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  • 151. Graham, Wendy J
    et al.
    Conombo, S Ghislaine
    Zombré, D Sosthène
    Meda, Nicolas
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    De Brouwere, Vincent
    Undertaking a complex evaluation of safe motherhood in rural Burkina Faso.2008Inngår i: Trop Med Int Health, ISSN 1365-3156, Vol. 13 Suppl 1, s. 1-5Artikkel i tidsskrift (Fagfellevurdert)
  • 152.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Chuc, NT
    Faculty of Public Health, Hanoi Medical University, Viet Nam.
    Phuc, HD
    Institute of Mathematics, Hanoi, Viet Nam.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Inequality in mortality in Vietnam during a period of rapid transition2010Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, nr 2, s. 232-239Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The associations between socioeconomic variables and mortality for 41,000 adults Vietnamese followed from January 1999 to March 2008 are estimated using Cox's proportionally hazard models. Also, we use decomposition techniques to investigate the relative importance of socioeconomic factors for explaining inequality in age-standardized mortality risk. The results confirm previously found negative association between mortality and income and education, for both men and women. We also found that marital status, at least for men, explain a large and growing part of the inequality. Finally, estimation results for relative education variables suggest that there exist positive spillover of education, meaning that that higher education of one's neighbors or spouse might reduce ones mortality risk.

    Fulltekst (pdf)
    Inequality in mortality in Vietnam during a period of rapid transition
  • 153. Grodzinsky, E
    et al.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Juto, P
    Olcén, P
    Fälth-Magnusson, K
    Persson, L A
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    New automated immunoassay measuring immunoglobulin A antigliadin antibodies for prediction of celiac disease in childhood.2001Inngår i: Clinical and diagnostic laboratory immunology, ISSN 1071-412X, Vol. 8, nr 3, s. 564-570Artikkel i tidsskrift (Fagfellevurdert)
  • 154.
    Grönblom-Lundström, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Rehabilitation in light of different theories of health: Outcome for patients with low-back complaints - a theoretical discussion2001Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The aim of this thesis was to investigate if the outcome of rehabilitation efforts is depending on what view health care has in relation to what need of care people have and if the outcome for different groups of patients with low-back complaints (specific versus non-specific complaints) is various successful. The outcome is measured in length of sick leave, number of spells and granted sickness and disability pensions.

    This thesis combines a theoretical analysis of different theories of health with studies of two empirical materials. One material comprises a group of individuals with low-back complaints (specific versus non-specific complaints) from a nation-wide survey of Living Conditions conducted by Statistics Sweden in 1981. The other material comprises a sample of individuals on sick leave either due to low-back complaints or other kinds of complaints than low-back complaints. The outcome of these studies are measured as to what extent people with low-back complaints are granted a disability pension (Paper III) and which the characteristics are of those on sick leave due to low-back complaints compared to those with other kinds of complaints (Paper IV). The results from Paper III revealed a difference concerning socio-economic group and granted disability pension between those with specific, non-specific and frequent low-back complaints. Those with non-specific and frequent low-back complaints were to higher extent manual workers and disability pensioners. The results of Paper IV reveals also a socio-economic difference besides that those with low-back complaints had longer sick leave periods and more spells. 

    What does these results indicate? Are non-specific and frequent low-back complaints not successfully treated within the health care system? Is this due to how these matters have been identified? Are these individuals truly disabled due to their low-back complaints, if so how are they assessed and treated? I believe that the notions of health and disease as well as the social context in which people act influence the outcome of rehabilitation. If people judge their health as bad (here due to low-back troubles) and in need of health care and the health care system do not recognise their need when not identified as diseased a problem arises. These individuals claim that their ability to work is hampered due to the low-back complaint and the society has an obligation and needs a legitimate solution for those individuals that cannot support themselves due to ill health. This obligation makes a demand on the health care system.

    If non-specific complaints are assessed as non-medical problems, from a biomedical point of view, health care lacks measures to take care of these people if they ought to be taken care of within the health care system at all. But this outcome (a disability pension) may also indicate that people suffer from a “true” illness although not defined by objective findings. If that is the state one may ask if there is a lack of sufficient diagnostic procedures and measures as well. A rehabilitation approach stemming from a humanistic social perspective might lead to a more favourable outcome for people with low-back complaints, whether or not these complaints have been identified in a biomedical sense, as this perspective take into account both the goals, the resources and the social context of that individual. 

    This thesis has paid attention to the matter that conceptual notions, which seldom are considered within clinical praxis, are of vital importance for the outcome of rehabilitation. Health care falls short especially when it comes to non-specific and frequent low-back complaints and this may be due to the biomedical model being used too strictly within a domain where other models, here exemplified as Pörn’s Theory of Health, might result in a more favourable rehabilitation outcome for the individual.

    Fulltekst (pdf)
    Rehabilitation in light of different theories of health
  • 155.
    Grönblom-Lundström, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Low-back complaints and other complaints as a reason for sick listing: a comparative study regarding work-related factors, socio-demographic factors, leisure-time, social support and perceived healthManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    The aim of this study was to investigate in what way people on sick leave due to low-back troubles distinguish as a group from other individuals on sick leave. The population in this study consisted of all individuals 20-64 years of age, who in 1991 belonged to a local health insurance office in northern Sweden. All individuals, born on day 5, 15 and 25, who had been on sick leave due to low-back (LB) complaints (low-back group) and a random sample of individuals, who had been on sick leave due to other kinds of complaints (reference group) constituted the study sample. Information was collected from their sickness records and from a questionnaire sent to each individual comprising questions about education, working environment, perceived health, social support, leisure time activities and smoking habits. There were no differences found regarding the sex of the individuals, leisure time activities or social support between the two studied groups. In the multivariate logistic regression analysis the result revealed that the LB group had longer sick leave periods, more spells and was to greater extent blue-collar workers.

    This may indicate differences in the working situation between the groups, which in turn may aggravate LB problems leading to longer sick leave or more spells. 

  • 156.
    Grönblom-Lundström, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Self-reported low-back complaints in a random population sample: specific versus non-specific complaintsManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    The purpose of this study was to investigate the distribution of selfreported low-back (LB) complaints in the social structure, and to investigate how the variables - physical work load, physical ability, Activities of Daily Living (ADL), mental job strain, social support, health and smoking - were associated with the different LB complaints. The Survey of Living Conditions carried out by Statistics Sweden 1980-81 has been used as the basis of the investigation. The LB complaints were dichotomised into specific and non-specific LB complaints according to an assumed grade of measurability. The non-specific LB complaints showed a social gradient which specific complaints did not despite the association with some of the variables. People, with a non-specific LB complaint, were besides that associated with a higher risk to become a sickness and disability pensioner than people with a specific LB complaint. This may indicate that either strategies used within the health care system in general are more suitable for specific complaints perhaps due to their higher grade of measurability or that people with a non-specific complaint suffers from an incapacitating illness that cannot be cured.

  • 157. Gustafsson, Monika
    et al.
    Ekholm, Jan
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    From shame to respect: musculoskeletal pain patients' experience of a rehabilitation programme, a qualitative study2004Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, nr 3, s. 97-103Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This study aimed to describe and analyse how participants with fibromyalgia or chronic, widespread, musculoskeletal pain, 1 year after completion, experienced a rehabilitation programme; and what knowledge and strategies they had gained.

    Design, methods and subjects: Semi-structured interviews with 16 female patients were analysed using the grounded theory method of constant comparison.

    Results: One core category, from shame to respect, and 4 categories, developing body awareness/knowledge, setting limits, changing self-image and negative counterbalancing factors, and hopelessness and frustration over one's employment situation emerged from the data. The core category represents a process where the informants changed emotionally. Three categories were identified as important for starting and maintaining the process, one category affected the process negatively.

