The association between the neighbourhood social environment and obesity in Brazil: a cross-sectional analysis of the ELSA-Brasil study.

OBJECTIVE: To investigate the association between the neighbourhood social environment, including social cohesion, perceived neighbourhood safety, perceived neighbourhood violence, and obesity in Brazil. DESIGN: Cross-sectional study. SETTING: 6 state capitals in Brazil (Salvador, Vitoria, Belo Horizonte, Porto Alegre, Sao Paulo and Rio de Janeiro) PARTICIPANTS: Current or former employees of five federal universities and one research centre in each of the six Brazilian state capitals who were participants of the baseline wave (2008-2010) of the Brazilian Longitudinal Study of Adult Health (n=11 456; 56% women; 56% White, 28% Brown, and 16% Black). PRIMARY OUTCOME MEASURE: Obesity, based on measured weight and height, and defined as having a body mass index ≥30 kg/m2. RESULTS: No associations were found between the neighbourhood social environment and obesity among men. In multilevel logistic regression models adjusted for age, education, skin colour, state of residence, and individual-level social cohesion and perceived violence scores, respectively, women living in the least socially cohesive neighbourhoods and in those perceived as most violent had higher odds of obesity compared with their counterparts (OR=1.25, 95% CI=1.02-1.53; OR=1.28, 95% CI=1.04-1.56, respectively). When stratified by neighbourhood socioeconomic status (SES)-defined based on number of people per household, proportion of children 0-4 years, median income and per cent of white residents at the neighbourhood level-results for social cohesion and for violence remained only for women residing in high SES and low SES neighbourhoods, respectively. CONCLUSIONS: In this civil-servant sample in six large cities in Brazil, the neighbourhood social environment was associated with obesity among women, but not men. Neighbourhood-level interventions to increase social cohesion and reduce violence may help in the prevention of obesity among women in Brazil.

Characteristics of neighborhood environment (social cohesion and safety) and common mental disorders in ELSA-Brasil study: a multilevel analysis.

The purpose of this study was to determine if self-reported characteristics of social cohesion and local neighborhood safety positively affect the mental health of their residents, regardless of individual characteristics. A sample of participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline was used. The Clinical Interview Schedule-Revised (CIS-R) instrument was used for tracking common mental disorders (CMD). Social cohesion and safety were measured by validated scales of neighborhood environment self-reported characteristics. The multilevel logistic regression model was used to estimate the effect in neighborhoods (level 2) and individuals (level 1), as well as the odds ratios for each neighborhood explanatory variable and social characteristics in the CMD. The results showed that part of the variance (2.3%), in the common mental disorders prevalence is attributed to local neighborhoods. The characteristics of social cohesion and safety remained significant, even after the adjustment of individual explanatory variables. This study confirmed the hypothesis that individuals living in neighborhoods where they perceive low social cohesion and safety present a higher chance of developing CMD.

Characteristics of neighborhood environment (social cohesion and safety) and common mental disorders in ELSA-Brasil study: a multilevel analysis / Características do ambiente do bairro (coesão social e segurança) e transtornos mentais comuns no estudo ELSA-Brasil: uma análise multinível / Características del ambiente en barrios (cohesión social y seguridad) y trastornos mentales frecuentes en el estudio ELSA-Brasil: un análisis multinivel

The purpose of this study was to determine if self-reported characteristics of social cohesion and local neighborhood safety positively affect the mental health of their residents, regardless of individual characteristics. A sample of participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline was used. The Clinical Interview Schedule-Revised (CIS-R) instrument was used for tracking common mental disorders (CMD). Social cohesion and safety were measured by validated scales of neighborhood environment self-reported characteristics. The multilevel logistic regression model was used to estimate the effect in neighborhoods (level 2) and individuals (level 1), as well as the odds ratios for each neighborhood explanatory variable and social characteristics in the CMD. The results showed that part of the variance (2.3%), in the common mental disorders prevalence is attributed to local neighborhoods. The characteristics of social cohesion and safety remained significant, even after the adjustment of individual explanatory variables. This study confirmed the hypothesis that individuals living in neighborhoods where they perceive low social cohesion and safety present a higher chance of developing CMD.

