curso de vida

JOSÉ FERNANDO GÓMEZ MONTES

PROGRAMA DE INVESTIGACIONES EN GERONTOLOGÍA Y GERIATRÍA

UNIVERSIDAD DE CALDAS

MANIZALES

INVESTIGACION EN

EPIDEMIOLOGIA DE CURSO DE

VIDA:

ESTUDIO IMIAS

• Teorías de la distribución de la salud.

• Epidemiología de curso de vida.

• Estudio IMIAS: discapacidad de

movilidad.

• Hipótesis sobre la transición de la

discapacidad.

• Conclusiones

CONTENIDOS:

TEORIAS INTEGRADORAS DE LAS

CAUSAS DE ENFERMEDAD

(TEORIAS DE LA DISTRIBUCION

DE LA ENFERMEDAD)

“¿Por qué algunos individuos tienen la hipertensión?” es diferente a “¿Por qué algunas poblaciones tienen mucha hipertensión, mientras que en otras es rara?”

1. PRODUCCION SOCIAL DE LA ENFERMEDAD / ECONOMIA POLITICA DE LA SALUD. Determinantes sociales de la salud.

2. TEORIA ECOSOCIAL Y PERSPECTIVAS DINAMICAS RELACIONADAS MULTI-NIVEL. Disparidades (desigualdades) de la salud.

3. TEORIA PSICO-SOCIAL. Estresores múltiples. De la “etiología específica” a la “susceptibilidad generalizada”.

Moiso A. Determinantes de salud. Fundamentos de Salud Pública

Early determinants of the ageing trajectory. Best Practice & Research Clinical Endocrinology & Metabolism 26 (2012) 613–626

ES EL ESTUDIO DE LOS EFECTOS A LARGO PLAZO EN LA

SALUD O EL RIESGO DE ENFERMEDAD POR EXPOSICIONES

FISICAS O SOCIALES DURANTE LA GESTACION, LA INFANCIA,

LA ADOLESCENCIA, LA ADULTEZ TEMPRANA Y EN LA VEJEZ.

Su objetivo es dilucidar los procesos biológicos, conductuales y

psicosociales que operan a través del curso de vida individual, o a

través de generaciones, que influencian el desarrollo del riesgo de

enfermar.

EPIDEMIOLOGIA DEL CURSO DE VIDA

Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J. J Epidemiol Community Health 2003 57:778-783

MODELO SOBRE LOS EFECTOS DE LA

NUTRICIÓN EN LA SALUD DE LOS

ANCIANOS.

LOS MODELOS

Acumulación de riesgos (Hipótesis de la acumulación)

Cadena de riesgos

Periodos críticos (critical periods)

Movilidad social (social mobility)

Independiente

Acumulación con

agrupación de riesgos

Efecto aditivo

Efecto disparador

Factores mediadores

Factores modificadores

Acumulación de riesgos

Cadenas de riesgo

MODELO DE PERIODOS

CRÍTICOS

Un periodo crítico en el desarrollo es una ventana de

tiempo durante la que ocurren cambios de forma rápida en

la organización de los sistemas biológicos

Durante estos periodos, la organización puede ser

modificada de forma favorable o desfavorable.

« Biological programming », « Latency model »

El modelo postula que los cambios durante los periodos

críticos pueden causar enfermedades más tarde en la vida.

Variación « critical period with later modifiers effects »=

interacciones entre los factores iniciales y posteriores = el

efecto de una exposición al inicio de la vida varía según los

niveles de exposición posteriores

MODELO DE PERIODOS

CRÍTICOS

A

TiempoPeriodo

crítico

B

E

N

F

E

R

M

E

D

A

DInducción

Inicio de la

enfermedad

detección

Latencia

Factor modificador

Exposición

Periodo crítico= el sistema es plástico y sensible al medio ambiente

MODELO DE PERIODO CRITICO

(MODELO LATENTE)

EXPOSICION A INFECCIONES

Hepatitis B

Tuberculosis

Poliomielitis

H. Pilory

Fiebre reumática

Enfermedad de Chagas

Malaria

EXPOSICIONES MEDIOAMBIENTALES

Plomo

Deficiencia de yodo

Polución dentro de la casa

Malnutrición proteico -energética

Trauma al nacer

MOVILIDAD

SOCIAL

Las exposiciones en la infancia pueden

ser revertidas en la edad adulta

• Exposiciones en útero/infancia y enfermedad cardiovascular y

DM.