    Conclusion: The rehabilitation programme started the process of change, from shame to respect. The informants learned new strategies for handling their pain and other symptoms; they improved their self-image and communication in their social environment.

  • 158. Gustavsson, M
    et al.
    Ekholm, J
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    From shame to respect - musculoskeletal pain patients' experiences of rehabilitation2004Inngår i: Rehabilitation Medicine, Vol. 36, s. 97-103Artikkel i tidsskrift (Fagfellevurdert)
  • 159. Gómez Real, F
    et al.
    Svanes, C
    Björnsson, E H
    Franklin, Karl
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Franklin, K
    Gislason, D
    Gislason, T
    Gulsvik, A
    Janson, C
    Jögi, R
    Kiserud, T
    Norback, D
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Torén, K
    Wentzel-Larsen, T
    Omenaas, E
    Hormone replacement therapy, body mass index and asthma in perimenopausal women: a cross sectional survey.2006Inngår i: Thorax, ISSN 0040-6376, Vol. 61, nr 1, s. 34-40Artikkel i tidsskrift (Fagfellevurdert)
  • 160.
    Hagberg, Lars
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Cost-effectiveness of the promotion of physical activity in health care2007Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Introduction

    Physical inactivity is a major cause of reduced quality of life, as well as many common diseases and even premature death. Most people, globally, are scarcely or rarely physically active. Consequently, physical inactivity influences the burden of disease, and increases its societal costs. In view of this, it is necessary to ask how health care should respond when the population and the patients are either inactive or rarely physically active. Cost-effectiveness analyses of the promotion of physical activity in health care can contribute substantially to health care policy.

    Aims

    The overall aim of this thesis was to investigate the cost-effectiveness of physical activity promotion in the health care system. The specific aims were: (I) to provide a model for analyzing cost-effectiveness and equity in health for community-promoted physical activity, (II) to review current knowledge about the cost-effectiveness of health care based interventions aimed at improving physical activity, (III) to evaluate the cost effectiveness of physical activity promotion as a treatment method in primary health care, (IV) to illustrate the importance of enjoyment of exercise in interventions aimed at promoting physical activity, and (V) to describe a method of valuing the time spent on exercise.

    Methods

    Standard methods for economic evaluation were studied and adapted to create a model for the evaluation of physical activity promotion (I). Relevant databases were searched for published articles, and the articles found were analyzed using this economic evaluation model (II). A trial in primary health care was evaluated in a cost-utility analysis based on the model (III). In the same trial, the association between time spent on exercise and enjoyment of exercise was analyzed (IV). A model for valuing the time spent on exercise was developed based on existing approaches to the valuation of time, and used in two different groups of exercisers; experienced and inexperienced (V).

    Results

    An economic evaluation model was developed, as was a model to calculate an intervention’s effect on equity in health (I). In total, 26 articles were found regarding the cost-effectiveness of physical activity promotion in health care, and 20 of these described interventions, which the authors considered to be cost-effective (II). The treatment of patients in primary health care by the promotion of physical activity was shown to be cost-effective (III). For the same group of patients, time spent on exercise was associated with enjoyment of exercise (IV). A model for valuing the time spent on exercise was developed and used. Time costs were significantly higher among inexperienced exercisers (V).

    Conclusions

    There are many examples of interventions promoting physical activity that may be regarded as cost-effective. In general, it seems to be cost effective to promote physical activity among patients with increased risk, or who manifest poor health associated with physical inactivity. Unfortunately, there is still little evidence of when physical activity should be used, or what the best design of such an intervention might be. Although there is still a need for stronger evidence, the Swedish health care system should use the promotion of physical activity as a standard method among the following patients:

    • those who manifest increased risk (such as high blood pressure) of ill health due to a physically inactive lifestyle;

    • frail older people, especially those with increased risk of fall injuries;

    • those requiring rehabilitation after heart failure.

    Fulltekst (pdf)
    FULLTEXT01
  • 161.
    Hagberg, Lars A
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Epidemiologi och folkhälsovetenskap.
    Cost-effectiveness of healthcare-based interventions aimed at improving physical activity.2006Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 34, nr 6, s. 641-653Artikkel i tidsskrift (Fagfellevurdert)
  • 162.
    Hagberg, Lars Axel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Epidemiologi och folkhälsovetenskap.
    Is promotion of physical activity a wise use of societal resources? Issues of cost-effectiveness and equity in health.2005Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 15, nr 5, s. 304-312Artikkel i tidsskrift (Fagfellevurdert)
  • 163. Hall, Charles S
    et al.
    Fottrell, Edward
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. UCL Institute for Global Health, London, UK.
    Wilkinson, Sophia
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Assessing the impact of mHealth interventions in low- and middle-income countries: what has been shown to work?2014Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, s. 1-12, artikkel-id 25606Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Low-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people's lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders.

    DESIGN: Comprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications.

    RESULTS: There is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects.

    CONCLUSIONS: Over all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base.

    Fulltekst (pdf)
    Fulltext
  • 164.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    An agenda for unemployment research: a challenge for public health.2005Inngår i: Int J Health Serv, ISSN 0020-7314, Vol. 35, nr 4, s. 765-77Artikkel i tidsskrift (Fagfellevurdert)
  • 165.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Do health consequences of unemployment differ among young men and women?2006Inngår i: Unemployment and health: International and interdisciplinary perspectives, Bowen Hills , 2006, s. 135-142Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 166.
    Hammarström, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Health selection in a 14-year follow-up study--a question of gendered discrimination?2005Inngår i: Soc Sci Med, ISSN 0277-9536, Vol. 61, nr 10, s. 2221-32Artikkel i tidsskrift (Fagfellevurdert)
  • 167.
    Hang, Hoang Minh
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Epidemiology of unintentional injuries in rural Vietnam2004Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The main objective of this epidemiological study was to assess the incidence of unintentional non-fatal injuries, together with their determinants and consequences, in a defined Vietnamese population, thus providing a basis for future prevention. A one-year follow-up survey involved four quarterly cross-sectional household injury interviews during 2000. This cohort study was based within a demographic surveillance site in Bavi district, northern Vietnam, which provides detailed, longitudinal information in a continuous and systematic way. Findings relate to three phases of the injury process: before, during and after injury.

    The study showed that unintentional non-fatal injuries were an important health problem in rural Vietnam. The high incidence rate of 89/1000 pyar reflected almost one tenth of the population being injured every year. Home injuries were found to be most common, often due to a lack of proper kitchens and dangerous surroundings in the home. Road traffic injuries were less common but tended to be more severe, with longer periods of disability and higher unit costs compared with other types of injury. The leading mechanisms of injury were impacts with other objects, falls, cuts and crushing. Males had higher injury incidence rates than females except among the elderly. Elderly females were often injured due to falls in the home. Being male or elderly were significant risk factors for injury. Poverty was a risk factor for injuries in general and specifically for home and work related injuries, but not for road traffic injuries. The middle income group was at higher risk of traffic injuries, possibly due to their greater mobility.

    Injuries not only affected people’s health, but were also a great financial burden. The cost of an injury, on average, corresponded to approximately 1.3 months of earned income, increasing to 7 months for a severe injury. Ninety percent of the economic burden of injury fell on households, only 8% on government and 2% on health insurance agencies. Self-treatment was the most common way of treating injuries (51.7%), even in some cases of severe injury. There was a low rate of use of public health services (23.2%) among injury patients, similar to private healthcare (22.4%). High cost, long distances, residence in mountains, being female and coming from ethnic minorities were barriers for seeking health services. People with health insurance sought care more, but the coverage of health insurance was very low.

