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

Cutaneous melanin pigment plays a critical role in camouflage, mimicry, social communication, and protection against harmful effects of solar radiation. Melanogenesis is under complex regulatory control by multiple agents interacting via pathways activated by receptor-dependent and -independent mechanisms, in hormonal, auto-, para-, or intracrine fashion. Because of the multidirectional nature and heterogeneous character of the melanogenesis modifying agents, its controlling factors are not organized into simple linear sequences, but they interphase instead in a multidimensional network, with extensive functional overlapping with connections arranged both in series and in parallel. The most important positive regulator of melanogenesis is the MC1 receptor with its ligands melanocortins and ACTH, whereas among the negative regulators agouti protein stands out, determining intensity of melanogenesis and also the type of melanin synthesized. Within the context of the skin as a stress organ, melanogenic activity serves as a unique molecular sensor and transducer of noxious signals and as regulator of local homeostasis. In keeping with these multiple roles, melanogenesis is controlled by a highly structured system, active since early embryogenesis and capable of superselective functional regulation that may reach down to the cellular level represented by single melanocytes. Indeed, the significance of melanogenesis extends beyond the mere assignment of a color trait.

https://www.physiology.org/doi/pdf/10.1152/physrev.00044.2003

Melanin Pigmentation in Mammalian Skin and Its Hormonal Regulation

http://www.ernaehrungsdenkwerkstatt.de/fileadmin/user_upload/EDWText/Personen/Popkin_Nutrition_Transition_global__dynamics_AJCN_84_289_2006.pdf

Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases

https://estrip.org/content/users/tinypliny/1010/CokeObesityDiabetes.pdf

Sugar-sweetened beverages and risk of obesity and type 2 diabetes: Epidemiologic evidence

Nutrition Planning, Assessment and EvaluationService, Food and Nutrition Division, FAO, Rome, ItalyThe Joint WHO/FAO Expert Consultation on diet,nutrition and the prevention of chronic diseases tookplace in Geneva from 28 January to 1 February 2002. Theoverall objective of the Consultation was to review andupdate current international recommendations on diet,nutrition and the prevention of chronic diseases byevaluating the latest scientiﬁc evidence and lessonslearned from implementing national interventionstrategies to reduce the burden of these diseases. Speciﬁcobjectives included:1. Reviewing the changes in the dietary and healthpatternsworldwideandexaminingtheirrelationshiptoemergence of chronic diseases, particularly obesity,type 2 diabetes, hypertension and cardiovasculardiseases, cancer, dental disease, and osteoporosis.2. Reviewing the latest scientiﬁc evidence on therelationship between diet, nutrition and chronicdiseases.3. Examining diet, nutrition and health issues from a lifecourse perspective.4. Considering gene/nutrient interactions and theirimplications.5. Formulating recommendations concerning diet andnutrition for the prevention of chronic diseases toassist countries in developing and implementingeffective evidence-based multisectoral policies andstrategies.6. Identifying further research needs.The selection of the expert participants followed standardcriteria, including geographic and sex balance, inconsultation with regional ofﬁces. Thirty experts wereidentiﬁed,halffromdevelopingcountriesandcountriesineconomic transition where diet-related chronic diseasesare an increasing public health problem. Before beingofﬁcially invited to participate, all were requested todeclare possible conﬂicts of interest to ensure the qualityand neutrality of each expert’s contributions.Four working groups composed of world-renownedexperts prepared background papers on majordiet-related chronic diseases, such as obesity, type-2diabetes,cardiovasculardiseasesandcancer,thatincludedcurrent trends for each disease, a review of the strengthand weakness of the scientiﬁc evidence linking diet anddisease, and its policy implications. Other experts wereresponsible for papers on dental diseases and osteoporo-sis while WHO staff prepared a paper on the life courseapproach and FAO staff prepared a review of the globaland regional food consumption patterns and trends.Each background paper was peer-reviewed; papers weresubmitted, together with comments by peer-reviewers(some 20 in all), to the Expert Consultation as a generalframework for discussion.Report preparationFollowinground-tableconsultationswithnongovernmen-tal organizations and industry associations in April 2002to obtain feedback on the Expert Consultation’s initialdraftreport,thedraftreportwasmadeavailableonWHO’swebsite for review and comment by all interested partiesuntil June 2002.In August 2002, the Consultation’s Chairperson, Vice-Chairperson and rapporteurs met in Geneva with theWHO/FAO secretariat members as well as with severalexpertsonphysicalactivitytoreviewmorethan120setsofcomments from governments of FAO/WHO MemberStates, representatives of the scientiﬁc community,nongovernmental organizations, commercial enterprisesandinterestedindividuals.Thesecommentswerelikewiseposted in their entirety on WHO’s website for publicscrutiny. In October 2002, several members of the ExpertConsultationmetwiththeChairpersonandtheWHO/FAOSecretariatto ﬁnalize severalpending issues. In December2002, the ﬁnal draft report was sent to the members of theExpert Consultation for review and ﬁnal approval. Thereport was then ﬁnalized and published in the WHOTechnical Report Series (TRS 916)