O objetivo do estudo foi determinar se características auto-referidas de coesão social e segurança local dos bairros afetam positivamente a saúde mental de seus residentes, independentemente de características individuais. Uma amostra de participantes da linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) foi usada. O instrumento Clinical Interview Schedule-Revised (CIS-R) foi usado para identificar transtornos mentais comuns (TMC). A coesão social e segurança foram medidos por meio de escalas validadas de características auto-relatadas do ambiente do bairro. Um modelo de regressão logística multinível foi usado para estimar os efeitos nos bairros (nível 2) e nos indivíduos (nível 1), bem como os odds ratios para cara variável explicativa de bairro e características sociais nos TMC. Os resultados demonstram que parte da variância (2,3%) da prevalência de TCM é atribuível aos bairros. As características de coesão social e segurança permaneceram significativas mesmo depois do ajuste de características explicativas individuais. Este estudo confirma a hipótese de que indivíduos que residem em bairros onde percebem baixa coesão social e segurança têm maior chance de desenvolver TCM.

El objetivo de este estudio fue determinar si las características autoinformadas de cohesión social y seguridad local en barrios afectan positivamente la salud mental de sus residentes, independientemente de sus características individuales. Se utilizó como punto de partida una muestra de participantes del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil). Además, se utilizó la herramienta Clinical Interview Schedule-Revised (CIS-R) para realizar un seguimiento de los trastornos mentales más comunes (TMC). La cohesión social y seguridad se midieron mediante escalas validadas de características autoinformadas del vecindario. El modelo de regresión logística multinivel se usó para estimar el efecto en los barrios (nivel 2) e individuos (nivel 1), así como las odds ratios para cada variable explicatoria de barrio y características sociales en los TMC. Los resultados mostraron que parte de la varianza (2,3%) en la prevalencia de TMC es atribuida a los barrios. Las características de cohesión social y seguridad fueron significativas, incluso después del ajuste de las variables individuales explicatorias. Este estudio confirmó la hipótesis de que los individuos que viven en barrios, donde percibían una baja cohesión social y seguridad, presentan una probabilidad más alta de desarrollar TMC.

Focusing neighborhood context and self-rated health in the Pró-Saúde Study.

The influence of neighborhood characteristics on self-rated health has been little studied. A multilevel approach using hierarchical models was applied to analyze the relationship between the socioeconomic characteristics in 621 neighborhoods (level 2) in the city of Rio de Janeiro, Brazil, and the self-rated health of 3,054 university employees (level 1) from the baseline of the Pró-Saúde Study. Neighborhoods were created using the SKATER algorithm (Spatial 'K'luster Analysis by Tree Edge Removal) to cluster census tracts according to four indicators and a minimum population of 5,000 people. After adjustment for individual factors (per capita income, schooling, age, sex, ethnicity, health-related behavior and chronic diseases), low level of neighborhood income and higher numbers of members per household were significantly associated with poor self-rated health. Participants living in medium income-level neighborhoods were 34% more likely to self-rate their health as being poor. Those living in areas with a higher density of members per household were 50% more likely to present poor self-rated health. Neighborhood context influences self-rated health, beyond the effect of individual factors. Worsening neighborhood socioeconomic conditions affect health adversely, which in turn increasing the chance of poor self-rated health.

Focusing neighborhood context and self-rated health in the Pró-Saúde Study / O foco no contexto da vizinhança na autoavaliação da saúde no Estudo Pró-Saúde / Analizando el contexto del vecindario y autoevaluación de salud en el Estudio Pró-Saúde

The influence of neighborhood characteristics on self-rated health has been little studied. A multilevel approach using hierarchical models was applied to analyze the relationship between the socioeconomic characteristics in 621 neighborhoods (level 2) in the city of Rio de Janeiro, Brazil, and the self-rated health of 3,054 university employees (level 1) from the baseline of the Pró-Saúde Study. Neighborhoods were created using the SKATER algorithm (Spatial 'K'luster Analysis by Tree Edge Removal) to cluster census tracts according to four indicators and a minimum population of 5,000 people. After adjustment for individual factors (per capita income, schooling, age, sex, ethnicity, health-related behavior and chronic diseases), low level of neighborhood income and higher numbers of members per household were significantly associated with poor self-rated health. Participants living in medium income-level neighborhoods were 34% more likely to self-rate their health as being poor. Those living in areas with a higher density of members per household were 50% more likely to present poor self-rated health. Neighborhood context influences self-rated health, beyond the effect of individual factors. Worsening neighborhood socioeconomic conditions affect health adversely, which in turn increasing the chance of poor self-rated health.