    Some prevention strategies might include education and raising awareness about the possible dangers of injury and the importance of seeking appropriate care following injury. To avoid household hazards, several strategies could be used: better light in the evening, making gravel paths around the house, clearing moss to avoid slipping, wearing protective clothing when using electrical equipment and improving kitchens. Similarly, improving road surfaces, having separate paths for pedestrians and cyclists and better driver training could reduce road accidents.

    In Vietnam, and especially in a rural district without any injury register system, a community-based survey of unintentional injuries has been shown to be a feasible approach to injury assessment. It gave more complete results than could have been obtained from facility-based studies and led to the definition of possible prevention strategies.

    Fulltekst (pdf)
    FULLTEXT01
  • 168. Hang, Hoang Minh
    et al.
    Bach, T T
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Unintentional injuries over a 1-year period in a rural Vietnamese community: describing an iceberg.2005Inngår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 119, nr 6, s. 466-473Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To document unintentional injuries in a rural community over a 1-year period as a basis for prioritizing preventive activities. STUDY DESIGN: Quarterly home visits over 1 year to elicit experience of injury among household members in the preceding 3 months. METHODS: In total, 24,776 people living in rural communities in the Bavi District, Northern Vietnam, were surveyed in home visits during 2000. In the home visits, injuries that needed care or disrupted normal activities were recorded, together with their circumstances. RESULTS: Overall, 2079 new non-fatal injuries were recorded over 23,338 person-years, a rate of 89/1000 person-years-at-risk. Males had a significantly higher injury rate than females for all age groups except for those aged 35-59 years and the elderly (P<0.05). The elderly were at highest risk of injury (P<0.05), particularly females. Home injuries occurred at the highest overall rate, particularly among the elderly. Road traffic injuries were most common among children. Most injuries involved contact with another object. Less than one-quarter of injury victims sought care at a health facility. CONCLUSIONS: Community-based household surveys revealed the hidden part of the injury iceberg, as well as showing high incidence rates, indicating that injury is an important public health problem which should be a priority for intervention in rural Vietnam, and probably elsewhere. This comprehensive study is intended to contribute evidence and methods to the Ministry of Health's national programme for injury prevention, and to a wider audience.

  • 169. Hang, Hoang Minh
    et al.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Difficulties in getting treatment for injuries in rural Vietnam2009Inngår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 123, nr 1, s. 58-65Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Knowledge about the health-seeking behaviour of injury patients is important for the improvement of community health services. The aims of this study were: (1) to describe the healthcare-seeking behaviour of injury patients; (2) to examine factors associated with injury patients seeking care at health facilities; and (3) to describe the costs of health care for injury patients. STUDY DESIGN: This study took place in Bavi District, northern Vietnam within a longitudinal community surveillance site (FilaBavi). All non-fatal unintentional injuries occurring in a sample of 24,776 people during 2000 were recorded. METHOD: The injury questionnaire included information on care-seeking behaviour, severity and consequences of injury. Both univariate and multivariate logistic regression models were used to find associations between sociodemographic factors and utilization of any health services, as well as for each type of health service used, compared with the group who did not use any health services. RESULT: Of 24,776 persons living in the study area, 1917 reported 2079 new non-fatal debilitating injuries during the four 3-month periods of observation. Health-seeking behaviour relating to the first 1917 injuries was analysed. Self-treatment was most common (51.7%), even in cases of severe injury. There was low usage of public health services (23.2%) among injury patients. Long distances, poor economic status and residence in difficult geographic areas such as highlands and mountains were barriers for seeking health services. A large proportion of household income was spent on treating injury patients. Poor people spent a greater proportion of their income on health care than the rich, and often used less qualified or untrained private providers. CONCLUSIONS: These results demonstrate the logistical and financial difficulties associated with the treatment of injuries in rural Vietnam. This suggests the need to make public health subsidies available more efficiently and equitably. Whilst this study looked at the situation specifically in the context of injury treatment, it is likely that similar patterns apply in other areas of health care.

  • 170.
    Hang, Hoang Minh
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Ekman, Robert
    Bach, Ton That
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Svanström, Leif
    Community-based assessment of unintentional injuries: a pilot study in rural Vietnam2003Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, nr Supplement 62, s. 38-44Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: Although unintentional injuries are recognised as a major public health problem globally, little is known about their patterns and rates at the community level in most low-income countries. Rapid social development, leading to increased traffic and industrialization, may be changing patterns of injury. Injuries within the home environment have not so far been recognized to the same extent as traffic and work-related injuries in Vietnam, largely because they have not been effectively counted. This study took place in northern Vietnam, in the context of a longitudinal community surveillance site called FilaBavi, as a pilot project aiming to determine the community incidence of unintentional injury and to explore appropriate methods for community-based injury surveillance. METHODS: An initial study population of 23,807 was identified and asked about their experience of injury in the preceding three months. RESULTS: Overall 450 new injuries were detected over 5,952 person-years, a rate of 76 per 1,000 person-years. Males were injured at 1.6 times the rate of females, and home and road traffic accidents were most common. Most injuries occurred during unpaid household tasks. Cutting and crushing injuries occurred most frequently. Of 221 deaths from all causes in the FilaBavi population during 1999 among 43,444 person-years, 25 were attributed to unintentional injuries and two to suicide. Unintentional injury was the third leading cause of death in this community, with a case-fatality rate of 0.8%. DISCUSSION: The findings suggest that greater attention needs to be directed toward the prevention of injuries occurring in the home in rural Vietnam. On the basis of this pilot study, a one-year study using the same approach is under way to characterize the patterns of unintentional injury in more detail, including any seasonal variation.

  • 171. Hang, Minh Hang
    et al.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Svanström, Leif
    Incidence and seasonal variation of injury in rural Vietnam: a community-based survey2004Inngår i: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 42, nr 8, s. 691-701Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study objective: To describe seasonal effects on injury incidence at the community level and to assess the relative merits of cross-sectional or longitudinal surveillance for injuries in such a setting.

    Population and methods: This study took place in Bavi district, northern Vietnam, in the context of a longitudinal community surveillance site called FilaBavi. All non-fatal unintentional injuries which occurred in a sample of 24,776 people living in 5801 households were recorded during 2000. Four interview surveys per household were conducted continuously during 2000, each covering a 3-month period of recall. Injury morbidity data were analysed according to gender, age and circumstances of injury. Statistical analyses were based on monthly, quarterly and annual incidence rates with 95% confidence intervals. Significant differences between incidence rates were noted where the 95% confidence interval of the rate ratio excluded unity.

    Results: There were 1917 persons who experienced a total of 2079 new non-fatal injuries during the period of observation, corresponding to an incidence of 89/1000 person-years. Seasonal variations were found in all types of injury. Overall, the highest incidence rates were observed in July and April, while the lowest monthly rates were found in May and November. Peaks were observed in February and April for traffic injuries, June for work-related injuries, July, August and October for home injuries. A significantly higher incidence rate was found in the third quarter survey (103/1000 person-years, p<0.05).

    Conclusion: There can be interesting and significant seasonal variations in injury incidence within a community such as seen here in rural Vietnam and these variations have important implications for the design and planning of injury surveillance activities. Seasonal effects may cause invalid assessments of an injury problem if only cross-sectional household surveys are used, demonstrating the need for longitudinal approaches to injury incidence surveillance.

