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  • 301. Ludvigsson, Jonas F
    et al.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Coeliac disease: Decision tool needs to be developed for children.2007Inngår i: The BMJ, E-ISSN 1756-1833, Vol. 334, nr 7599, s. 864-Artikkel i tidsskrift (Annet vitenskapelig)
    Fulltekst (pdf)
    Coeliac Disease Decision tool needs to be developed for children
  • 302. Lugalla, Joe
    et al.
    Emmelin, Maria
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Mutembei, Aldin
    Sima, Mwiru
    Kwesigabo, Gideon
    Killewo, Japhet
    Dahlgren, Lars
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Social, cultural and sexual behavioral determinants of observed decline in HIV infection trends: lessons from the Kagera Region, Tanzania.2004Inngår i: Soc Sci Med, ISSN 0277-9536, Vol. 59, nr 1, s. 185-98Artikkel i tidsskrift (Fagfellevurdert)
  • 303. Lugina, Helen I
    et al.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Christensson, Kyllike
    Lindmark, Gunilla
    Assessing mothers' concerns in the postpartum period: methodological issues.2004Inngår i: J Adv Nurs, ISSN 0309-2402, Vol. 48, nr 3, s. 279-90Artikkel i tidsskrift (Fagfellevurdert)
  • 304.
    Lundqvist, Gunnar
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Sandström, Herbert
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Patterns of tobacco use: a 10-year follow-up study of smoking and snus habits in a middle-aged Swedish population2009Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, nr 2, s. 161-167Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To study longitudinal patterns of tobacco use over a 10-year period among middle-aged men and women in Västerbotten County, Northern Sweden.

    Methods: The study is based on data from the 16,486 (8800 women and 7686 men) in the Västerbotten Intervention Programme (VIP) where people were invited to a health screening and counselling programme at 30, 40, 50 and 60 years of age.

    Results: Smoking decreased from 22.3% to 15.6% among women and from 18.5% to 12.7% among men. Use of snus (Swedish moist snuff) increased from 3.1% to 6.0% among women and from 24.6% to 26.3% among men. The number of people who used both snus and cigarettes was stable: 0.5% to 0.8% from baseline to follow-up for women, and 4.1% to 3.3% for men. The number of tobacco-free adults increased from 75.2% to 79.2% for women and from 61.1% to 64.3% for men. Of those who became smoke-free during the 10-year follow-up period, 80% of the women and 66% of the men quit smoking without transitioning to snus use.

    Conclusions: The majority of middle-aged Swedish men and women in this cohort that quit smoking did so without becoming snus dependent. In spite of an increasing use of snus, overall there was a decline in the number of people using tobacco products.

  • 305.
    Lämås, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindholm, Lars
    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.
    Engström, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jacobsson, Catrine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Effects of abdominal massage in management of constipation: a randomized controlled trial2009Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 46, nr 6, s. 759-767Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Associated with decreases in quality of life, constipation is a relatively common problem. Abdominal massage appears to increase bowel function, but unlike laxatives with no negative side effects. Because earlier studies have methodological flaws and cannot provide recommendations, more research is needed.

    Objective. This study investigates the effects of abdominal massage on gastrointestinal functions and laxative intake in people who have constipation.

    Design. Randomized controlled trial.

    Participants and method. A sample of 60 people with constipation was included and randomised in two groups. The intervention group received abdominal massage in addition to an earlier prescribed laxative and the control group received only laxatives according to earlier prescriptions. Gastrointestinal function was assessed with Gastrointestinal Symptoms Rating Scale (GSRS) on three occasions; at baseline, week 4 and week 8. The statistical methods included linear regression, Wilcoxon sign rank test, and Mann-Whitney U-test.

    Result. Abdominal massage significantly decreased severity of gastrointestinal symptoms assessed with GSRS according to total score (p=.003), constipation syndrome (p=.013), and abdominal pain syndrome (p=.019). The intervention group also had significant increase of bowel movements compared to the control group (p=.016). There was no significant difference in the change of the amount of laxative intake after 8 weeks.

    Conclusions. Abdominal massage decreased severity of gastrointestinal symptoms, especially constipation and abdominal pain syndrome, and increased bowel movements. The massage did not lead to decrease in laxative intake, a result that indicates that abdominal massage could be a complement to laxatives rather than a substitute.

  • 306.
    Lämås, Kristina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Willman, Ania
    Sektionen för hälsa, Blekinge Tekniska Högskola.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Jacobsson, Catrine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Economic evaluation of nursing practices: a review of literature2009Inngår i: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 56, nr 1, s. 13-20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The importance of cost-effectiveness of nursing practices and its influence on prioritizations has been discussed in literature. It is, however, unclear to what extent health economic analysis has been used in the area of nursing.