• Pobre nutrición y mortalidad, dificultades de cognición y DM.

• Enfermedades específicas (Fiebre Reumática/malaria) y

enfermedad cardiovascular y mortalidad.

• Pobre salud y discapacidad/limitación funcional y

enfermedades crónicas.

• SES pobre y mortalidad, discapacidad/limitación funcional y

cognición.

• Sobrevivencia de los padres y discapacidad/limitación

funcional y cognición.

CONDICIONES TEMPRANAS EN LA INFANCIA Y SALUD EN ANCIANOS: PAISES DE BAJO Y MEDIO INGRESO

CONCLUSIONES

Journal of Developmental Origins of Health and Disease (2013), 4(1), 10–29.

DIFERENCIAS DE GENERO EN MOVILIDAD: QUÉ SE PUEDE APRENDER PARA MEJORAR LA MOVILIDAD

AL ENVEJECER?

Natal, Brazil Kingston, Ontario

Manizales, Colombia St Hyacinthe , Quebec

http://upload.wikimedia.org/wikipedia/commons/c/cc/Sth-tempete-centreville.jpg

FOLLOW-UP (AGE 65-74)

Baseline

3rd year

5th

year

Mobility; life

course,

Gender,

Neighborhood and

social networks,

biological

pathways,

Chronic conditions

Mobility;

Violence,

chronic

conditions

Mobility;

Violence,

chronic

conditions

PERDIDA DE MOVILIDAD

Source: IMIAS, 2012

PERDIDA DE MOVILIDAD: ACTIVIDADES DE

VIDA DIARIA

23.44 22.84

38.24

14.2

24.39

38.1

32.5

44.86

22.16

25.48

0

5

10

15

20

25

30

35

40

45

50

Natal P=0.002 (M=192/W=210)

Manizales P=0.053 (M=162/W=160)

Tirana P=0.387 (M=69 /W=122)

St Hyacinthe P=0.054 (M=162/W=194)

Kingston P=0.854 (M=82/W=157)

MEN WOMEN

Vafaei A, Zunzunegui MV, Guralnik J, Curcio CL, Gomez F, Guerra R, Alvarado BE. Evaluation of the late life disability instrument

(LLDI) in low income older populations. (Manuscript in revision)

PERDIDA DE MOVILIDAD

(OBJETIVA)

Source: IMIAS, 2012

15.1

6.17

11.76

4.94

7.32

24.29

15.63

26.17

8.257.64

0

5

10

15

20

25

30

Natal P=0.021 (M=192/W=210)Manizales P=0.006 (M=162/W=160)Tirana P=0.022 (M=68 /W=107)St Hyacinthe P=0.231 (M=131/W=147)Kingston P=0.928 (M=82/W=157)

MEN WOMEN

Figure 1. Low physical performance (SPPB < 8)

VÍAS EXPLICATIVAS DE

LA DISCAPACIDAD DE LA

MOVILIDAD AL

ENVEJECER

1. Vías biológicas.

2. Perspectiva de curso de vida.

3. Medioambiental: perspectiva ecosocial.

4. Clínica: condiciones crónicas específicas.

• 77 al menos 1 enfermedad

• 44 al menos 2 enfermedades

• 19 al menos 1 discapacidad

• 17 al menos 1 enfermedad y 1 discapacidad

• 12 al menos 1 discapacidad y 2 enfermedades

• 21 ni discapacidad ni enfermedad

LATINOAMERICA DE CADA 100 ANCIANOS:

Rose AMC. et al. Public Health 2008; 8:124

PREVALENCIA DE LIMITACIONES DE

MOVILIDAD, AJUSTADA POR EDAD

0

5

10

15

20

25

30

35

40

45

50

Buenos Aires Bridgetown Sao Paulo Santiago Havana Mexico Montevideo

Men

Women

OR=2.34

Heterogeneity: p= 0.04

Lifting and carrying 10 pounds, walking several

blocks, climbing a flight of stairs, kneeling /

stooping / crouching, and getting up from a chair

OR 95% CI

Pobreza en la infancia 1.28 1.12- 1.46

Salud pobre 1.17 1.04- 1.31

Hambre antes 15 años 1.47 1.23 – 1.76

Falta de escolaridad 1.39 1.17- 1.64

Ingreso insuficiente 1.54 1.35- 1.74

Comorbilidad 3.16 2.80- 3.52

Deterioro cognoscitivo 3.90 2.26-6.74

CONDICIONES SOCIALES Y LIMITACION

DE MOVILIDAD EN ANCIANAS EN LAC

Alvarado B, Guerra R, Zunzunegui MV. J of Aging and Health 2007

THE INTERNATIONAL MOBILITY IN AGING STUDY (IMIAS) IS A LONGITUDINAL STUDY OF AGING

CONDUCTED IN CANADA (KINGSTON, ST HYACINTHE), ALBANIA (TIRANA), BRAZIL (NATAL) AND

COLOMBIA (MANIZALES) TO EXPLAIN THE SEX GAP IN MOBILITY USING A LIFE-COURSE AND GENDER

PERSPECTIVE. IT IS FINANCED BY THE CANADIAN INSTITUTES FOR HEALTH RESEARCH.

THE HYPOTHESIS IS THAT THE GAP IN MOBILITY DISABILITY BETWEEN MEN AND WOMEN DIMINISHES

AS GENDER EQUALITY INCREASES IN THE MAINSTREAM SOCIETIES OF DIFFERENT COUNTRIES.

SYMPOSIUM

THE SEX GAP OF MOBILITY DISABILITY:

THE EMBODIMENT OF GENDER

CHAIR: JACK GURALNIK

CO-CHAIR: MARIA VICTORIA ZUNZUNEGUI

DISCUSSANT: K MARKIDES

FACTORES TEMPRANOS

Pobre nutrición

Sobrevivencia de los padres

Pobre salud

SES pobre

FACTORES EN LA VIDA MEDIA

SES adulto

Embarazos a temprana edad

Restricción espacio de vida

Depresión

Ejercicio físico limitado

Dietas no saludables

FACTORES AL ENVEJECER

Peso / obesidad


Depresión CONDICIONES DE SALUD

OA rodilla problemas articulares

Mayor prevalencia sx metabólico

Diabetes M. Enf. cardiovascular

Medio ambiente

Espacio de vidaLimitación funcional

Discapacidad

CHILDHOOD SOCIAL AND ECONOMIC ADVERSITIES

AND PHYSICAL PERFORMANCE IN PEOPLE AGED 65-74

LIVING IN CANADA, BRAZIL, COLOMBIA AND ALBANIA.

Ricardo Guerra, Dimitri Taurino Guedes, Fernando Gomez, Mai Thanh Tu, Georges Koné Karna, Alban Ylli, Jack Guralnik

In IMIAS, we examined associations of physical performance Short

Physical Performance Battery, SPPB) with social (parental death,

drug/alcohol abuse, witness violence and experience physical abuse) and

economic (low socio-economic status, hunger, parental unemployment and

father’s manual occupation) adversities during the first 15 years of life.

Cumulative index of social and economic adversity varied from 0 to 4

according to the number of reported adverse events. Poor function

(SPPB<8) was present in 7.8% of the Kingston sample (Ontario), 6.7% in

St Hyacinthe (Quebec), 20.8% in Tirana (Albania), 18.4% in Manizales

(Colombia) and 19.9% in Natal (Brazil). Logistic regression analyses

revealed poor function in old age was associated with high exposure to

childhood social adversities (OR=3.49, CI: 2.0;6.0) and high exposure to

economic adversity (OR=1.80, CI: 1.0;3.2), adjusting for research site, age

and sex.

FACTORES TEMPRANOS

Pobre nutrición


Pobre salud

SES pobre


SES adulto



Depresión




Peso / obesidad






Medio ambiente


Discapacidad

EARLY AGE AT FIRST BIRTH IS ASSOCIATED

WITH LOW PHYSICAL PERFORMANCE IN OLD

AGE.

Catherine Pirkle, Beatriz Alvarado, Ricardo Guerra, Carmen-Lucia Curcio, Alban Ylli, Jack Guralnik.

Early age at first birth (EAFB) is a risk factor for obstetrical complication, because physiological development is often incomplete, and it may have long-term implications for physical performance and mobility.