  • 172.
    Hansson, Maja
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Chotai, Jayanti
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nordström, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Bodlund, Owe
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Comparison of two self-rating scales to detect depression: HADS and PHQ-92009Inngår i: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 59, nr 566, s. e283-288Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: More than half of patients with depression go undetected. Self-rating scales can be useful in screening for depression, and measuring severity and treatment outcome. AIM: This study compares the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ-9) with regard to their psychometric properties, and investigates their agreement at different cut-off scores. METHOD: Swedish primary care patients and psychiatric outpatients (n = 737) who reported symptoms of depression completed the self-rating scales. Data were collected from 2006 to 2007. Analyses with respect to internal consistency, factor analysis, and agreement (Cohen's kappa) at recommended cut-offs were performed. RESULTS: Both scales had high internal consistency (alpha = 0.9) and stable factor structures. Using severity cut-offs, the PHQ-9 (> or =5) diagnosed about 30% more patients than the HADS depression subscale (HADS-D; > or =8). They recognised the same prevalence of mild and moderate depression, but differed in relation to severe depression. When comparing recommended screening cut-offs, HADS-D > or =11 (33.5% of participants) and PHQ-9 > or =10 (65.9%) agreement was low (kappa = 0.35). Using the lower recommended cut-off in the HADS-D (> or =8), agreement with PHQ-9 > or =10 was moderate (kappa = 0.52). The highest agreement (kappa = 0.56) was found comparing HADS-D > or =8 with PHQ-9 > or =12. This also equalised the prevalence of depression found by the scales. CONCLUSION: The HADS and PHQ-9 are both quick and reliable. The HADS has the advantage of evaluating both depression and anxiety, and the PHQ-9 of being strictly based upon the Diagnostic and Statistical Manual of Mental Disorders. The agreement between the scales at the best suitable cut-off is moderate, although the identified prevalence was similar. This indicates that the scales do not fully identify the same cases. This difference needs to be further explored.

  • 173.
    Hartini, T Ninuk S
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Padmawati, R Siwi
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Surjono, Achmad
    Winkvist, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    The importance of eating rice: changing food habits among pregnant Indonesian women during the economic crisis2005Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 61, nr 1, s. 199-210Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article presents qualitative and quantitative research findings on food habits of pregnant Indonesian women in relation to the economic crisis that arose in 1997. Between 1996 and 1998, dietary intakes were estimated for 450 pregnant women in Central Java. Between January and June 1999, four focus group discussions, 16 in-depth interviews and four non-participant observations were held with women, two in-depth interviews were held with traditional birth attendants, and four with midwives. Women were categorized as urban or rural, rich or poor, and according to rice field ownership. The women reported that before the crisis they bought more foods and cooked more meals and snacks. During the crisis, cooking methods became simpler and cooking tasty foods was more important than cooking nutritious foods. This involved using plenty of spices and cooking oil, but reducing the use of expensive nutritious foods. The herbal drink jamu was drunk by 15% of pregnant women; its consumption was lower during than before the economic crisis. Twenty-six percent of the women avoided certain foods due to food taboos, and most of these women avoided beneficial foods; this phenomenon decreased during the crisis among the rich and the rural, poor, landless women. In spite of increased prices for rice, women did not decrease their rice consumption during the crisis because rice was believed to have the highest value for survival, to provide strength during pregnancy and delivery, and to be easier to store and cook. Finally, children and husbands had highest priority in being served food, and women were the last to eat.

  • 174.
    Hartini, Theresia Ninuk Sri
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Food habits, dietary intake and nutritional status during economic crisis among pregnant women in Central Java, Indonesia2004Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    FOOD HABITS, DIETARY INTAKE AND NUTRITIONAL STATUS DURING ECONOMIC CRISIS AMONG PREGNANT WOMEN IN CENTRAL JAVA, INDONESIA

    Th. Ninuk Sri Hartini, Epidemiology and Public Health Sciences, Dept. of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Community Health and Nutrition Research Laboratories, Gadjah Mada University, Jogjakarta, Indonesia; Nutrition Academy, Ministry of Health, Jogjakarta, Indonesia

    ABSTRACT

    Objectives: The overall objective of this thesis was to study the effect of the economic crisis on food habits, dietary intake and nutritional status among pregnant women in Purworejo District, Central Java, Indonesia.

    Subjects and methods: Since 1994, the Community Health and Nutrition Research Laboratories (CHN-RL), Gadjah Mada University, Jogjakarta, Indonesia have operated a surveillance system in Purworejo District, Central Java, Indonesia. Between 1996 and 1998, a monthly monitoring of new pregnancies took place within the surveillance system. This project included a detailed evaluation of dietary intake during pregnancy. Each trimester six repeated 24-hour recalls were conducted on 450 pregnant women. Weight and mid-upper arm circumference (MUAC) were measured monthly, height and serum ferritin concentration was measured once. Here, the dietary intake and nutritional status of the women during the second trimester are evaluated in relation to the emergence of the economic crisis, that started in 1997. Women were classified into four socio-economic groups. A computer program (Inafood) was developed to calculate nutrient intake. To support the quantitative results, a qualitative study was carried out between January and June 1999. Focus group discussions were held with four groups of women, in-depth interviews with 16 women, three traditional birth attendants and four midwives, and observations were carried out with four women. Here, food habits and coping strategies in relation to the economic crisis were explored.

    Results: Before the crisis, more than 80% of the pregnant women had inadequate energy and 40% had inadequate protein and vitamin A intake. All women had inadequate calcium and iron intake. The food intake consisted of rice, nuts and pulses and vegetables, meaning that it was mainly plant-based food. Rice behaved as a strongly inferior good in economic term, meaning that its consumption increased in spite of its price increase. Rice remained an important supplier of energy, protein and carbohydrates also during the crisis. Especially, rural, poor women with access to rice fields increased their rice intake and decreased their intake of non-rice staple foods. Reasons for the continued rice intake included the women had been accustomed to eating rice since they were born and that cooking methods for non-rice staple foods were difficult. The intake of animal food was low initially and decreased further during the economic crisis. Rich women decreased their intake of fat. The intake of nuts and pulses and vegetables increased for most groups. Nuts and pulses were an important supplier of calcium and iron, and vegetables were an important supplier of vitamin A. The rural, poor women with access to rice fields kept their food taboos also during the crisis. Rich women were able to maintain a good nutrient intake during the crisis, although fat intake decreased. Also, urban poor and rural, poor, landless women had an increased intake “during crisis” because relatives and neighbour provided some foods and perhaps also because of the government support programme.

    Conclusion: Before the crisis, energy and nutrient intake of pregnant women were inadequate. The food pattern of the women was predominately plant-based. Rich women were able to maintain a good nutrient intake during the crisis, although fat intake decreased. Rural poor women with access to rice fields had a higher rice intake than other groups throughout the crisis. Urban poor and rural poor, landless women experienced a decreased intake of most nutrients in the transition period but an increased intake during the crisis, reflecting government intervention and support from relatives and neighbours. The latter, however, is not sustainable. Thus, vulnerable groups are at risk of developing nutritional deficiencies without food support programmes.

    Key words: Food intake, nutrient intake, nutritional status, food pattern, pregnancy, food habits, coping strategies, economic crisis, Indonesia.