Existem relativamente poucos estudos sobre a influência das características de vizinhança sobre a auto-avaliação da saúde. Foi aplicada uma abordagem multinível com modelos hierárquicos para analisar a relação entre as características socioeconômicas de 621 vizinhanças (nível 2) da cidade do Rio de Janeiro, Brasil, e a auto-avaliação da saúde de 3.054 servidores universitários (nível 1) da linha de base do Estudo Pró-Saúde. As vizinhanças foram criadas pela aplicação do algoritmo SKATER (Spatial 'K'luster Analysis by Tree Edge Removal) aos setores censitários, de acordo com quatro indicadores e uma população mínima de 5 mil habitantes. Depois de ajustar para fatores individuais (renda per capita, escolaridade, idade, sexo, raça/cor, comportamentos relacionados à saúde e doenças crônicas), houve uma associação significativa entre renda baixa e número maior de pessoas por domicílio na vizinhança e autoavaliação da saúde "ruim". Os residentes de vizinhanças de renda média apresentaram probabilidade 34% maior de avaliar a própria saúde como "ruim". Aqueles que viviam em vizinhanças com maior número médio de pessoas por domicílio mostraram uma probabilidade 50% maior de autoavaliação da saúde "ruim". Para além de fatores individuais, o contexto de vizinhança influencia a autoavaliação da saúde. Piores condições socioeconômicas da vizinhança afetam negativamente a saúde, que por sua vez aumenta as chances de autoavaliação da saúde "ruim".

La influencia de las características del vecindario en la salud autoevaluada se ha estudiado escasamente. Se aplicó un análisis multinivel usando modelos jerárquicos para analizar la relación entre las características socioeconómicas en 621 vecindarios (nivel 2), dentro de la ciudad de Río de Janeiro, Brasil, y la salud autoevaluada de 3.054 empleados universitarios (nivel 1), procedentes de la base de referencia del Estudio Pró-Saúde. Se crearon vecindarios con el uso del algoritmo SKATER (Spatial 'K'luster Analysis by Tree Edge Removal), con el fin de agrupar secciones del censo, de acuerdo con cuatro indicadores y una población mínima de 5.000 personas. Tras el ajuste por factores individuales (ingresos per cápita, escolarización, edad, sexo, etnia, comportamiento informado de salud y enfermedades crónicas), el bajo nivel de ingresos en el vecindario y el alto número de miembros por hogar estuvieron significativamente asociados a un escasa salud autoevaluada. Los participantes que vivían en vecindarios con un nivel de ingresos medios tuvieron una probabilidad un 34% mayor de autoevaluar su salud más bien como mala. Quienes estaban viviendo en vecindarios con una densidad más alta de miembros por vivienda tuvieron una probabilidad de un 50% mayor de presentar una salud autoevaluada mala. El contexto del vecindario influencia la salud autoevaluada, además del efecto de los factores individuales. Un empeoramiento de las condiciones socioeconómicas en el vecindario afecta adversamente a la salud, que a su vez aumenta la oportunidad de una salud autoevaluada como mala.

Anti-Inflammatory Activity of Babassu Oil and Development of a Microemulsion System for Topical Delivery.

Babassu oil extraction is the main income source in nut breakers communities in northeast of Brazil. Among these communities, babassu oil is used for cooking but also medically to treat skin wounds and inflammation, and vulvovaginitis. This study aimed to evaluate the anti-inflammatory activity of babassu oil and develop a microemulsion system with babassu oil for topical delivery. Topical anti-inflammatory activity was evaluated in mice ear edema using PMA, arachidonic acid, ethyl phenylpropiolate, phenol, and capsaicin as phlogistic agents. A microemulsion system was successfully developed using a Span® 80/Kolliphor® EL ratio of 6 : 4 as the surfactant system (S), propylene glycol and water (3 : 1) as the aqueous phase (A), and babassu oil as the oil phase (O), and analyzed through conductivity, SAXS, DSC, TEM, and rheological assays. Babassu oil and lauric acid showed anti-inflammatory activity in mice ear edema, through inhibition of eicosanoid pathway and bioactive amines. The developed formulation (39% A, 12.2% O, and 48.8% S) was classified as a bicontinuous to o/w transition microemulsion that showed a Newtonian profile. The topical anti-inflammatory activity of microemulsified babassu oil was markedly increased. A new delivery system of babassu microemulsion droplet clusters was designed to enhance the therapeutic efficacy of vegetable oil.

