This new edition of Ann Bowling's well-known and highly respected text has been thoroughly revised and updated to reflect key methodological developments in health research. It is a comprehensive, easy to read, guide to the range of methods used to study and evaluate health and health services. It describes the concepts and methods used by the main disciplines involved in health research, including: demography, epidemiology, health economics, psychology and sociology.The research methods described cover the assessment of health needs, morbidity and mortality trends and rates, costing health services, sampling for survey research, cross-sectional and longitudinal survey design, experimental methods and techniques of group assignment, questionnaire design, interviewing techniques, coding and analysis of quantitative data, methods and analysis of qualitative observational studies, and types of unstructured interviewing. With new material on topics such as cluster randomization, utility analyses, patients' preferences, and perception of risk, the text is aimed at students and researchers of health and health services. It has also been designed for health professionals and policy makers who have responsibility for applying research findings in practice, and who need to know how to judge the value of that research.

Research Methods in Health. Investigating health and health services

High blood pressure (HBP) is the leading risk factor for years of life lost in Brazil. Factors associated with HBP awareness, treatment and control need to be understood better. Our aim is to estimate prevalence, awareness, and types of anti-hypertensive treatment and to investigate the association of HBP control with social position. Data of 15,103 (54% female) civil servants in six Brazilian state capitals collected at the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010) were used to estimate prevalence and cross-sectional association of HBP control with education, per capita family income and self-reported race, using multiple logistic regression. Blood pressure was measured by the oscillometric method. 35.8% were classified as presenting HBP; 76.8% of these used anti-hypertensive medication. Women were more aware than men (84.8% v. 75.8%) and more often using medication (83.1% v. 70.7%). Adjusted HBP prevalence was, in ascending order, Whites (30.3%), Browns (38.2%) and Blacks (49.3%). The therapeutic schemes most used were angiotensin-converting enzyme inhibitors, in isolation (12.4%) or combined with diuretics (13.3%). Among those in drug treatment, controlled blood pressure was more likely in the (postgraduate) higher education group than among participants with less than secondary school education (PR = 1.21; 95% CI: 1.14–1.28), and among Asian (PR = 1.21; 95% CI: 1.12–1.32) and ‘Whites (PR = 1.19; 95% CI: 1.12–1.26) compared to Blacks. Socioeconomic and racial inequality—as measured by different indicators—are strongly associated with HBP control, beyond the expected influence of health services access.

/pdf/prevalence-awareness-treatment-and-influence-of-387g69mst2.pdf

Prevalence, Awareness, Treatment and Influence of Socioeconomic Variables on Control of High Blood Pressure: Results of the ELSA-Brasil Study.

Objective To evaluate the association of ultra-processed food (UPF) consumption with gains in weight and waist circumference, and incident overweight/obesity, in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Design We applied FFQ at baseline and categorized energy intake by degree of processing using the NOVA classification. Height, weight and waist circumference were measured at baseline and after a mean 3·8-year follow-up. We assessed associations, through Poisson regression with robust variance, of UPF consumption with large weight gain (1·68 kg/year) and large waist gain (2·42 cm/year), both being defined as ≥90th percentile in the cohort, and with incident overweight/obesity. Setting Brazil. Participants Civil servants of Brazilian public academic institutions in six cities (n 11 827), aged 35-74 years at baseline (2008-2010). Results UPF provided a mean 24·6 (sd 9·6) % of ingested energy. After adjustment for smoking, physical activity, adiposity and other factors, fourth (>30·8 %) v. first ( 17·8 % of energy as UPF. Conclusions Greater UPF consumption predicts large gains in overall and central adiposity and may contribute to the inexorable rise in obesity seen worldwide.

/pdf/ultra-processed-foods-incident-overweight-and-obesity-and-4fq5hiot33.pdf

Ultra-processed foods, incident overweight and obesity, and longitudinal changes in weight and waist circumference: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

The article describes assessments and measurements performed in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). Some assessments including anthropometric assessment, casual blood pressure measurement, and ankle-brachial index have an established clinical application while others including pulse wave velocity, heart rate variability, and carotid intima-media thickness have no established application and do not have reference values for healthy Brazilian population but may be important predictors of cardiovascular outcomes. Blood pressure measurement following postural change maneuver was included in the ELSA-Brasil because it has not been much tested in epidemiological studies. Innovative approaches were developed for assessing the ankle-brachial index using an automatic device instead of the mercury column to measure blood pressure and for assessing the anterior-posterior diameter of the right lobe of the liver by ultrasound for quantitative assessment of nonalcoholic fatty liver disease. All ELSA-Brasil subjects were younger (35 years or more) than those included in other cohorts studying subclinical atherosclerosis. The inclusion of younger individuals and a variety of assessments make the ELSA-Brasil a relevant epidemiology study nationwide and worldwide.