    Fulltekst (pdf)
    FULLTEXT01
  • 175.
    Hartini, TNS
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Winkvist, A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindholm, L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stenlund, H
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Surjono, A
    Food pattern during economic crisis among pregnant women in Purworejo District, Central Java, Indonesia.2003Inngår i: Food and Nutrition Bulletin, ISSN 0379-5721, E-ISSN 1564-8265, Vol. 24, nr 3, s. 256-267Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A cross-sectional study was conducted between 1996 and 1998. Six 24-hour recalls were performed during the second trimester of pregnancy among 450 women in Purworejo District, Central Java, Indonesia. The objectives of the study were to assess the food intake and food pattern among pregnant women before and during the economic crisis. Before the crisis, rich women had the highest intakes of animal foods, fats and oils, and sugar. Food intake among the urban poor and the rural landless poor subgroups was influenced by the emerging economic crisis. Although the price of rice increased, the intake of rice also increased among all subgroups. Rural poor women with access to rice fields increased their intake of rice and decreased their intake of nonrice staple foods (p < .05). There were significant decreases in the consumption of chicken by rich women and rural poor women with access to rice fields (p < .05). Rice was a strongly inferior good and remained an important supplier of energy, protein, and carbohydrate. Nuts and pulses were important suppliers of calcium and iron, and vegetables were an important supplier of vitamin A. Rich women increased their intake of nuts and pulses, vegetables, fats and oils, and sugar when their intake of rice increased (p < .05). The food patterns were based on rice, nuts and pulses, and vegetables, i.e., plant food. All but the rich women decreased their intake of nutritious foods such as meat, chicken, and fruits. The intake of nuts and pulses and of vegetables increased, whereas the intake of cooking oil and sugar remained constant.

  • 176.
    Hartini, TNS
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Winkvist, A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindholm, L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, V
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Nurdiati, DS
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Surjono, A
    Nutrient intake and iron status of urban and rural poor without access to rice fields are affected by the emerging economic crisis: the case of pregnant Indonesian women2003Inngår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 57, nr 5, s. 654-666Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: We evaluated the adequacy of nutrient intake in comparison with the Indonesian Estimated Average Requirement (EARs) among pregnant Indonesian women and explain the short-term effect of economic crisis on nutrient intake and iron status. DESIGN: Cross-sectional study. SETTING: Purworejo District, Central Java, located 60 km west of Yogyakarta Province, Indonesia. SUBJECTS: During the period from 1996 to 1998, up to six 24 h recalls were performed during the second trimester of pregnancy among 450 women. Nutrient intake and iron status was evaluated in relation to date of data collection relative to the economic crisis that emerged in August 1997. A computer program (Inafood) was developed to calculate nutrient intake. RESULTS:: Forty percent of the pregnant women were at risk of inadequate intake of energy and protein, and 70% were at risk of inadequate intake of vitamin A, calcium and iron even before the crisis. Our results also demonstrate an effect of short-term economic crisis on nutrient intake and iron status. When the crisis emerged, urban poor experienced a decrease in intake of most nutrients. During the crisis, rich women experienced a significant decrease in fat (P<0.05). Negative changes in fat density during crisis were experienced by the rich and the rural, poor, and access to rice field subgroups (P<0.01). A significant increase in carbohydrate densities was seen for the rich and rural, poor, and access to rice fields groups (P<0.05). Urban poor experienced decreased serum ferritin concentration (P<0.05), whereas rich women experienced a significant increase (P<0.05). CONCLUSIONS: Urban poor and rural poor landless women were most directly affected by the emerging economic crisis.

  • 177.
    Hartini, TNS
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Winkvist, A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindholm, L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Surjono, A
    Hakimi, M
    Energy intake during economic crisis depends on initial wealth and access to rice fields: the case of pregnant Indonesian women2002Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 61, nr 1, s. 57-71Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Starting in August 1997, Indonesia experienced a radical and rapid deterioration in its economy. Between 1996 and 1998, dietary intake during the second trimester was measured in 450 pregnant women in Purworejo, Central Java, Indonesia. Using six 24 h recalls we describe the consequences of the economic crisis on the energy intake of pregnant Indonesian women. Depending on the date of data collection, women were grouped into 'before crisis', 'transition' and 'during crisis'. Mean energy intake among groups was compared using ANOVA and Student's t-test. All groups of pregnant women already had a mean energy intake before the emerging crisis that was lower than the Indonesian recommended dietary allowances (RDA). Nevertheless, energy intake differed significantly among women with different education levels (P = 0.00) and from different socio-economic groups (P = 0.00). 'During transition', a significant decrease in energy intake was experienced by urban poor women (P = 0.01). Poor women with access to rice fields had a higher rice consumption than other groups throughout the period. Our results most likely reflect the effect of higher rice price on income and welfare. 'During crisis', energy intake improved among vulnerable groups, perhaps reflecting government intervention.

  • 178.
    Hassler, Sven
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    The health condition in the Sami population of Sweden, 1961-2002: Causes of death and incidences of cancer and cardiovascular diseases2005Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The Sami people are the Natives of northern Scandinavia. The knowledge of the health and living conditions of the Swedish Sami is extremely limited which is in contrast to the large amount of detailed information on health and socioeconomic issues that is available for other circumpolar Natives. The encounter with the western society and the acculturation process has for many native populations had serious health consequences, causing a dramatic increase of lifestyle related diseases such as cancer, diabetes, stroke, obesity and hypertension as well as a dramatic increase of suicide and drug abuse.

    The overall objective of this thesis was to investigate the health conditions of the Sami population of Sweden using causes of death and incidences of cancer and cardiovascular diseases (CVD) as health indicators, and to evaluate their possible association with acculturative factors such as assimilation, integration, separation and marginalization.

    A Sami population was identified containing a total of 41 721 individuals. Specific cohorts were selected from this population for the different studies. A four times as large demographically matched non-Sami control population was used for comparisons.

    A study of causes of death, 1961-2000, showed small differences in overall mortality and life expectancy between the Sami and the non-Sami. However, Sami men showed significantly lower mortality risks for cancers but higher for external cause of injury and Sami women higher risks for diseases of the circulatory system (CVD) and of the respiratory system. An increased risk of dying from subarachnoid haemorrhage (SAH) was observed among both Sami men and women.

    The increased risk of dying from accidents among male reindeer herders is suggested to be caused by the increased socioeconomic pressure and the extensive use of terrain vehicles. It is concluded that commercial reindeer management is one of the most dangerous occupations in Sweden.

    In a study of the cancer risk among the reindeer herding Sami between 1961-1997, an overall lower risk to develop cancers, particularly prostate and malignant lymphoma was observed among the reindeer herding Sami. The risk for stomach cancer was significantly higher in relation to their non-Sami neighbours.

    The Sami and the non-Sami had similar risk factor-patterns for CVD. The main differences were related to working conditions and lifestyle factors of the reindeer herding Sami - the women showed a more unfavourable risk factor pattern than the men.

    Higher incidences of stroke were observed among Sami men and women compared to their non-Sami neighbours while the mortality rates of stroke were similar. The mortality ratio of AMI was increased for Sami women in spite of similar incidence ratios. A higher risk of SAH was observed among all groups of Sami. According to traditional socioeconomic risk factors, the differences in the levels of income and education observed between the Sami and the non-Sami, were poorely associated with the disparities of CVD.

    As has been shown, only minor differences in the health indicators were found between the Sami and their non-Sami neighbours. This is in clear contrast to several other native populations for which the health situation is largely unfavourable in comparison with that of the general population.

    The observed differences between the Sami and the non-Sami probably reflect differences in lifestyle, psychosocial and genetic factors. The relation between these factors and the acculturation process is dicussed, and it is suggested that separation or segregation of the reindeer herding Sami and the assimilation of the other Sami have influenced the health condition of the Sami, but with the largest impact probably prior to 1961 and the earliest start of follow-up for the studies in this thesis. Thus, the similarities in health between the Sami and the non-Sami 1961-2002, are probably a result of centuries of close interaction that has caused similarities in culture, attitudes and lifestyle, as well as equal accessibility to the health care services and the social security systems.

