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Zhang, Y., Gu, Y., Wang, N., Zhao, Q., Ng, N., Wang, R., . . . Zhao, G. (2019). Association between anthropometric indicators of obesity and cardiovascular risk factors among adults in Shanghai, China. BMC Public Health, 19(1), Article ID 1035.
Open this publication in new window or tab >>Association between anthropometric indicators of obesity and cardiovascular risk factors among adults in Shanghai, China
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1035Article in journal (Refereed) Published
Abstract [en]

Background: To determine the optimal cut-off values and evaluate the associations of body mass index (BMI), waist circumference (WC) and waist-height ratio (WHtR) with cardiovascular disease (CVD) risk factors. Methods: A large-scale cross-sectional survey was conducted among 35,256 adults aged 20-74 years in Shanghai between June 2016 and December 2017. Receiver operating characteristic (ROC) analyses were conducted to assess the optimal cut-off anthropometric indices of CVD risk factors including hypertension, diabetes, dyslipidemia and hyperuricemia. Multivariate Logistic regression models were preformed to evaluate the odds ratio of CVD risk factors. Results: The area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of hypertension and diabetes, and AUCs were higher in women than men. The optimal cut-off values of WHtR were approximately 0.51 in both sexes, while the cut-off values of BMI and WC were higher for men compared with women. The optimal cutoff values of BMI and WC varied greatly across different age groups, but the difference in WHtR was relatively slight. Among women, the optimal threshold of anthropometric indices appeared to increase with age for hypertension and diabetes. The odds ratio between anthropometric indices and CVD risk factors were attenuated with age. WHtR had the greatest odds ratio for CVD risk factors among adults under 60 years old except for women with hypertension, while among 60-74 years, BMI yielded the greatest odds ratio in terms of all CVD outcomes except for women with diabetes. Conclusions: WHtR had the best performance for discriminating hypertension and diabetes and potentially be served as a standard screening tool in public health. The associations between three anthropometric indices and CVD risk factors differed by sex and decreased with age. These findings indicated a need to develop age- and gender-specific difference and make effective strategies for primary prevention of CVDs.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Cardiovascular diseases, Obesity, Anthropometric indices, Risk factors
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162865 (URN)10.1186/s12889-019-7366-0 (DOI)000480259500004 ()31375086 (PubMedID)
Available from: 2019-09-05 Created: 2019-09-05 Last updated: 2019-09-05Bibliographically approved
Lestari, S. K., Ng, N., Kowal, P. & Santosa, A. (2019). Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison. International Journal of Environmental Research and Public Health, 16(8), Article ID 1341.
Open this publication in new window or tab >>Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison
2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 8, article id 1341Article in journal (Refereed) Published
Abstract [en]

The low- and middle-income countries (LMICs) are experiencing rapid population ageing, yet knowledge about disability among older populations in these countries is scarce. This study aims to identify the prevalence and factors associated with disability among people aged 50 years and over in six LMICs. Cross-sectional data from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007-2010) in China, Ghana, India, Mexico, the Russian Federation, and South Africa was used. Multivariable logistic regression analyses were undertaken to examine the association between sociodemographic factors, health behaviours, chronic conditions, and activities of daily living (ADL) disability. The prevalence of disability among older adults ranged from 16.2% in China to 55.7% in India. Older age, multimorbidity, and depression were the most common factors related to disability in all six countries. Gender was significant in China (OR = 1.14, 95% CI: 1.01-1.29), Ghana (OR = 1.22, 95% CI: 1.01-1.48) and India (OR = 1.65, 95% CI: 1.37-1.99). Having no access to social capital was significantly associated with ADL disability in China (OR = 2.57, 95% CI: 1.54-4.31) and South Africa (OR = 4.11, 95% CI: 1.79-9.43). Prevalence data is valuable in these six ageing countries, with important evidence on mitigating factors for each. Identifying determinants associated with ADL disability among older people in LMICs can inform how to best implement health prevention programmes considering different country-specific factors.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
older adults, physical function, disability, ADL, WHO SAGE, LMICs
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-159624 (URN)10.3390/ijerph16081341 (DOI)000467747100034 ()31013975 (PubMedID)
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-06-13Bibliographically approved
Byass, P., Ng, N. & Wall, S. (2019). Nurturing Global Health Action through its first decade. Global Health Action, 12(1), Article ID 1569847.
Open this publication in new window or tab >>Nurturing Global Health Action through its first decade
2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1569847Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-158193 (URN)10.1080/16549716.2019.1569847 (DOI)000457989300001 ()30727852 (PubMedID)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-24Bibliographically approved
Eriksson, M., Lindgren, U., Ivarsson, A. & Ng, N. (2019). The effect ofneighbourhood social capital on child injuries: a gender-stratified analysis. Health & Place, Article ID 102205.
Open this publication in new window or tab >>The effect ofneighbourhood social capital on child injuries: a gender-stratified analysis
2019 (English)In: Health & Place, article id 102205Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-163497 (URN)10.1016 (DOI)
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-09-23
Näslund, U., Ng, N., Lundgren, A., Fhärm, E., Grönlund, C., Johansson, H., . . . Norberg, M. (2019). Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. The Lancet, 393(10167), 133-142
Open this publication in new window or tab >>Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial
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2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10167, p. 133-142Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.

METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.

FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).

INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-154318 (URN)10.1016/S0140-6736(18)32818-6 (DOI)000455437100026 ()30522919 (PubMedID)
Funder
Västerbotten County Council, Dnr ALFVLL-298001Swedish Research Council, Dnr 521-2013-2708Swedish Research Council, 2016-01891Swedish Heart Lung Foundation, Dnr 20150369Swedish Heart Lung Foundation, 20170481
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-02-22Bibliographically approved
Pujilestari, C. U., Nyström, L., Norberg, M. & Ng, N. (2019). Waist circumference and all-cause mortality among older adults in rural Indonesia. International Journal of Environmental Research and Public Health, 16, Article ID 116.
Open this publication in new window or tab >>Waist circumference and all-cause mortality among older adults in rural Indonesia
2019 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, article id 116Article in journal (Refereed) Published
Abstract [en]

Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007–2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
abdominal obesity, deaths, Indonesia, older people, waist circumference
National Category
Gerontology, specialising in Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-152117 (URN)10.3390/ijerph16010116 (DOI)000459111400116 ()30609857 (PubMedID)
Note

Originally included in thesis in manuscript form

Available from: 2018-09-27 Created: 2018-09-27 Last updated: 2019-03-20Bibliographically approved
Karhina, K., Eriksson, M., Ghazinour, M. & Ng, N. (2019). What determines gender inequalities in social capital in Ukraine?. SSM - Population Health, 8, Article ID 100383.
Open this publication in new window or tab >>What determines gender inequalities in social capital in Ukraine?
2019 (English)In: SSM - Population Health, ISSN 2352-8273, Vol. 8, article id 100383Article in journal (Other academic) Epub ahead of print
Abstract [en]

Background

Social capital is a social determinant of health that has an impact on equity and well-being. It may be unequally distributed among any population. The aims of this study are to investigate the distribution of different forms of social capital between men and women in Ukraine and analyse how potential gender inequalities in social capital might be explained and understood in the Ukrainian context.

Method

The national representative cross-sectional data from the European Social Survey (wave 6) was used with a sample of 1377 women and 797 men. Seven outcomes that represent cognitive and structural social capital were constructed i.e. institutional trust, generalised trust, reciprocity, safety, as well as bonding, bridging and linking forms. Multivariate logistic regression and post-regression Fairlies decompositions were used for the analyses.

Results

There are several findings that resulted from the analyses i), access to institutional trust, linking and bridging social capital is very limited; ii), the odds for almost all forms of social capital (besides safety) are lower for men; iii), feeling about income and age explain most of the gender differences and act positively, as well as offsetting the differences.

Conclusion

Social capital is unequally distributed between different population groups. Some forms of social capital have a stronger buffering effect on women than on men in Ukraine. Reducing gender and income inequalities would probably influence the distribution of social capital within the society.