    Aim: The aim of this paper was to investigate how studies of nursing practices apply economic evaluations.

    Methods: A literature review was conducted that included studies through August 2007. The search was performed using Medline, CINAHL, PsycINFO, Econlit, DARE, HTA, NHS EED, Cochrane reviews, and clinical trials with a search term connected to nursing and health economics. Protocols were used in the screening procedure and the result is reported in a descriptive form.

    Results: The search identified 115 studies published between1984 and august 2007. Studies were found in the following nursing practices: provision of support and treatment (n=17); assessing suffering/wellbeing (n=1); preventing or treating ill health (n=53); and organization of individual care (n=44). In 22% of all studies, the authors explicitly presented the health economic method used. In 25% of all studies, the perspective of the economic analysis was explicitly stated and there were a large variability in cost considered in the analysis. In 82 studies, the authors reported cost-effective intervention.

    Conclusions: Although economic evaluation of nursing practice has increased, it is still a rather small area. According to the items elucidated in this study, further methodological improvement is needed to evaluate the economics of nursing.

  • 307.
    Löfgren, Curt
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Olofsson, Mona
    Department of Medicine, Skellefteå County Hospital, Skellefteå, Sweden.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Is cardiac consultation with remote-controlled real-time echocardiography a wise use of resources?2009Inngår i: Telemedicine journal and e-health, ISSN 1530-5627, E-ISSN 1556-3669, Vol. 15, nr 5, s. 431-438Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Northern Sweden is a sparsely populated area with six hospitals and about 50 healthcare centers. The elderly population is a large proportion of the total of population, and the incidence of cardiovascular disease is high. The objective of this research was to analyze the costs and benefits of cardiac consultation in healthcare centers involving long-distance, remote-controlled, real-time echocardiography. The distance diagnostics were developed and tested in two healthcare centers. Experiences of the feasibility of this approach were used as a basis for an economic analysis with regard to heart failure. The societal costs for two different systems were calculated, namely, traditional hospital diagnosis versus distance diagnosis using the new system. The potential prime gainers were the patients. Their traveling time, and thereby their time costs, were significantly reduced. The quality of care may also have been improved. From the health authorities' perspective, the costs of the two systems were approximately equal. Since county council costs are not greatly affected, the large reduction in patient travel time and the improved quality of care ought to be a sufficient incentive for large-scale tests.

  • 308.
    Löfgren, Curt
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Thanh, Nguyen
    Institute of Health Economics, Edmonton, Canada.
    Chuc, Nguyen
    Dept. of Health Economics, Faculty of Public Health, Hanoi Medical University, Vietnam.
    Emmelin, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    People's willingness to pay for health insurance in rural Vietnam2008Inngår i: Cost Effectiveness and Resource Allocation, E-ISSN 1478-7547, Vol. 6, s. 16-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The inequity caused by health financing in Vietnam, which mainly relies on out-of-pocket payments, has put pre-payment reform high on the political agenda. This paper reports on a study of the willingness to pay for health insurance among a rural population in northern Vietnam, exploring whether the Vietnamese are willing to pay enough to sufficiently finance a health insurance system.

    METHODS: Using the Epidemiological Field Laboratory for Health Systems Research in the Bavi district (FilaBavi), 2070 households were randomly selected for the study. Existing FilaBavi interviewers were trained especially for this study. The interview questionnaire was developed through a pilot study followed by focus group discussions among interviewers. Determinants of households' willingness to pay were studied through interval regression by which problems such as zero answers, skewness, outliers and the heaping effect may be solved.

    RESULTS: Households' average willingness to pay (WTP) is higher than their costs for public health care and self-treatment. For 70-80% of the respondents, average WTP is also sufficient to pay the lower range of premiums in existing health insurance programmes. However, the average WTP would only be sufficient to finance about half of total household public, as well as private, health care costs. Variables that reflect income, health care need, age and educational level were significant determinants of households' willingness to pay. Contrary to expectations, age was negatively related to willingness to pay.

    CONCLUSION: Since WTP is sufficient to cover household costs for public health care, it depends to what extent households would substitute private for public care and increase utilization as to whether WTP would also be sufficient enough to finance health insurance. This study highlights potential for public information schemes that may change the negative attitude towards health insurance, which this study has uncovered. A key task for policy makers is to win the trust of the population in relation to a health insurance system, particularly among the old and those with relatively low education.