    Fulltekst (pdf)
    FULLTEXT01
  • 179.
    Hassler, Sven
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Johansson, Robert
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Sjölander, Per
    Grönberg, Henrik
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Damber, Lena
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Causes of death in the Sami population of Sweden, 1961-20002005Inngår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 34, nr 3, s. 623-629Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Indigenous people often have a pattern of mortality that is disadvantageous in comparison with the general population. The knowledge on causes of death among the Sami, the natives of northern Scandinavia, is limited. The aim of the present study was to compare gender and cause specific mortality patterns for reindeer herding Sami, non-herding Sami, and non-Sami between 1961 and 2000. METHODS: A Sami cohort was constructed departing from a group of index-Sami identified as either reindeer herding Sami or Sami eligible to vote for the Sami parliament. Relatives of index-Sami were identified in the National Kinship Register and added to the cohort. The cohort contained a total of 41 721 people (7482 reindeer herding Sami and 34 239 non-herding Sami). A demographically matched non-Sami reference population four times as large, was compiled in the same way. Relative mortality risks were analysed by calculating standardized mortality ratios (SMRs). RESULTS: The differences in overall mortality and life expectancy of the Sami, both reindeer herding and non-herding, compared with the reference population were relatively small. However, Sami men showed significantly lower SMR for cancers but higher for external causes of injury. For Sami women, significantly higher SMR was found for diseases of the circulatory system and diseases of the respiratory system. An increased risk of dying from subarachnoid haemorrhage was observed among both Sami men and women. CONCLUSIONS: The similarities in mortality patterns are probably a result of centuries of close interaction between the Sami and the non-Sami, while the observed differences might be due to lifestyle, psychosocial and/or genetic factors.

  • 180.
    Hassler, Sven
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Sjölander, Per
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Johansson, Robert
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Grönberg, Henrik
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Damber, Lena
    Umeå universitet, Medicinsk fakultet, Strålningsvetenskaper, Onkologi.
    Fatal accidents and suicide among reindeer-herding Sami in Sweden2004Inngår i: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 63 Suppl 2, s. 384-388Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Over the last decades, reindeer-herding management has experienced dramatic changes, e.g. increased motorization and socio-economic pressure. The aim of the present study was to investigate whether these changes have increased the risk of fatal, work-related accidents and suicide between 1961 and 2000. STUDY DESIGN AND METHODS: A cohort containing 7,482 members of reindeer-herding Sami families was extracted from national population registers. Information on fatal accidents and suicide was obtained from the Swedish Causes of Death Register, and compared to the expected number of deaths in a demographically matched control population of non-Sami. RESULTS: The male reindeer herding Sami showed a significantly increased risk of dying from accidents such as vehicle accidents and poisoning. No significant increased risk of suicide was observed. A comparison between the periods of 1961-1980 and 1981-2000 showed non-significant differences in risk, although a trend towards increased risks was observed for most types of external causes of death except suicide. CONCLUSIONS: It is suggested that the increased socio-economic pressure and the extensive use of terrain vehicles have increased the risk for fatal accidents among Swedish reindeer herders, and that commercial reindeer management is one of the most dangerous occupations in Sweden.

  • 181.
    Hernell, Olle
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Forsberg, G
    Hammarström, ML
    Hammarström, S
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Celiac disease: Effect of weaning on disease risk2005Inngår i: Nestlé Nutrition Workshops, 2005, s. 27-42Konferansepaper (Annet vitenskapelig)
  • 182.
    Hernell, Olle
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Forsberg, G
    Hammarström, S
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hammarström, M-L
    Coeliac disease: a model to study oral tolerance2002Inngår i: Gut Ecology, Martin Dunitz, London , 2002, s. 73-79Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 183.
    Hernell, Olle
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, L A
    Coeliac disease: effect of early feeding on the incidence of the disease.2001Inngår i: Early Hum Dev, ISSN 0378-3782, Vol. 65 Suppl, s. S153-60Artikkel i tidsskrift (Fagfellevurdert)
  • 184.
    Herrera Rodríguez, Andrés
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Dahlblom, Kjerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kullgren, Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Pathways to suicidal behaviour among adolescent girls in Nicaragua2006Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 62, nr 4, s. 805-814Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Adolescent girls are the most frequent suicide attempters worldwide. However, there is little knowledge about pathways leading to suicidal behaviour among young people, in particular in low-income countries. This study explores the motives and processes related to suicidal behaviour among young girls in Nicaragua. Individual in-depth interviews were conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. The audio-taped interviews lasted 2–4 h and were transcribed, translated into English and coded for content. Grounded theory and content analysis were used to construct a theory of the mechanisms behind their suicidal behaviour.

    A tentative model exploring pathways to suicidal behaviour is described with four main categories: structuring conditions, triggering events, emotions and actions taken. The model illustrates the dialectic interplay between structure and actions taken. Actions taken were categorized as problem solving or various forms of escape where failure with either of these strategies resulted in a suicide attempt.

    Dysfunctional families, absent fathers and lack of integration into society were some of the structuring conditions that lead to emotional distress. Abuse, deaths in the family, break-up with boyfriends or suicide among friends acted as triggering events. A striking finding was the obvious narrative competence of the girls.

    Our findings indicate that suicide prevention programmes for young people must offer support from professionals, independent of their family and social networks. Institutions in the community in contact with young people with suicidal behaviour must develop communicative skills to offer a trusting environment mobilising the resources that young people have.

  • 185. Hoa, Nguyen Quynh
    et al.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lundborg, Cecilia Stålsby
    Chuc, Nguyen Thi Kim
    Drug use and health-seeking behavior for childhood illness in Vietnam--a qualitative study.2007Inngår i: Health Policy, ISSN 0168-8510, Vol. 82, nr 3, s. 320-9Artikkel i tidsskrift (Fagfellevurdert)
  • 186. Hoang, Van Minh
    et al.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Dao, Lan Huong
    Nguyen, Thi Kim Chuc
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Risk factors for chronic disease among rural Vietnamese adults and the association of these factors with sociodemographic variables: findings from the WHO STEPS survey in rural Vietnam, 2005.2007Inngår i: Preventing Chronic Disease, E-ISSN 1545-1151, Vol. 4, nr 2, s. A22-Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
    fulltext
  • 187. Hoang, Van Minh
    et al.
    Dao, Lan Huong
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Nguyen, Thi Kim Chuc
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Cardiovascular disease mortality and its association with socioeconomic status: findings from a population-based cohort study in rural Vietnam, 1999-2003.2006Inngår i: Preventing Chronic Disease, E-ISSN 1545-1151, Vol. 3, nr 3, s. A89-Artikkel i tidsskrift (Fagfellevurdert)
  • 188.
    Hoi, Le Van
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Phuc, Ho D
    Institute of Mathematics, Vietnamese Academy of Science and Technology, Vietnam.
    Dung, Truong V
    Hanoi Medical University, Vietnam.
    Chuc, Nguyen TK
    Hanoi Medical University, Vietnam.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Remaining life expectancy among older people in a rural area of Vietnam: trends and socioeconomic inequalities during a period of multiple transitions2009Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 9, nr 1, s. 471-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Better understanding of the trends and disparities in health at old age in terms of life expectancy will help to provide appropriate responses to the growing needs of health and social care for the older population in the context of limited resources. As a result of rapid economic, demographic and epidemiological changes, the number of people aged 60 and over in Vietnam is increasing rapidly, from 6.7% in 1979 to 9.2% in 2006. Life expectancy at birth has increased but not much are known about changes in old ages. This study assesses the trends and socioeconomic inequalities in RLE at age 60 in a rural area in an effort to highlight this vulnerable group and to anticipate their future health and social needs.

    METHODS: An abridged life table adjusted for small area data was used to estimate cohort life expectancies at old age and the corresponding 95% confidence intervals from longitudinal data collected by FilaBavi DSS during 1999-2006, which covered 7,668 people at age 60+ with 43,272 person-years, out of a total of 64,053 people with 388,278 person-years. Differences in life expectancy were examined according to socioeconomic factors, including socio-demographic characteristics, wealth, poverty and living arrangements.