https://www.scielo.br/pdf/rsp/v47s2/en_0034-8910-rsp-47-00-2-0054.pdf

Afericoes e exames clinicos realizados nos participantes do ELSA-Brasil

Objective To verify if the intake of ultra-processed foods is associated with higher BMI and waist circumference (WC) among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Design Cross-sectional analysis of the ELSA-Brasil baseline (2008-2010). Dietary information obtained through an FFQ was classified according to characteristics of food processing (NOVA) and used to estimate the percentage energy contribution from ultra-processed foods (i.e. industrial formulations, elaborated from food processing, synthetic constituents and food additives) to individuals' total energy intake. BMI and WC and their respective cut-off points served as response variables. Associations were estimated through linear and multinomial logistic regression models, after adjusting for confounders and total energy intake. Setting Six Brazilian capital cities, 2008-2010. Subjects Active and retired civil servants, aged 35-64 years, from universities and research organizations (n 8977). Results Ultra-processed foods accounted for 22·7 % of total energy intake. After adjustments, individuals in the fourth quartile of percentage energy contribution from ultra-processed foods presented (β; 95 % CI) a higher BMI (0·80; CI 0·53, 1·07 kg/m2) and WC (1·71; 1·02, 2·40 cm), and higher chances (OR; 95 % CI) of being overweight (1·31; 1·13, 1·51), obese (1·41; 1·18, 1·69) and having significantly increased WC (1·41; 1·20, 1·66), compared with those in the first quartile. All associations suggest a dose-response gradient. Conclusions Results indicate the existence of associations between greater energy contribution from ultra-processed foods and higher BMI and WC, which are independent of total energy intake. These findings corroborate public policies designed to reduce the intake of this type of food.

/pdf/consumption-of-ultra-processed-food-and-obesity-cross-3dgc4ngab0.pdf

Consumption of ultra-processed food and obesity: cross sectional results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort (2008-2010).

This article describes the development of the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) questionnaire. We ﬁ rst address the selection of topics whose contents have to cover the knowledge available on the complex causal network of outcomes and allow comparability with similar studies. Then we deal with the “translation and adaptation of measurement instruments” including neighborhood environment rating scales, depression and anxiety disorder rating scale and a food frequency questionnaire and discuss criteria that guided “theme block sequencing”. And ﬁ nally we focus on the practical importance of “pretesting and pilot studies”. The ELSA may provide an original contribution regarding factors that cause or aggravate the outcomes of interest in the Brazilian population, as well as protective factors. DESCRIPTORS: Questionnaires. Data Collection. Socioeconomic Factors. Life Style. Food Habits. Risk Factors. Multicenter Studies as Topic, methods. Cohort Studies.INTRODUCAO

/pdf/questionario-do-elsa-brasil-desafi-os-na-elaboracao-de-4yxszuy63n.pdf

Questionário do ELSA-Brasil: desafi os na elaboração de instrumento multidimensional Questionnaire development in ELSA-Brasil: challenges of a multidimensional instrument

The ELSA-Brasil ( Estudo Longitudinal de Saude do Adulto – Brazilian Longitudinal Study for Adult Health) is a cohort study composed of 15,105 adults followed up in order to assess the development of chronic diseases, especially diabetes and cardiovascular disease. Its size, multicenter nature and the diversity of measurements required effective and efﬁ cient mechanisms of quality assurance and control. The main quality assurance activities (those developed before data collection) were: careful selection of research instruments, centralized training and certi ﬁ cation, pretesting and pilot studies, and preparation of operation manuals for the procedures. Quality control activities (developed during data collection and processing) were performed more intensively at the beginning, when routines had not been established yet. The main quality control activities were: periodic observation of technicians, test-retest studies, data monitoring, network of supervisors, and cross visits. Data that estimate the reliability of the obtained information attest that the quality goals have been achieved.

Estratégias e desenvolvimento de garantia e controle de qualidade no ELSA-Brasil Strategies and development of quality assurance and control in the ELSA-Brasil

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Questionário do ELSA-Brasil: desafi os na elaboração de instrumento multidimensional Questionnaire development in ELSA-Brasil: challenges of a multidimensional instrument

Estratégias e desenvolvimento de garantia e controle de qualidade no ELSA-Brasil Strategies and development of quality assurance and control in the ELSA-Brasil