Association between perceived neighbourhood characteristics, physical activity and diet quality: results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: The study explores associations between perceived neighbourhood characteristics, physical activity and diet quality, which in Latin America and Brazil have been scarcely studied and with inconsistent results. METHODS: We conducted a cross-sectional analysis of 14,749 individuals who participated in the Brazilian Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto, ELSA-Brasil) baseline. The study included current and retired civil servants, aged between 35 and 74 years, from universities and research institutes in six Brazilian states. The International Physical Activity Questionnaire (IPAQ) long form was used to characterize physical activity during leisure time and commuting; additional questions assessed how often fruit and vegetables were consumed, as a proxy for diet quality. Neighbourhood characteristics were evaluated by the "Walking Environment" and "Availability of Healthy Foods" scales originally used in the Multi-Ethnic Study of Atherosclerosis (MESA). Associations were examined using multinomial logistic regression. RESULTS: Perceiving a more walkable neighbourhood was positively associated with engaging in leisure time physical activity and doing so for longer weekly. Compared with those who saw their neighbourhood as less walkable, those who perceived it as more walkable had 1.69 (95 % CI 1.57-1.83) and 1.39 (1.28-1.52) greater odds of engaging in leisure time physical activity for more than 150 min/week or up to 150 min/week (vs. none), respectively. Perceiving a more walkable neighbourhood was also positively associated with transport-related physical activity. The same pattern was observed for diet: compared with participants who perceived healthy foods as less available in their neighbourhood, those who saw them as more available had odds 1.48 greater (1.31-1.66) of eating fruits, and 1.47 greater (1.30-1.66) of eating vegetables, more than once per day. CONCLUSIONS: Perceived walkability and neighbourhood availability of healthy food were independently associated with the practice of physical activity and diet quality, respectively, underlining the importance of neighbourhood-level public policies to changing and maintaining health-related habits.

Assessment of participation bias in cohort studies: systematic review and meta-regression analysis / Avaliação do viés de participação em estudos de coorte: uma revisão sistemática e metarregressão / Evaluación del sesgo de participación en estudiosde cohortes: una revisión sistemática y metarregresión

Abstract The proportion of non-participation in cohort studies, if associated with both the exposure and the probability of occurrence of the event, can introduce bias in the estimates of interest. The aim of this study is to evaluate the impact of participation and its characteristics in longitudinal studies. A systematic review (MEDLINE, Scopus and Web of Science) for articles describing the proportion of participation in the baseline of cohort studies was performed. Among the 2,964 initially identified, 50 were selected. The average proportion of participation was 64.7%. Using a meta-regression model with mixed effects, only age, year of baseline contact and study region (borderline) were associated with participation. Considering the decrease in participation in recent years, and the cost of cohort studies, it is essential to gather information to assess the potential for non-participation, before committing resources. Finally, journals should require the presentation of this information in the papers.

Resumo A proporção de não-participação em estudos de coorte está associada também à exposição e à probabilidade de ocorrência do evento poder gerar viés nas estimativas de interesse. O objetivo do presente trabalho é realizar uma revisão sistemática e metanálise de artigos que descrevem a participação em estudos de coorte e avaliar as características associadas à participação. Foi realizada uma revisão sistemática (MEDLINE, Scopus e Web of Science), buscando-se artigos que descrevessem a proporção de participação na linha de base de estudos de coorte. De 2.964 artigos inicialmente identificados, foram selecionados 50. Entre esses, a proporção média de participação foi de 64,7%. Utilizando-se o modelo de metarregressão com efeitos mistos, somente a idade, ano da linha de base e a região do estudo (limítrofe) estiveram associados à participação. Considerando a diminuição na participação em anos mais recentes e o custo dos estudos de coorte, é essencial buscar informações que permitam avaliar o potencial de não-participação antes de comprometer os recursos.