    RESULTS: Life expectancies at age 60 have increased by approximately one year from the period 1999-2002 to 2003-2006. The increases are observed in both sexes, but are significant among females and relate to improvements among those who belong to the middle and upper household wealth quintiles. However, life expectancy tends to decrease in the most vulnerable groups. There is a wide gap in life expectancy according to poverty status and living arrangements, and the gap by poverty status has widened over the study period. The gender gap in life expectancy is consistent across all socioeconomic groups and tends to be wider amongst the more disadvantaged population.

    CONCLUSIONS: There is a trend of increasing life expectancy among older people in rural areas of Vietnam. Inequalities in life expectancy exist between socioeconomic groups, especially between different poverty levels and also patterns of living arrangements. These inequalities should be addressed by appropriate social and health policies with stronger targeting of the poorest and most disadvantaged groups.

    Fulltekst (pdf)
    fulltext
  • 189. Holmberg, L
    et al.
    Duffy, SW
    Yen, AMF
    Tabár, L
    Vitak, B
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Frisell, J
    Differences in endpoints between the Swedish W-E (two county) trial of mammographic screening and the Swedish overview: methodological consequences.2009Inngår i: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 16, nr 2, s. 73-80Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To characterize and quantify the differences in the number of cases and breast cancer deaths in the Swedish W-E Trial compared with the Swedish Overview Committee (OVC) summaries and to study methodological issues related to trials in secondary prevention.

    SETTING: The study population of the W-E Trial of mammography screening was included in the first (W and E county) and the second (E-county) OVC summary of all Swedish randomized mammography screening trials. The OVC and the W-E Trial used different criteria for case definition and causes of death determination.

    METHOD: A Review Committee compared the original data files from W and E county and the first and second OVC. The reason for a discrepancy was determined individually for all non-concordant cases or breast cancer deaths.

    RESULTS: Of the 2615 cases included by the W-E Trial or the OVC, there were 478 (18%) disagreements. Of the disagreements 82% were due to inclusion/exclusion criteria, and 18% to disagreement with respect to cause of death or vital status at ascertainment. For E-County, the OVC inclusion rules and register based determination of cause of death (second OVC) rather than individual case review (W-E Trial and 1st OVC) resulted in a reduction of the estimate of the effect of screening, but for W-County the difference between the original trial and the OVC was modest.

    CONCLUSIONS: The conclusion that invitation to mammography screening reduces breast cancer mortality remains robust. Disagreements were mainly due to study design issues, while disagreements about cause of death were a minority. When secondary research does not adhere to the protocols of the primary research projects, the consequences of such design differences should be investigated and reported. Register linkage of trials can add follow-up information. The precision of trials with modest size is enhanced by individual monitoring of case status and outcome status such as determination of cause of death.

  • 190.
    Horton, Richard
    et al.
    The Lancet, London NW1 7BY, UK.
    Beaglehole, Robert
    Bonita, Ruth
    Auckland, New Zealand .
    Raeburn, John
    Auckland, New Zealand .
    McKee, Martin
    London, UK.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    The Federation's Pages2014Inngår i: Journal of Public Health Policy, ISSN 0197-5897, E-ISSN 1745-655X, Vol. 35, nr 3, s. 351-356Artikkel i tidsskrift (Fagfellevurdert)
  • 191. Hounton, Sennen
    et al.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. University of Aberdeen, Immpact, Aberdeen, Scotland.
    Brahima, Bassane
    Towards reduction of maternal and perinatal mortality in rural Burkina Faso: communities are not empty vessels2009Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Reducing maternal and perinatal mortality in sub Saharan Africa remains challenging and requires effective and context specific interventions. OBJECTIVE: The aims of this paper were to demonstrate the impact of the community mobilisation of the Skilled Care Initiative (SCI) in reducing maternal and perinatal mortality and to describe the concept and implementation in order to guide replication and scaling up. DESIGNS: A quasi experimental design was used to assess the extent to which the SCI was associated with increased institutional births, maternal and perinatal mortality reduction in an intervention (Ouargaye) versus a comparison (Diapaga) district. A geo-referenced census was conducted to retrospectively assess changes in outcomes and process measures. A detailed description of activities, rationale and timing of implementation were gathered from the SCI project officers and summarised. Data analyses included descriptive statistics and multivariate analyses. RESULTS: At macro level, the main significant difference between Ouargaye and Diapaga districts was the scope and intensity of the community-based interventions implemented in Ouargaye. There was a temporal association relationship before and after the implementation of the demand-driven interventions and a remarkable 30% increase in institutional births in the intervention district compared to 10% increase in comparison district. There was a significant reduction of perinatal mortality rates (OR =0.75, CI 0.70-0.80) in intervention district and a larger decrease in maternal mortality ratios in intervention district, although statistical significance was not reached. A comprehensive framework of community mobilisation strategy is proposed to improve maternal and child health in poorest communities. CONCLUSION: Controlling for the availability and quality of health services, working in partnership and effectively with communities, and not for them - hence characterising communities as not being empty vessels - can have impacts on outcomes. Here, in the district with a community mobilisation programme, there was a marked increase in institutional births and reductions in maternal and perinatal deaths.

    Fulltekst (pdf)
    Towards reduction of maternal and perinatal mortality in rural Burkina Faso: communities are not empty vessels
  • 192. Hounton, Sennen
    et al.
    Menten, Joris
    Ouédraogo, Moctar
    Dubourg, Dominique
    Meda, Nicolas
    Ronsmans, Carine
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    De Brouwere, Vincent
    Effects of a Skilled Care Initiative on pregnancy-related mortality in rural Burkina Faso.2008Inngår i: Trop Med Int Health, ISSN 1365-3156, Vol. 13 Suppl 1, s. 53-60Artikkel i tidsskrift (Fagfellevurdert)
  • 193.
    Hultdin, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Thøgersen, Ann Margreth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Nilsson, T K
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Elevated plasma homocysteine: cause or consequence of myocardial infarction?2004Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 256, nr 6, s. 491-498Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To determine whether a first myocardial infarction leads to increased plasma homocysteine concentrations and whether the association between homocysteine and myocardial infarction was greater at follow-up compared with baseline. DESIGN: A population-based, prospective, nested case-referent study. SETTING: Screening took place at the nearest health survey centre in northern Sweden. SUBJECTS: Of more than 36,000 persons screened, 78 developed a first myocardial infarction (average 18 months after sampling). Fifty of these had participated in a follow-up health survey (average 8(1/2) years between surveys) and were sex- and age-matched with 56 referents. MAIN OUTCOME MEASURES: Comparison of plasma homocysteine levels in case and referent subjects before and after development of a first myocardial infarction. RESULTS: No statistically significant difference was found between cases and referents regarding homocysteine at baseline or follow-up. Plasma homocysteine and plasma creatinine increased significantly, and plasma albumin decreased significantly over time. Conditional univariate logistic regression indicated that high homocysteine at follow-up but not baseline was associated with first myocardial infarction (OR 2.49; 95% CI: 1.03-6.02), but the relation disappeared in multivariate analyses including plasma creatinine and plasma albumin. High plasma creatinine remained associated with first myocardial infarction at both baseline (OR 2.94; 95% CI: 1.05-8.21) and follow-up (OR 3.38; 95% CI: 1.21-9.48). CONCLUSION: In this study, first myocardial infarction did not cause increased plasma homocysteine concentration.