    Fulltekst (pdf)
    People's willingness to pay for health insurance in rural Vietnam
  • 309. Löfgren, Monika
    et al.
    Ekholm, Jan
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    'A constant struggle': successful strategies of women in work despite fibromyalgia.2006Inngår i: Disabil Rehabil, ISSN 0963-8288, Vol. 28, nr 7, s. 447-55Artikkel i tidsskrift (Fagfellevurdert)
  • 310.
    Löfroth, Emil
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Centre for Epidemiology, National Board of Health and Welfare, SE-106 30, Stockholm, Sweden.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Wilhelmsen, Lars
    Rosén, Måns
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Centre for Epidemiology, National Board of Health and Welfare, SE-106 30, Stockholm, Sweden.
    Optimising health care within given budgets: primary prevention of cardiovascular disease in different regions of Sweden2006Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 75, nr 2, s. 214-229Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study investigated the consequences of applying strict health maximisation to the choice between three different interventions with a defined budget. We analysed three interventions or preventing cardiovascular diseases, through doctor's advice on smoking cessation, through blood-pressure-lowering drugs. and through lipid-lowering drugs. A state transition model has been used to estimate the cost-utility ratios for entire population in three different county Councils in Sweden, where the populations were stratified into mutually excluding risk groups. The incremental cost-utility ratios are being presented in a league table and combined with the local resources and the local epidemiological data as a proxy for need for treatment, All interventions with an incremental cost-utility ratio exceeding the threshold ratios are excluded from being funded, The threshold varied between 1687 EURO and 6192 EURO. The general reallocation of resources between the three interventions Was a 60% reduction of blood-pressure-lowering drugs with redistribution of resources to advice on smoking cessation and to lipid-lowering drugs. One advantage of this method is that the results are very concrete. Recommendations can thereby he more precise which hopefully will create a public debate between decision-makers, practising phsicians and patient groups.

  • 311. Löwhagen, Gun-Britt
    et al.
    Berntsson, Matilda
    Bonde, Ellen
    Tunbäck, Petra
    Krantz, Ingela
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Acceptance and outcome of herpes simplex virus type 2 antibody testing in patients attending an STD clinic: recognized and unrecognized infections2005Inngår i: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 85, nr 3, s. 248-252Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The majority of herpes simplex virus type 2 (HSV-2) genital infections are asymptomatic. We wanted to evaluate the acceptance of HSV-2 antibody testing among people attending an STD clinic and to estimate, after counselling, the percentage of recognized and unrecognized HSV-2 infections. First visitors to an STD clinic were invited to participate by answering a questionnaire and taking a blood test for HSV-2 antibodies. HSV-2 seropositive individuals, who were unaware of having genital herpes, were offered an HSV-2 counselling visit and follow-up, Of 1769 patients offered testing, 57% accepted. Of 152 (15%) HSV-2 seropositive individuals, 41% had a self-reported history of genital herpes, approximately 30% had genital symptoms and 30% had no genital symptoms. The percentage of patients reporting genital symptoms was much higher in HSV-2 seropositives (45%) without a history of genital herpes than in an HSV-2 seronegative group (28%). HSV-2 antibody testing should be performed generously in all cases of uncharacteristic genital symptoms,

  • 312. Majoko, F M
    et al.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Munjanja, S P
    Mason, E
    Lindmark, G
    Relation of parity to pregnancy outcome in a rural community in Zimbabwe.2004Inngår i: Afr J Reprod Health, ISSN 1118-4841, Vol. 8, nr 3, s. 198-206Artikkel i tidsskrift (Fagfellevurdert)
  • 313. Majoko, F
    et al.
    Munjanja, S P
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Mason, E
    Lindmark, G
    Randomised controlled trial of two antenatal care models in rural Zimbabwe.2007Inngår i: BJOG, ISSN 1471-0528, Vol. 114, nr 7, s. 802-11Artikkel i tidsskrift (Fagfellevurdert)
  • 314. Majoko, F
    et al.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Munjanja, S
    Mason, E
    Lindmark, G
    Does maternity care improve pregnancy outcomes in women with previous complications? A study from Zimbabwe.2005Inngår i: Trop Doct, ISSN 0049-4755, Vol. 35, nr 4, s. 195-8Artikkel i tidsskrift (Fagfellevurdert)
  • 315. Majoko, F
    et al.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Munjanja, S P
    Lindmark, G
    Effectiveness of referral system for antenatal and intra-partum problems in Gutu district, Zimbabwe.2005Inngår i: J Obstet Gynaecol, ISSN 0144-3615, Vol. 25, nr 7, s. 656-61Artikkel i tidsskrift (Fagfellevurdert)
  • 316.
    Marklund, Marie
    et al.
    Umeå universitet, Medicinsk fakultet, Odontologi, Ortodonti.
    Stenlund, Hans
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Franklin, Karl
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin.
    Mandibular Advancement Devices in 630 Men and Women With Obstructive Sleep Apnea and Snoring2004Inngår i: Chest, Vol. 125, nr 4, s. 1270-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study objective: To evaluate the tolerability and to find predictors of treatment success for an individually adjusted, one-piece mandibular advancement device in patients with snoring and obstructive sleep apnea.