Resumen La proporción de no participación en estudios de cohorte se asocia también con la exposición y probabilidad de ocurrencia de hechos que pueden generar sesgos en las estimaciones de interés. El objetivo de este estudio es realizar una revisión sistemática y un metaanálisis de artículos que describen la participación en estudios de cohortes y evaluar las características asociadas con la participación. Una revisión sistemática fue realizada (MEDLINE, Scopus y Web of Science), en busca de artículos que describen la relación de participación basada en estudios de cohortes. Se seleccionaron 2964 artículos, de los cuales se identificaron preliminarmente 50. Entre estos, la proporción promedio de participación fue de un 64,7%. Utilizando la metarregresión, sólo la edad, años de referencia y la región de estudio (borderline) se asociaron con la participación. Teniendo en cuenta la disminución de la participación en los últimos años, y el coste de los estudios de cohortes, es esencial buscar información para evaluar el potencial de la no participación antes de comprometer recursos.

Assessment of participation bias in cohort studies: systematic review and meta-regression analysis.

The proportion of non-participation in cohort studies, if associated with both the exposure and the probability of occurrence of the event, can introduce bias in the estimates of interest. The aim of this study is to evaluate the impact of participation and its characteristics in longitudinal studies. A systematic review (MEDLINE, Scopus and Web of Science) for articles describing the proportion of participation in the baseline of cohort studies was performed. Among the 2,964 initially identified, 50 were selected. The average proportion of participation was 64.7%. Using a meta-regression model with mixed effects, only age, year of baseline contact and study region (borderline) were associated with participation. Considering the decrease in participation in recent years, and the cost of cohort studies, it is essential to gather information to assess the potential for non-participation, before committing resources. Finally, journals should require the presentation of this information in the papers.

[Ethical issues in longitudinal studies: the case of ELSA-Brasil]. / Aspectos éticos em estudos longitudinais: o caso do ELSA-Brasil.

The debate about ethics in research with human beings has historically emphasized experimental studies because of their greater potential to harm the subjects involved. However, observational studies also include risks and relevant questions to be discussed. This article aims to present and discuss the ethical aspects involved in the implementation of ELSA-Brasil, a longitudinal multicenter study, with public funding, in which the research subjects and investigators are employees of the same institutions. The procedures adopted to meet the ethical requirements and commitments are described, as well as the casuistics that guided the actions according to their guiding principles (beneficence, autonomy and social justice). We present some moral problems that required consideration of risks and benefits at the confluence with the study's objectives, and we conclude with comments on the peculiarities and the potential benefits of a longitudinal study.

[Social capital in ELSA-Brasil: test-retest reliability of the Resource Generator scale]. / Capital social no ELSA-Brasil: confiabilidade teste-reteste do Resource Generator scale.

OBJECTIVE: To estimate the test-retest reliability of items of the Resource Generator scale for assessing social capital in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). METHODS: The social capital was applied in a subsample of 281 participants from six ELSA investigation centers, on two occasions with an interval of seven to 14 days. The instrument consists of 31 items that represent concrete situations to evaluate the access to different types of resources. In addition, it evaluates the strength of ties (family, friends or acquaintances) for the available resources. Statistical analyses were performed through use of the kappa statistic (k) and prevalence-adjusted kappa (ka). RESULTS: A high frequency was found for social resources (above 50%). Regarding the presence or absence of resources, prevalence-adjusted reliability (ka) varied from 0.54 to 0.97. With regard to the source for the resource, the reliability estimates ranged from ka = 0.45 ("someone who has good contacts with the media") to ka = 0.86 ("someone who completed secondary education"). CONCLUSIONS: The scale presented adequate levels of reliability, which varied according to the type of resource.

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

This article describes the development of the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) questionnaire. We first 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 finally 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.

[Cross-cultural adaptation and reliability of measurements on self-reported neighborhood characteristics in ELSA-Brasil]. / Adaptação transcultural e confi abilidade de medidas de características autorreferidas de vizinhança no ELSA-Brasil.

OBJECTIVE: To describe the process involved in adapting scales for measuring neighborhood characteristics to Brazilian Portuguese. METHODS: The dimensions addressed were social cohesion, environment suitable for physical activity, availability of healthy foods, safety, perceived violence and victimization. The adaptation process involved assessment of equivalence between the original scales and the Portuguese versions. The test-retest reliability was assessed in a subsample of 261 participants from the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil), who answered the same questionnaire on two different occasions, separated by an interval of 7 to 14 days. RESULTS: The aspects of equivalence assessed were shown to be adequate. The intraclass correlation coefficient ranged from 0.83 (95%CI 0.78;0.87) for Social Cohesion to 0.90 (95%CI 0.87;0.92) for Walking Environment. The scales showed internal consistency (Cronbach's alpha) ranging from 0.60 to 0.84. CONCLUSIONS: The measurements on self-reported neighborhood characteristics had very good reproducibility and good internal consistency (Cronbach's alpha). The results suggest that these scales can be used in studies involving Brazilian populations with characteristics similar to those of ELSA-Brasil.