Keywords
social capital, Ukraine, gender, inequality
National Category
Medical and Health Sciences Social Sciences
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-159716 (URN)10.1016/j.ssmph.2019.100383 (DOI)
Available from: 2019-06-04 Created: 2019-06-04 Last updated: 2019-06-13Bibliographically approved
Dewi, F. S. T., Choiriyyah, I., Indriyani, C., Wahab, A., Lazuardi, L., Nugroho, A., . . . Utarini, A. (2018). Designing and collecting data for a longitudinal study: the Sleman Health and Demographic Surveillance System (HDSS). Scandinavian Journal of Public Health, 46(7), 704-710
Open this publication in new window or tab >>Designing and collecting data for a longitudinal study: the Sleman Health and Demographic Surveillance System (HDSS)
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2018 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 7, p. 704-710Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: This paper describes the methodological considerations of developing an urban Health and Demographic Surveillance System (HDSS), in the Sleman District of Yogyakarta, Indonesia.

METHODS: 1) The Sleman District was selected because it is mostly an urban area. 2) The minimum sample size was calculated to measure infant mortality as the key variable and resulted in a sample of 4942 households. A two-stage cluster sampling procedure with probability proportionate to size was applied; first, 216 Censuses Blocks (CBs) were selected, and second, 25 households in each CB were selected. 3) A baseline survey was started in 2015, and collected data on demographic and economic characteristics and verbal autopsy (VA); the 2nd cycle collected updated demographic data, VA, type of morbidity (communicable and non-communicable diseases, disability and injury) and health access. 4) The data were collected at a home visit through a Computer-Assisted Personal Interview (CAPI) on a tablet device, and the data were transferred to the server through the Internet. 5) The quality control consisted of spot-checks of 5% of interviews to control for adherence to the protocol, re-checks to ensure the validity of the interview, and computer-based data cleaning. 6) A utilization system was designed for policy-makers (government) and researchers.

RESULTS: In total, 5147 households participated in the baseline assessment in 2015, and 4996 households participated in the second cycle in 2016 (97.0% response rate).

CONCLUSIONS: Development of an urban HDSS is possible and is beneficial in providing data complementary to the existing demographic and health information system at local, national and global levels.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Sleman HDSS, design paper, field laboratory, longitudinal study, surveillance, urban area
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-142183 (URN)10.1177/1403494817717557 (DOI)000452488900005 ()28752803 (PubMedID)
Available from: 2017-11-24 Created: 2017-11-24 Last updated: 2019-01-22Bibliographically approved
Septiono, W., Ng, N., Kuipers, M. & Kunst, A. (2018). Did local smoke free policy in Indonesia prevent youth from smoking?. Paper presented at 17th World Conference on Tobacco or Health, 7-9 March 2018, Cape Town, South Africa. Tobacco Induced Diseases, 16(1), 55-56, Article ID A149.
Open this publication in new window or tab >>Did local smoke free policy in Indonesia prevent youth from smoking?
2018 (English)In: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 16, no 1, p. 55-56, article id A149Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Although Indonesia has not ratified the WHO Framework Convention on Tobacco Control, it has developed a series of tobacco control policies at the local level. Strong presence of tobacco industry is marked with intensive marketing towards young people. This study assessed the impact of local smoke-free policy (SFP) on prevalence of daily and non-daily smoking among youth living in 33 provinces, 98 municipalities, and 412 regencies in Indonesia in 2007 and 2013.

Methods: Data on 239,170 adolescents (12-17 years old) was derived from the 2007 and 2013 basic health survey (RISKESDAS) performed by Indonesia Ministry of Health. Information on local tobacco control policies was derived from official documents from 84 districts and 8 provinces. District SFP and provincial SFP were distinguished. A multilevel logistic regression analysis compared the odds of daily and non-daily smoking between areas with and without SFP.

Results: Respondents who reported smoked daily was 4.6 % and non-daily was 4.4% in 2007. Smoking prevalence rates were high among males, in older adolescents, areas with high GDP per-capita, and rural areas. Different models consistently observed significantly reduction of daily smoking (OR:0.85; CI95%:0.79-0.90) and non-daily smoking (OR:0.92; CI95%:0.86-0.98) prevalence between 2007 and 2013. No difference in daily smoking and non-daily smoking was observed between districts with and without SFP. Intermediate compared with no provincial SFP was significantly associated to reduce the odds of non-daily (OR:0.82; CI95%:0.69-0.98) smoking, while no association was found between no provincial SFP and high group.

