mediated by BMI. Reproductive history was not associated with performance in gait speed. Conclusions: This study provides evidence that adolescent childbirth and multiparity are related to worse physical performance in middle-aged women from a low income setting. Reproductive history may partially account for earlier physical decline and greater disability in women from lower income settings.

Background: Adolescent childbirth and elevated parity are relatively common in middle and low-income countries and they may be related to the higher prevalence and earlier onset of physical decline documented in these settings, especially in women. The aim of this paper is to investigate whether reproductive history is associated with physical function in middle-aged women from Northeast Brazil. Methods: The relationship between poor physical performance (grip strength, gait speed and chair stand), early maternal age at first birth (<18 years old), and multiparity (≥3 children) was evaluated in a community sample of 473 women living in Parnamirim (Northeast Brazil). Linear regression models were used to examine the relationship of interest; in addition, mediation analyses were employed to assess indirect effects of obesity and family income. Results: Women who gave birth at less than 18 years of age took approximately 0.50 s longer to complete the chair stand test compared to women who gave birth at 18 years or older. Moreover, women who gave birth to < 3 children completed the chair stand test 0.42 s faster compared to those who had ≥ 3 children. The relation between reproductive history and physical performance was mediated by BMI. Reproductive history was not associated with performance in gait speed. Conclusions: This study provides evidence that adolescent childbirth and multiparity are related to worse physical performance in middle-aged women from a low income setting. Reproductive history may partially account for earlier physical decline and greater disability in women from lower income settings.

Data from many high- and low- or middle-income countries have linked exposures during key developmental periods (in particular pregnancy and infancy) to later health and disease. Africa faces substantial challenges with persisting infectious disease and now burgeoning non-communicable disease.This paper opens the debate to the value of strengthening the developmental origins of health and disease (DOHaD) research focus in Africa to tackle critical public health challenges across the life-course. We argue that the application of DOHaD science in Africa to advance life-course prevention programmes can aid the achievement of the Sustainable Development Goals, and assist in improving health across generations. To increase DOHaD research and its application in Africa, we need to mobilise multisectoral partners, utilise existing data and expertise on the continent, and foster a new generation of young African scientists engrossed in DOHaD.

Background The fetal origins hypothesis suggests that an adverse prenatal environment, indexed by low birthweight (LBW), may increase the risk of developing later disease. Recently the hypothesis has been extended to psychological outcomes, especially depression. The aim of this analysis was to test, for the first time in a developing country setting, the association between LBW and psychological symptoms, in Soweto, South Africa.

Background: Investigations of the structure of psychological well-being items are useful for advancing knowledge of what dimensions define psychological well-being in practice. Ryff has proposed a multidimensional model of psychological well-being and her questionnaire items are widely used but their latent structure and factorial validity remains contentious. Methods: We applied latent variable models for factor analysis of ordinal/categorical data to a 42item version of Ryff's psychological well-being scales administered to women aged 52 in a UK birth cohort study (n = 1,179). Construct (predictive) validity was examined against a measure of mental health recorded one year later. Results: Inter-factor correlations among four of the first-order psychological well-being constructs were sufficiently high (> 0.80) to warrant a parsimonious representation as a secondorder general well-being dimension. Method factors for questions reflecting positive and negative item content, orthogonal to the construct factors and assumed independent of each other, improved model fit by removing nuisance variance. Predictive validity correlations between psychological well-being and a multidimensional measure of psychological distress were dominated by the contribution of environmental mastery, in keeping with earlier findings from cross-sectional studies that have correlated well-being and severity of depression. Conclusion: Our preferred model included a single second-order factor, loaded by four of the six first-order factors, two method factors, and two more distinct first-order factors. Psychological well-being is negatively associated with dimensions of mental health. Further investigation of precision of measurement across the health continuum is required.

Background: Adolescent childbirth and elevated parity are relatively common in middle and low-income countries and they may be related to the higher prevalence and earlier onset of physical decline documented in these settings, especially in women. The aim of this paper is to investigate whether reproductive history is associated with physical function in middle-aged women from Northeast Brazil. Methods: The relationship between poor physical performance (grip strength, gait speed and chair stand), early maternal age at first birth (<18 years old), and multiparity (≥3 children) was evaluated in a community sample of 473 women living in Parnamirim (Northeast Brazil). Linear regression models were used to examine the relationship of interest; in addition, mediation analyses were employed to assess indirect effects of obesity and family income. Results: Women who gave birth at less than 18 years of age took approximately 0.50 s longer to complete the chair stand test compared to women who gave birth at 18 years or older. Moreover, women who gave birth to < 3 children completed the chair stand test 0.42 s faster compared to those who had ≥ 3 children. The relation between reproductive history and physical performance was mediated by BMI. Reproductive history was not associated with performance in gait speed. Conclusions: This study provides evidence that adolescent childbirth and multiparity are related to worse physical performance in middle-aged women from a low income setting. Reproductive history may partially account for earlier physical decline and greater disability in women from lower income settings.