Leite de mulheres brasileiras apresenta anticorpos IgA secretores (SIgA) que neutralizam o rotavírus G9P[5] / Milk from Brazilian women presents secretory IgA antibodies and neutralizes rotavirus G9P[5]

OBJETIVO: Verificar a presença de SIgA anti-rotavírus sorotipo G9P[5] e a capacidade de neutralização do vírus de amostras de leite de mulheres brasileiras. MÉTODOS: Foram determinados os níveis de anticorpos SIgA reativos contra rotavírus G9 em 30 amostras de leite materno por ELISA usando suspensões purificadas do vírus. A capacidade das amostras de neutralizarem o rotavírus G9P[5] foi analisada em ensaio de de Neutralização utilizando células MA-104. RESULTADOS: Foram observadas grandes variações individuais referentes aos níveis de SIgA e títulos de neutralização, mas todas as amostras mostraram certa capacidade de neutralizar o G9P[5]. Verificamos uma correlação positiva altamente significativa entre os níveis de anticorpos e os títulos de neutralização. CONCLUSÕES: A alta correlação entre níveis de anticorpos anti-rotavírus e a capacidade neutralizante das amostras de leite sugere um possível papel protetor desses anticorpos contra a infecção. Esses resultados também apoiam o incentivo à prática do aleitamento materno.

OBJECTIVE: To verify the presence of anti-rotavirus serotype G9P[5] SIgA and the virus neutralization capacity of milk samples from Brazilian women. METHODS: SIgA antibody levels reactive to rotavirus G9 were determined in 30 maternal milk samples by enzyme-linked immunosorbent assay (ELISA) using purified virus suspensions. The samples' capacity to neutralize rotavirus G9P[5] was analyzed using the MA-104 cells neutralization assay. RESULTS: Great individual variations were observed regarding the SIgA levels and neutralization titers, but all samples showed some G9P[5] neutralizing ability. A highly significant positive correlation was observed between antibody levels and neutralization titers. CONCLUSIONS: The high correlation between anti-rotavirus antibody levels and neutralizing capacity of the milk samples suggests a possible protective role of these antibodies against infection. These results also support the encouragement of the breast-feeding practice.

Milk from Brazilian women presents secretory IgA antibodies and neutralizes rotavirus G9P[5].

OBJECTIVE: To verify the presence of anti-rotavirus serotype G9P[5] SIgA and the virus neutralization capacity of milk samples from Brazilian women. METHODS: SIgA antibody levels reactive to rotavirus G9 were determined in 30 maternal milk samples by enzyme-linked immunosorbent assay (ELISA) using purified virus suspensions. The samples' capacity to neutralize rotavirus G9P[5] was analyzed using the MA-104 cells neutralization assay. RESULTS: Great individual variations were observed regarding the SIgA levels and neutralization titers, but all samples showed some G9P[5] neutralizing ability. A highly significant positive correlation was observed between antibody levels and neutralization titers. CONCLUSIONS: The high correlation between anti-rotavirus antibody levels and neutralizing capacity of the milk samples suggests a possible protective role of these antibodies against infection. These results also support the encouragement of the breast-feeding practice.

Questionario do ELSA-Brasil: desafios na elaboracao de instrumento multidimensional / Questionnaire development in ELSA-Brasil: challenges of a multidimensional instrument

O artigo apresenta o processo de elaboração do questionário utilizado no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Iniciamos pelo relato sobre a "Seleção de Temas" abordados no questionário, cujo conteúdo teria que abranger o conhecimento disponível acerca da complexa rede de causalidade dos desfechos de interesse, assim como possibilitar a comparabilidade com estudos semelhantes. Contextualizamos a "tradução e a adaptação de instrumentos de medida", necessárias no caso de escalas de avaliação de vizinhanças, do instrumento para diagnóstico de transtornos depressivos e de ansiedade, e do questionário de frequência alimentar. A seguir, comentamos os critérios que nortearam a "ordem dos blocos temáticos" e finalmente a importância prática dos "pré-testes e estudos-piloto". As relações entre o conjunto de informações reunidas no ELSA poderão constituir contribuição original sobre os fatores que causam ou agravam os desfechos de interesse no contexto brasileiro, assim como sobre seus fatores de proteção.