Conclusions: Smoke-free policies at the municipal level seemed to have no effect to reduce smoking among youth in local settings of Indonesia while policies at the provincial level were associated with lower smoking rates. To have better result of the smoking prevention among youth in the future, we suggest enhancing provincial SFP and strengthening the implementation of local SFP as well.

Place, publisher, year, edition, pages
EUEP European Publishing, 2018
Keywords
WCTOH
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-148032 (URN)10.18332/tid/83829 (DOI)000431841800150 ()
Conference
17th World Conference on Tobacco or Health, 7-9 March 2018, Cape Town, South Africa
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2018-06-09Bibliographically approved
Egondi, T., Ettarh, R., Kyobutungi, C., Ng, N. & Rocklöv, J. (2018). Exposure to Outdoor Particles (PM2.5) and Associated Child Morbidity and Mortality in Socially Deprived Neighborhoods of Nairobi, Kenya. Atmosphere, 9(9), Article ID 351.
Open this publication in new window or tab >>Exposure to Outdoor Particles (PM2.5) and Associated Child Morbidity and Mortality in Socially Deprived Neighborhoods of Nairobi, Kenya
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2018 (English)In: Atmosphere, ISSN 2073-4433, E-ISSN 2073-4433, Vol. 9, no 9, article id 351Article in journal (Refereed) Published
Abstract [en]

Exposure to air pollution is associated with adverse health outcomes. However, the health burden related to ambient outdoor air pollution in sub-Saharan Africa remains unclear. This study examined the relationship between exposure to outdoor air pollution and child health in urban slums of Nairobi, Kenya. We conducted a semi-ecological study among children under 5 years of age from two slum areas and exposure measurements of particulate matter (PM2.5) at the village level were aligned to data from a retrospective cohort study design. We used logistic and Poisson regression models to ascertain the associations between PM2.5 exposure level and child morbidity and mortality. Compared to those in low-pollution areas (PM2.5 < 25 µg/m3), children in high-pollution areas (PM2.5 ≥ 25 µg/m3) were at significantly higher risk for morbidity in general (odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.11–1.41) and, specifically, cough (OR = 1.38, 95% CI: 1.20–1.48). Exposure to high levels of pollution was associated with a high child mortality rate from all causes (IRR = 1.22, 95% CI: 1.08–1.39) and respiratory causes (IRR = 1.12, 95% CI: 0.88–1.42). The findings indicate that there are associated adverse health outcomes with air pollution in urban slums. Further research on air pollution health impact assessments in similar urban areas is required.

Place, publisher, year, edition, pages
MDPI, 2018
Keywords
air pollution, child health, child morbidity, child mortality, particulate matter, urban poor
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-153822 (URN)10.3390/atmos9090351 (DOI)000448137500026 ()
Available from: 2018-12-11 Created: 2018-12-11 Last updated: 2018-12-11Bibliographically approved
Projects
Enabling a smoke free society in Indonesia ? an integrated system-based intervention [2014-08010_Forte]; Umeå UniversityNetwork for International Longitudinal Studies on Ageing (NILSA). [2015-01499_Forte]; Umeå UniversityEffective use of today?s data to train tomorrow?s researchers on ageing and health [2016-07276_Forte]; Umeå UniversityCausation and Novel Risk Modelling for Person-Centred Prevention and Control of Cardiovascular Diseases [2017-02246_VR]; Umeå UniversityMitigating poverty and disablement in older age: Understanding the complex interactions of factors influencing equitable healthy ageing in Myanmar [2018-05196_VR]; Umeå UniversitySTAR-C: Sustainable behaviour change for health supported by person-Tailored, Adaptive, Risk-aware digital Coaching in a social context [2018-01461_Forte]; Umeå UniversityDesigning implementation research for integration of tuberculosis, diabetes, and tobacco control programme: research link collaboration between India, Indonesia, and Sweden [2018-05194_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0556-1483

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