Background Adolescent childbirth and elevated parity are relatively common in middle and low-income countries and they may be related to the higher prevalence and earlier onset of physical decline documented in these settings, especially in women. The aim of this paper is to investigate whether reproductive history is associated with physical function in middle-aged women from Northeast Brazil. Methods The relationship between poor physical performance (grip strength, gait speed and chair stand), early maternal age at first birth (&lt;18 years old), and multiparity (≥3 children) was evaluated in a community sample of 473 women living in Parnamirim (Northeast Brazil). Linear regression models were used to examine the relationship of interest; in addition, mediation analyses were employed to assess indirect effects of obesity and family income. Results Women who gave birth at less than 18 years of age took approximately 0.50 s longer to complete the chair stand test compared to women ...

Background: Life grid, a visual tool for mapping important life events along the passage of time is not explored in collecting retrospective data on chronic oral diseases among adolescents. Aim: To develop and test the use of life grids for collecting retrospective life-course data on adolescents" chronic oral diseases from a population of adolescents and their parents. It was also aimed to describe the experiences of participants while using life grids. Methods and Material: Life grids along with interview schedules were developed and tested for content validity by Lawshe"s method using a panel of subject matter experts. A convenience sample of 81 adolescent school children aged 11 years and their parents were selected for testing life grids. Life course retrospective data on behavioral indicators for oral health was collected by using life grids among adolescents. The socioeconomic and biological indicators along the life course of adolescents were collected from their parents using life grids. Results: The interview measures showed test-retest reliability of 0.8 and split half reliability for various indicators used in the interview was found to be good. The content validity was quantitatively assessed using Content Validity Ratio (CVR) of Lawshe"s method which resulted in retaining the items for which the experts were in agreement that the item is essential to content validity. Life grids proved to be valuable aids in collecting retrospective data as well as elicit the past events more effectively. It helped interviewer and interviewee to engage in a more anchored, relaxed and constructive process to reflect on life course data. Conclusion: The use of life grids assisted by interview schedules was found to be reliable and proved to be valid measures to collect life course data among adolescents and their parents

Background
Adolescent childbirth and elevated parity are relatively common in middle and low-income countries and they may be related to the higher prevalence and earlier onset of physical decline documented in these settings, especially in women. The aim of this paper is to investigate whether reproductive history is associated with physical function in middle-aged women from Northeast Brazil.

Methods
The relationship between poor physical performance (grip strength, gait speed and chair stand), early maternal age at first birth (<18 years old), and multiparity (≥3 children) was evaluated in a community sample of 473 women living in Parnamirim (Northeast Brazil). Linear regression models were used to examine the relationship of interest; in addition, mediation analyses were employed to assess indirect effects of obesity and family income.

Results
Women who gave birth at less than 18 years of age took approximately 0.50 s longer to complete the chair stand test compared to women who gave birth at 18 years or older. Moreover, women who gave birth to < 3 children completed the chair stand test 0.42 s faster compared to those who had ≥ 3 children. The relation between reproductive history and physical performance was mediated by BMI. Reproductive history was not associated with performance in gait speed.

Conclusions
This study provides evidence that adolescent childbirth and multiparity are related to worse physical performance in middle-aged women from a low income setting. Reproductive history may partially account for earlier physical decline and greater disability in women from lower income settings.

The science of informatics has transformed the healthcare profession by the extraordinary revolution in information technology, and continues to do so. Oral health profession is no exception to this and the discipline of dental informatics is influencing it in clinical care, education, and research. The scope of dental informatics has not yet been extended to the use of artificial intelligence expert systems in diagnosis and treatment plan, effective tutoring systems, and continuing dental education programmes and research. The exchange of information among different healthcare professionals through networked computing is bringing the world together as a true global village. This can help in improved communication among experts, besides forming an interdisciplinary collaboration. Dental teaching institutions need to reshape the dental curriculum encompassing the science of information technology (IT) and informatics to better equip students in their ability to use IT tools in their training as well as future clinical practice and research endeavours. Dental informatics is of enormous benefit to research in dentistry, which only indicates the tremendous changes it can impart to clinical care as well as educational research. Hence, it is inevitable to continue to embrace dental informatics effectively in all spheres of oral health education, research, and clinical care.