  • 194.
    Huong, Dao Lan
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Mortality in transitional Vietnam2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Understanding mortality patterns is an essential pre-requisite for guiding public health action and for supporting development of evidence-based policy. However, such information is not sufficiently available in Vietnam. Mortality statistics and causes of death are solely collected from health facilities while most deaths occur at home without the presence of health professionals. Facility-based data cannot represent what happened in the wider community. This thesis studies the patterns and burdens of mortality as well as their relationships with socio-economic status in rural Vietnam. The overall aim is to contribute to the improvement of the current system of mortality data collection in the country for the purposes of public health planning and priority setting.

    The study was carried out within the framework of an ongoing Demographic Surveillance System (DSS) in Bavi district, Hatay province, northern rural Vietnam. This study used a verbal autopsy (VA) approach to identify cause of death in a cohort of approximately 250,000 person- years over a five-year period from 1999 to 2003.

    During the five year study, a total of 1,240 deaths were recorded and VA was successfully completed for 1,220 cases. Results revealed that VA was an appropriate and useful method for ascertaining cause of death in this rural Vietnamese community where specific data were otherwise scarce. The mortality pattern reflected a transitional pattern of disease in which the leading cause of death was cardiovascular diseases (CVD), followed by neoplasms, infectious and parasitic diseases, and external causes, accounting for 28.9%, 14.5%, 11.2%, and 9.8%, respectively. In terms of premature mortality, there were 85 and 55 Years of Life Lost (YLL) per 1,000 population for males and females respectively. The largest contributions to YLL were CVDs, malignant neoplasms, unintentional injuries, and perinatal and neonatal causes. In general, men had higher mortality rates than women for all mortality categories. In adults of 20 years and above, mortality rates increased substantially with age, and showed similar age effects for all mortality categories with the strongest association for non-communicable diseases (NCD). Education was an important factor for survival in general, and high economic status seemed to benefit men more than women. Compared with cancer and other NCD causes, higher CVD rates were observed among males, the elderly, and those without formal education, using a Cox proportional hazards model.

    This study is an initial effort to provide information on mortality patterns in a community using longitudinal follow-up of a dynamic cohort. Continuing the study using the VA approach as part of routine data collection in the setting will help to show trends in mortality patterns for the community over time, which may be useful for priority setting and health planning purposes, not only locally but also at the national level. Further analyses are needed to understand mortality inequality across all ages to have a comprehensive picture of mortality burdens in the setting. Validation studies and further standardization of VA methods should be carried out whenever possible to improve the performance and extension of the technique.

    Fulltekst (pdf)
    FULLTEXT01
  • 195.
    Huong, Dao Lan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Minh, Hoang Van
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Applying verbal autopsy to determine cause of death in rural Vietnam2003Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, nr Suppl. 62, s. 19-25Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Aims: Verbal autopsy (VA) is an attractive method for ascertaining causes of death in settings where the proportion of

    people who die under medical care is low. VA has been widely used to determine causes of childhood and maternal deaths,

    but has had limited use in assessing causes in adults and across all age groups. The objective was to test the feasibility of

    using VA to determine causes of death for all ages in Bavi District, Vietnam, in 1999, leading to an initial analysis of the

    mortality pattern in this area. Methods: Trained lay field workers interviewed a close caretaker of the deceased using a

    combination closed/open-ended questionnaire. Results: A total of 189 deaths were studied. Diagnoses were made by two

    physicians separately, with good agreement (k~0.84) and then combined to reach one single underlying cause of death for

    each case. The leading causes of death were cardiovascular and infectious diseases (accounting for 20.6% and 17.9% of the

    total respectively). Drowning was very prevalent in children under 15 (seven out of nine cases of drowning were in this age

    group). Discussion: One month seemed an acceptable minimum recall period to ensure mourning procedures were over. A

    combination VA questionnaire was an appropriate instrument provided it was supported by adequate training of

    interviewers. Two physicians were appropriate for making the diagnoses but predefined diagnostic methods for common

    causes should be developed to ensure more replicable results and comparisons, as well as to observe trends of mortality over

    time. The causes of death in this study area reflect a typical pattern for developing countries that are in epidemiological

    transition. No maternal deaths and a low infant mortality rate may be the result of improvements in maternal and child

    health in this study area. Using the VA gave more precise causes of death than those reported at death registration.

    Although the validity of the VA method used has not been fully assessed, it appeared to be an appropriate method for

    ascertaining causes of death in the study area.

    Key words: cause of death, community data, field survey, mortality, verbal autopsy, Vietnam.

  • 196. Huong, Dao Lan
    et al.
    Minh, Hoang Van
    Vos, Theo
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Van, Do Duc
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Burden of premature mortality in rural Vietnam from 1999 - 2003: analyses from a Demographic Surveillance Site2006Inngår i: Population Health Metrics, E-ISSN 1478-7954, Vol. 4, s. Article nr 9-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Assessing the burden of disease contributes towards evidence-based allocation of limited health resources. However, such measures are not yet commonly available in Vietnam. Taking advantage of the FilaBavi Demographic Surveillance Site (FilaBavi DSS) in Vietnam, this study aimed to establish the feasibility of applying the Years of Life Lost (YLL) technique in the context of a defined DSS, and to estimate the importance of the principal causes of premature mortality in a rural area of Vietnam between 1999 and 2003.

    Methods: Global Burden of Disease methods were applied. Causes of death were ascertained by verbal autopsy.

    Results: In five years, 1,240 deaths occurred and for 1,220 cases cause of death information from verbal autopsy was available. Life expectancy at birth was 71.0 (95% confidence interval 69.9–72.1) in males and 80.9 (79.9–81.9) in females. The discounted, but not age weighted YLL per 1,000 population was 85 and 55 for males and females, respectively. The leading causes of YLL and death counts were cardiovascular diseases, malignant neoplasms, unintentional injuries, and neonatal causes. Males contributed 54% of total deaths and 59% of YLL. Males experienced higher YLL than women across all causes. Filabavi mortality estimates are considerably lower than 2002 WHO country estimates for Vietnam. Also the FilaBavi cause distribution varies considerably from the WHO result.

    Conclusion: The combination of localised demographic surveillance, verbal autopsy and the application of YLL methods enable new insights into the magnitude and importance of significant public health issues in settings where evidence for planning is otherwise scarce. Local mortality data vary considerably from the WHO model-based estimates.

    Fulltekst (pdf)
    Burden of premature mortality in rural Vietnam from 1999 - 2003: analyses from a Demographic Surveillance Site
  • 197. Huong, Dao Lan
    et al.
    Van Minh, Hoang
    Janlert, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Van, Do Duc
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Socio-economic status inequality and major causes of death in adults: a 5-year follow-up study in rural Vietnam.2006Inngår i: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 120, nr 6, s. 497-504Artikkel i tidsskrift (Fagfellevurdert)
  • 198.
    Hurtig, Anna-Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Porter, JDH
    Ogden, JA
    Tuberculosis control and directly observed therapy from the public health / human rights perspective2005Inngår i: Perspectives on health and human rights, Routhledge, New York , 2005Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 199.
    Hurtig, Anna-Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Epidemiology vs epidemiology: the case of oil exploitation in the Amazon basin of Ecuador.2005Inngår i: Int J Epidemiol, ISSN 0300-5771, Vol. 34, nr 5, s. 1170-2Artikkel i tidsskrift (Fagfellevurdert)
  • 200.
    Hurtig, Anna-Karin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    San Sebastian, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Incidence of childhood leukemia and oil exploitation in the Amazon basin of Ecuador.2004Inngår i: International journal of occupational and environmental health, ISSN 1077-3525, Vol. 10, nr 3, s. 245-50Artikkel i tidsskrift (Fagfellevurdert)
1234567 151 - 200 of 557
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