This article describes the development of the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil) questionnaire. We first 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 finally 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.

Adaptacao transcultural e confiabilidade de medidas de caracteristicas autorreferidas de vizinhanca no ELSA-Brasil / Cross-cultural adaptation and reliability of measurements on self-reported neighborhood characteristics in ELSA-Brasil

OBJETIVO: Descrever o processo de adaptação de escalas de medida de características de vizinhança para o português brasileiro. MÉTODOS: As dimensões abordadas foram coesão social, ambiente propício para atividade física, disponibilidade de alimentos saudáveis, segurança em relação a crimes, violência percebida e vitimização. No processo de adaptação foram avaliados aspectos de equivalência entre as escalas originais e respectivas versões para o português. A confiabilidade teste-reteste foi avaliada em submostra de 261 participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) que responderam ao mesmo questionário em dois momentos distintos em um intervalo de tempo de sete a 14 dias entre as duas aplicações. RESULTADOS: Os aspectos de equivalência avaliados mostraram-se adequados. O coeficiente de correlação intraclasse variou entre 0,83 (IC95% 0,78;0,87) para Coesão Social e 0,90 (IC95% 0,87;0,92) para Ambiente para Atividade Física. As escalas apresentaram consistência interna (alfa de Cronbach) que variaram entre 0,60 e 0,84. CONCLUSÕES: As medidas autorreferidas de características de vizinhança tiveram reprodutibilidade muito boa e boa consistência interna. Os resultados sugerem que essas escalas podem ser utilizadas em estudos com população brasileira que apresente características similares àquelas do ELSA-Brasil. .

OBJECTIVE: To describe the process involved in adapting scales for measuring neighborhood characteristics to Brazilian Portuguese. METHODS: The dimensions addressed were social cohesion, environment suitable for physical activity, availability of healthy foods, safety, perceived violence and victimization. The adaptation process involved assessment of equivalence between the original scales and the Portuguese versions. The test-retest reliability was assessed in a subsample of 261 participants from the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil), who answered the same questionnaire on two different occasions, separated by an interval of 7 to 14 days. RESULTS: The aspects of equivalence assessed were shown to be adequate. The intraclass correlation coefficient ranged from 0.83 (95%CI 0.78;0.87) for Social Cohesion to 0.90 (95%CI 0.87;0.92) for Walking Environment. The scales showed internal consistency (Cronbach's alpha) ranging from 0.60 to 0.84. CONCLUSIONS: The measurements on self-reported neighborhood characteristics had very good reproducibility and good internal consistency (Cronbach's alpha). The results suggest that these scales can be used in studies involving Brazilian populations with characteristics similar to those of ELSA-Brasil. .

Aspectos eticos em estudos longitudinais: o caso do ELSA-Brasil / Ethical issues in longitudinal studies: the case of ELSA-Brasil

Historicamente a discussão acerca da eticidade dos atos em pesquisas com seres humanos privilegiou os estudos experimentais, pelo maior potencial de danos aos sujeitos envolvidos. Todavia, os estudos observacionais também envolvem riscos e suscitam questões relevantes. Neste artigo pretende-se apresentar e discutir aspectos éticos do desenvolvimento do ELSA-Brasil, um estudo longitudinal e multicêntrico, com financiamento público, no qual os sujeitos da pesquisa e pesquisadores pertencem às mesmas instituições. São descritos os procedimentos adotados para atender às exigências e compromissos éticos e a casuística que orientou as ações segundo seus princípios norteadores (beneficência, autonomia e justiça social). São apresentados alguns problemas morais que exigiram ponderação sobre riscos e benefícios na confluência com os objetivos do estudo e comentam-se peculiaridades de um estudo longitudinal e seus potenciais benefícios.

The debate about ethics in research with human beings has historically emphasized experimental studies because of their greater potential to harm the subjects involved. However, observational studies also include risks and relevant questions to be discussed. This article aims to present and discuss the ethical aspects involved in the implementation of ELSA-Brasil, a longitudinal multicenter study, with public funding, in which the research subjects and investigators are employees of the same institutions. The procedures adopted to meet the ethical requirements and commitments are described, as well as the casuistics that guided the actions according to their guiding principles (beneficence, autonomy and social justice). We present some moral problems that required consideration of risks and benefits at the confluence with the study's objectives, and we conclude with comments on the peculiarities and the potential benefits of a longitudinal study.