We examine the relationship between early age at first birth, defined as ≤18 years of age, poor physical performance (Short Physical Performance Battery≤8) and self-reported mobility disability in community representative samples of women between 65 and 74 years of age from Canada, Albania, Columbia, and Brazil (N=919). EAFB was significantly associated with poor physical performance and mobility disability. Adjusting for the study site, age, education and lifetime births, women who gave birth at a young age had 1.78(95% CI 1.19-2.65) the odds of poor SPPB and 2.31 (95%CI 1.52-3.53) the odds of mobility disability. These relationships were stronger in Canada and weaker in Albania, Colombia and Brazil, which may be attributable to decreased survival in women who would have gone on to have mobility problems had they survived.

FACTORES TEMPRANOS

Pobre nutrición


Pobre salud

SES pobre


SES adulto



Depresión




Peso / obesidad






Medio ambiente


Discapacidad

BEATRIZ ALVARADO, CARMEN-LUCIA CURCIO, RICARDO GUERRA, ALBAN YLLI, ELLEN FREEMAN, JACK

GURALNIK.

IN IMIAS, WE EXAMINED THE ASSOCIATIONS OF LSA SCORE WITH INCOME AND SOCIAL TIES AND

ACTIVITIES ACROSS RESEARCH SITES BY FITTING SEX SPECIFIC REGRESSIONS CONTROLLING FOR

AGE, SELF-RATED HEALTH, DEPRESSION SCORE AND PHYSICAL PERFORMANCE.

RESULTS: BOTH IN WOMEN AND MEN, A POSITIVE GRADIENT IN LSA ACCORDING TO INCOME WAS

OBSERVED; BEING MARRIED WAS NOT ASSOCIATED WITH LSA. AMONG WOMEN, HAVING FRIENDS

AND CHILDREN AND BEING INVOLVED IN SOCIAL ACTIVITIES WERE SIGNIFICANTLY ASSOCIATED WITH

HIGHER LSA. AMONG MEN, NO SOCIAL TIES OR ACTIVITIES WERE ASSOCIATED WITH LSA. SITE-SPECIFIC

ANALYSES SHOWED DIFFERENCES IN THE NATURE OF SOCIAL TIES RELEVANT FOR LSA: STRONGEST

ASSOCIATIONS WERE FOR FRIENDS IN TIRANA, BROTHERS AND SISTERS IN MANIZALES, SOCIAL

ACTIVITIES IN NATAL AND CHILDREN IN ST HYACINTHE. SOCIAL TIES WERE NOT ASSOCIATED WITH LSA

IN KINGSTON. WHILE POVERTY IMPACTS LIFE SPACE IN ALL SITES, SOCIAL RELATIONSHIPS MAY

INCREASE LIFE SPACE ONLY IN WOMEN AND MORE OUTSIDE CANADA THAN IN CANADA.

SOCIAL TIES, SOCIAL ACTIVITIES AND INCOME INFLUENCE LIFE SPACE ASSESSMENTS (LSA) IN OLD AGE:

FACTORES TEMPRANOS

Pobre nutrición


Pobre salud

SES pobre


SES adulto



Depresión




Peso / obesidad






Medio ambiente


Discapacidad

ALBAN YLLI, NANDINI DESHPANDE, SUSAN PHILLIPS, FERNANDO GOMEZ, RICARDO GUERRA, JACK GURALNIK.

IN IMIAS, WE EXAMINED WHETHER THE ASSOCIATION BETWEEN MOBILITY AND DEPRESSION REMAINED BEYOND POOR PHYSICAL PERFORMANCE.

METHOD: DIFFICULTY WALKING 400 METERS OR CLIMBING STAIRS WAS USED FOR MOBILITY DISABILITY(MD); CES-D FOR DEPRESSION, THE SHORT PHYSICAL PERFORMANCE BATTERY (SPPB) FOR PHYSICAL PERFORMANCE.

RESULTS: TWENTY SEVEN PERCENT HAD CESD SCORES OF 16 OR OVER, RANGING FROM 39% INTIRANA TO 10% IN KINGSTON; 38.3% HAD MD, RANGING FROM 55.3% IN TIRANA TO 20.2% IN KINGSTON. ADJUSTING FOR SPPB, AGE, EDUCATION, INCOME AND STUDY SITE, MD WAS HIGHER AMONG PEOPLE WITH DEPRESSION (58.6% VS. 30.8%, P<0.001); THIS ASSOCIATION WAS STRONG (OR 2.2; 1.7;2.9) AND SIMILAR FOR MEN (OR=1.9; 1.3;2.8) AND WOMEN (OR=2.3; 1.7;3.1). SITE-SPECIFIC MOBILITY DISABILITY OR FOR DEPRESSION WERE 3.8 (1.7;8.5) IN KINGSTON;2.8 (1.5;5.3) IN NATAL; 2.3 (1.4;3.7)IN TIRANA; 2.3(1.3;4.1) IN MANIZALES AND 1.4 (0.8;2.5) IN ST HYACINTHE.