/pdf/the-joint-who-fao-expert-consultation-on-diet-nutrition-and-3eo569pb7x.pdf

The joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic diseases: process, product and policy implications

Objective To determine the association between social, economic and behavioural risk factors and national prevalences of: oral cancer, dental caries (12-year-olds) and destructive periodontal disease (35–44-year-olds). Data sources Sources for the social and economic parameters were the UN Development Program; the behavioural risk factors' source was the World Health Organization, the UN Food and Agricultural Organization and the World Atlas of History. Oral diseases data came from UICC Globocan and the World Health Organization databases. Data extraction Data were extracted by hand from official publications. Data synthesis Data were synthesized and analyzed in sequence using SPSS, Pearson's correlation coefficient and multiple regression analyses. Conclusions There is a discernable association between the three oral diseases and the variables selected, which varies in strength, being strongest for chronic destructive periodontitis and weakest for oral cancer. Dental caries lies in between. The degree to which variables account for differences in the three oral diseases between the countries studied is striking, being insignificant for oral cancer incidence, modest for oral cancer mortality, stronger for dental caries and strongest for destructive periodontal disease. Removing variables with strong co-linearity with the Human Development Index has little effect on the regression coefficients.

/pdf/oral-diseases-and-socio-economic-status-ses-ckr7bld5pe.pdf

Oral diseases and socio-economic status (SES).

Food items consumed by students attending schools in different socioeconomic areas in Cape Town, South Africa.

Objectives. The first democratic government elected in South Africa in 1994 inherited huge inequalities in health status and health provision across all sections of the population. This study set out to assess, 4 years later, the influence of race and socioeconomic status (SES) on perceived quality of care from health care providers. Design. A 1998 countrywide survey of 3820 households assessed many aspects of health care delivery, including levels of satisfaction with health care providers among different segments of South African society. Results. Fifty-one percent (n = 1953) of the respondents had attended a primary care facility in the year preceding the interview and were retained in the analysis. Both race and SES were significant predictors of levels of satisfaction with the services of the health care provider, after adjusting for gender, age, and type of facility visited. White and high SES respondents were about 1.5 times more likely to report excellent service compared with Black and low SES respondents, respectively. Conclusion. In South Africa, race and SES are not synonymous and can no longer be considered reliable proxy indicators of one another. Each has distinct and significant but different degrees of association with client satisfaction. Any assessment of equity-driven health policy in South Africa should consider the impacts of both race and SES on client satisfaction as one of the indicators of success.

Patient satisfaction with health care providers in South Africa: the influences of race and socioeconomic status

Since 1997, South Africa has been developing and implementing food-based dietary guidelines for people aged >6 years. The complexity of the population, which contains different ethnic groups, as well as the rapid urbanization that is taking place, means that food-based dietary guidelines need to consider both overnutrition and undernutrition. The initial guidelines did not include guidance on sugar, and the Department of Health was not prepared to approve them until appropriate guidance on sugar was included. This paper summarizes the evidence available for such a guideline and the nature of that evidence. Other low- and middle-income countries, particularly those in Africa, may face a similar dilemma and might learn from our experience.

/pdf/evidence-to-support-a-food-based-dietary-guideline-on-sugar-if6pa0hev0.pdf

N.G. Myburgh

Papers

Oral diseases and socio-economic status (SES).

Food items consumed by students attending schools in different socioeconomic areas in Cape Town, South Africa.

Patient satisfaction with health care providers in South Africa: the influences of race and socioeconomic status

Evidence to support a food-based dietary guideline on sugar consumption in South Africa

Dental caries, socio-economic development and national oral health policies.