Capital social no ELSA-Brasil: confiabilidade teste-reteste do Resource Generator scale / Social capital in ELSA-Brasil: test-retest reliability of the Resource Generator scale

OBJETIVO: Estimar a confiabilidade teste-reteste dos itens do Resource Generator scale para avaliação de capital social no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). MÉTODOS: A escala de capital social foi aplicada em subamostra de 281 participantes dos seis Centros de Investigação do ELSA, em duas oportunidades, com intervalo de sete a 14 dias. O instrumento é constituído por 31 itens que representam situações concretas para avaliar o acesso a diferentes tipos de recursos, além de avaliar a fonte dos recursos disponíveis (familiares, amigos ou conhecidos). A análise estatística foi realizada por meio de estatísticas kappa (k) e kappa ajustado pela prevalência (ka). RESULTADOS: Os recursos sociais investigados foram encontrados com grande frequência (acima de 50%). Em relação à presença ou ausência dos recursos, as estimativas de confiabilidade ajustadas pela prevalência (ka) variaram de 0,54 a 0,97. No que se refere à fonte de recurso, essas estimativas variaram de ka = 0,45 (alguém que tenha bons contatos com a mídia) a ka = 0,86 (alguém que se formou no Ensino Médio). CONCLUSÕES: A escala apresentou níveis adequados de confiabilidade, que variaram de acordo com o tipo de recurso. .

OBJECTIVE: To estimate the test-retest reliability of items of the Resource Generator scale for assessing social capital in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). METHODS: The social capital was applied in a subsample of 281 participants from six ELSA investigation centers, on two occasions with an interval of seven to 14 days. The instrument consists of 31 items that represent concrete situations to evaluate the access to different types of resources. In addition, it evaluates the strength of ties (family, friends or acquaintances) for the available resources. Statistical analyses were performed through use of the kappa statistic (k) and prevalence-adjusted kappa (ka). RESULTS: A high frequency was found for social resources (above 50%). Regarding the presence or absence of resources, prevalence-adjusted reliability (ka) varied from 0.54 to 0.97. With regard to the source for the resource, the reliability estimates ranged from ka = 0.45 ("someone who has good contacts with the media") to ka = 0.86 ("someone who completed secondary education"). CONCLUSIONS: The scale presentedadequate levels of reliability, which varied according to the type of resource. .

Demarcation of local neighborhoods to study relations between contextual factors and health.

BACKGROUND: Several studies have highlighted the importance of collective social factors for population health. One of the major challenges is an adequate definition of the spatial units of analysis which present properties potentially related to the target outcomes. Political and administrative divisions of urban areas are the most commonly used definition, although they suffer limitations in their ability to fully express the neighborhoods as social and spatial units. OBJECTIVE: This study presents a proposal for defining the boundaries of local neighborhoods in Rio de Janeiro city. Local neighborhoods are constructed by means of aggregation of contiguous census tracts which are homogeneous regarding socioeconomic indicators. METHODOLOGY: Local neighborhoods were created using the SKATER method (TerraView software). Criteria used for socioeconomic homogeneity were based on four census tract indicators (income, education, persons per household, and percentage of population in the 0-4-year age bracket) considering a minimum population of 5,000 people living in each local neighborhood. The process took into account the geographic boundaries between administrative neighborhoods (a political-administrative division larger than a local neighborhood, but smaller than a borough) and natural geographic barriers. RESULTS: The original 8,145 census tracts were collapsed into 794 local neighborhoods, distributed along 158 administrative neighborhoods. Local neighborhoods contained a mean of 10 census tracts, and there were an average of five local neighborhoods per administrative neighborhood.The local neighborhood units demarcated in this study are less socioeconomically heterogeneous than the administrative neighborhoods and provide a means for decreasing the well-known statistical variability of indicators based on census tracts. The local neighborhoods were able to distinguish between different areas within administrative neighborhoods, particularly in relation to squatter settlements. CONCLUSION: Although the literature on neighborhood and health is increasing, little attention has been paid to criteria for demarcating neighborhoods. The proposed method is well-structured, available in open-access software, and easily reproducible, so we expect that new experiments will be conducted to evaluate its potential use in other settings. The method is thus a potentially important contribution to research on intra-urban differentials, particularly concerning contextual factors and their implications for different health outcomes.