DISCUSSION: DEPRESSED PEOPLE ARE LIKELY TO HAVE MOBILITY DISABILITY REGARDLESS OF THEIR CONTEXT, SEX AND PHYSICAL PERFORMANCE.

SELF REPORTED MOBILITY AND DEPRESSION IN OLDER MEN AND WOMEN OF FIVE COUNTRIES: THE IMIAS STUDY

FACTORES TEMPRANOS

Pobre nutrición


Pobre salud

SES pobre


SES adulto



Depresión




Peso / obesidad






Medio ambiente


Discapacidad

OBJECTIVE: TO SHOW THAT THAT AN EXCESS IN PREVALENCE OF METABOLIC SYNDROME IS OBSERVED IN WOMEN

FROM ALBANIA, BRAZIL AND COLOMBIA COMPARED WITH CANADIAN WOMEN WHILE NO VARIATIONS IN THIS

PREVALENCE ARE OBSERVED IN MEN FROM THOSE COUNTRIES. WE INVESTIGATED THE PREVALENCE OF METABOLIC

SYNDROME (METS) IN DIFFERENT SOCIETIES (CANADA, BRAZIL, COLOMBIA AND ALBANIA) AND ACROSS

GENDERS, AMONG REPRESENTATIVE COMMUNITY SAMPLES OF 1728 SUBJECTS, 65 -74 YEARS-OLD, USING DATA FROM

THE INTERNATIONAL MOBILITY IN AGING STUDY (IMIAS).

METHODS: METS WAS DEFINED BY THE NCEP-ATPIII CRITERIA, WITH THE PRESENCE OF AT LEAST THREE OF THESE

CONDITIONS: ABDOMINAL OBESITY, HYPERTENSION, HIGH TRIGLYCERIDES, HYPERGLYCAEMIA AND HIGH LDL.

PREVALENCE OF METS IN MEN AND WOMEN AND SEX ODDS RATIO FOR METS WERE ESTIMATED AT EACH SITE.

RESULTS: METS PREVALENCE VARIED IN WOMEN ACROSS SOCIETIES BUT NOT IN MEN: FROM 23.7% IN

KINGSTON, ONTARIO, TO 63.1% IN TIRANA, ALBANIA AMONG WOMEN AND FROM 22.1% IN SAINT

HYACINTHE, QUEBEC TO 33.5% IN TIRANA AMONG MEN. TAKING KINGSTON MEN AS REFERENCE, NO SIGNIFICANT

DIFFERENCES IN THE ODDS OF METS WERE OBSERVED AMONG MEN OF DIFFERENT SITES. TAKING KINGSTON WOMEN

AS REFERENCE, THE METS ODDS RATIO FOR WOMEN AT TIRANA WAS 5.62 (95%CI 3.51; 9.01); THE CORRESPONDING

OR AT NATAL WAS 3.59 (95% CI 1.97;6.55), AT MANIZALES 1.51 (0.85;2.68) AND AT SAINT HYACINTHE 1.21 (95%CI

0.74;1.98).

IN CANADA NO GENDER DIFFERENCE IN PREVALENCE OF METS WAS OBSERVED.

DISCUSSION: THESE RESULTS PROVIDE EVIDENCE FOR WIDE VARIATIONS OF THE PREVALENCE OF

METS AMONG WOMEN ACROSS SOCIETIES WHILE VARIATIONS IN MEN ARE SMALL.

EXCESS IN PREVALENCE OF METABOLIC SYNDROME IN WOMEN FROM MIDDLE INCOME COUNTRIES

ELLEN E. FREEMAN, NANDINI DESHPANDE, CARMEN-LUCIA CURCIO, HANEN

HARRABI, RICARDO GUERRA, JACK GURALNIK.

PREVIOUS RESEARCH DONE IN THE UNITED STATES HAS FOUND A RELATIONSHIP

BETWEEN WORSE VISION AND MORE RESTRICTED LIFE SPACE.

WE DETERMINED WHETHER THE RELATIONSHIP BETWEEN VISION AND LIFE SPACE

VARIED BY SEX AND ACROSS FIVE DIVERSE GLOBAL SITES.

HABITUAL VISUAL ACUITY WAS MEASURED BINOCULARLY USING THE TUMBLING E

CHART AT 2 METERS. MOBILITY WAS MEASURED USING THE COMPOSITE SCORE OF

THE LIFE SPACE ASSESSMENT WHICH RANGED FROM 0-120. MULTIPLE LINEAR

REGRESSION WAS USED TO ADJUST FOR AGE, EDUCATION, GENERAL HEALTH

STATUS, NUMBER OF COMORBIDITIES, AND INCOME WHILE STRATIFYING BYSEX AND

SITE. IN POOLED ANALYSES, WORSE VISUAL ACUITY WAS ASSOCIATED WITH MORE

RESTRICTED LIFE SPACE (P<0.001). STRATIFYING BY SEX, VISION WAS ONLY

ASSOCIATED WITH LIFE SPACE IN WOMEN (P<0.001). SITE DIFFERENCES WERE FOUND.

THE LOSS OF VISION APPEARS TO BE MORE DETRIMENTAL TO MOBILITY IN WOMEN

AND IN SOME ENVIRONMENTS THAN IN OTHERS. REASONS FOR THIS SHOULD BE

FURTHER EXPLORED.

THE RELATIONSHIP BETWEEN VISION AND LIFE

SPACE BY SEX AND GLOBAL SITE

FACTORES TEMPRANOS

Pobre nutrición


Pobre salud

SES pobre


SES adulto



Depresión




Peso / obesidad






Medio ambiente


Discapacidad

MARIA-VICTORIA ZUNZUNEGUI, SUSAN PHILLIPS, GEORGES KARNA, MAI THANHTU, GENTIANA QIRJAKO, RICARDO

GUERRA, FERNANDO GOMEZ.

WEEXAMINE SEX GAPS IN MOBILITY, ACTIVITIES OF DAILY LIVING DISABILITY AND PHYSICAL PERFORMANCE (SHORT

PHYSICAL PERFORMANCE BATTERY, SPPB) ACROSS DIVERSE POPULATIONS AND FORMULATE HYPOTHESES TO EXPLAIN

DIFFERENCES BETWEEN MEN AND WOMEN RELATING TO THE EMBODIMENT OF GENDER-RELATED LIFE COURSE

CONDITIONS.

AGE-ADJUSTED PREVALENCE RATES OF LOW SPPB, SELF-REPORTED MOBILITY DISABILITY AND ADL DISABILITY AT EACH

SITE WERE SIGNIFICANTLY HIGHER IN WOMEN THAN IN MEN EXCEPT FOR KINGSTON (ONTARIO). FEW DIFFERENCES IN

PHYSICAL FUNCTION OR MOBILITY WERE OBSERVED BETWEEN MEN AT DIFFERENT RESEARCH SITES. SITE DIFFERENCES

BETWEEN MEN AND WOMEN ARE THEREFORE DRIVEN BY DIFFERENCES BETWEEN WOMEN ACROSS SITES. AMONG

WOMEN, AND TAKING KINGSTON AS THE REFERENCE SITE, AGE-ADJUSTED ODDS RATIOS FOR POOR SPPB, MOBILITY

AND ADL DISABILITY WERE HIGHER FOR ST HYACINTHE, MANIZALES, NATAL AND TIRANA.

THE MOBILITY-SEX GAP IS SMALL OR DISAPPEARS IN THE MORE EGALITARIAN SITES (ONTARIO) WHILE IT REMAINS

LARGE IN SEX-SEGREGATED SOCIETIES (BRAZIL, COLOMBIA, ALBANIA).

THE MOBILITY GAP BETWEEN OLDER MEN AND WOMEN FROM DIVERSE POPULATIONS: THE EMBODIMENT OF GENDER

CONCLUSIONES

1. La perspectiva de curso de vida se enfoca en comprender como experiencias tempranas en la vida pueden formar la salud a travès de la via entera y potencialmente a través de generaciones.

2. Se debe dirigir la mirada hacia el papel del contexto, incluyento el contexto social y fìsico junto con factores biològicos. Todos ellos a travès del tiempo.

3. La perspectiva de curso de vida permitiría entender los determinantes y las disparidades en salud.

curso de vida

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