    Design: Prospective study.

    Setting: Departments of Respiratory Medicine and Orthodontics, Umeå University.

    Patients: Six hundred nineteen of 630 patients (98%), who consecutively received treatment for sleep apnea and snoring from February 1989 to August 2000, were followed up. They had a mean apnea-hypopnea index of 16 (range, 0.0 to 76) and a mean body mass index of 28 (range, 19 to 42).

    Measurements: Interviews, questionnaires, and overnight sleep apne a recordings. Patients with an apnea-hypopnea index of ≥10 in the supine and/or lateral position were considered to have obstructive sleep apnea. A lateral apnea-hypopnea index of < 10, together with a supine apnea-hypopnea index of ≥ 10, defined supine-dependent sleep apneas.

    Results: One hundred forty-eight of the 619 patients (24%) discontinued treatment. Female gender predicted treatment success, defined as an apnea-hypopnea index of < 10 in both the supine and lateral positions, with an odds ratio of 2.4 (p = 0,01). In the women, the odds ratios for treatment success were 12 for mild sleep apnea (p = 0.04), and 0.1 for complaints of nasal obstruction (p = 0.03). In the men, the odds ratios for treatment success were 6.0 for supine-dependent sleep apneas (p < 0.001), 2.5 for mild sleep apnea (p = 0.04), 1.3 for each millimeter of mandibular advancement (p = 0.03), and 0.8 for each kilogram of weight increase (p = 0.001).

    Conclusions: The mandibular advancement device is recommended for women with sleep apnea, for men with supine-dependent sleep apneas defined by a lateral apnea-hypopnea index of < 10, and for snorers without sleep apnea. Men who increase in weight during treatment reduce their chance of treatment success and are advised to be followed up with a new sleep apnea recording with the device.

  • 317. Mayosi, Bongani M
    et al.
    Flisher, Alan J
    Lalloo, Umesh G
    Sitas, Freddy
    Tollman, Stephen M
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Univ Witwatersrand, Sch Publ Hlth, MRC, Wits Rural Publ Hlth & Hlth Transit Res Unit Agin, Johannesburg, South Africa.
    Bradshaw, Debbie
    Transmissible cancer in Africa reply2009Inngår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 374, nr 9707, s. 2052-2053Artikkel i tidsskrift (Annet vitenskapelig)
  • 318. Mearin, M Luisa
    et al.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Dickey, William
    Coeliac disease: is it time for mass screening?2005Inngår i: Best Pract Res Clin Gastroenterol, ISSN 1521-6918, Vol. 19, nr 3, s. 441-52Artikkel i tidsskrift (Fagfellevurdert)
  • 319. Medina, Widman
    et al.
    Hurtig, Anna-Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    San Sebastián, Miguel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Quizhpe, Edy
    Romero, Cristian
    Dental caries in 6-12-year-old indigenous and non-indigenous schoolchildren in the Amazon basin of Ecuador.2008Inngår i: Brazilian dental journal, ISSN 1806-4760, Vol. 19, nr 1, s. 83-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to evaluate the caries experience among 6-12-year-old indigenous (Naporunas) and non-indigenous (recent settlers of mixed ethnic origin) schoolchildren, living in the Amazon basin of Ecuador. Cross-sectional data were obtained from 1,449 clinical exams according to the World Health Organization criteria. Nine (7.6%) indigenous and 3 (4.5%) non-indigenous children had no caries experience in their primary dentition at the age of 6. The mean dmft value (SD) among indigenous and non-indigenous children aged 6 was 6.40 (3.36) and 8.36 (3.93), respectively. Sixty-four (54.2%) indigenous and 29 (43.3%) non-indigenous children had no caries experience in their permanent first molars at the age of 6. Only 7 (6.26%) indigenous and 2 (2.60%) non-indigenous children were caries-free at the age of 12. The mean DMFT values (SD) for 12-year-olds were 4.47 (2.85) among indigenous and 5.25 (2.89) among non-indigenous children. Fillings were almost non existent. Caries rates were high among both groups, with untreated carious lesions predominating in all ages. The data of indigenous children suggest adoption of a non-traditional diet. An appropriate oral health response based primarily on prevention and health promotion is needed.

  • 320. Mejàre, I
    et al.
    Stenlund, Hans
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Zelezny-Holmlund, C
    Caries incidence and lesion progression from adolescence to young adulthood: a prospective 15-year cohort study in Sweden.2004Inngår i: Caries Res, ISSN 0008-6568, Vol. 38, nr 2, s. 130-41Artikkel i tidsskrift (Fagfellevurdert)
  • 321.
    Minh, Hoang Van
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Epidemiology of cardiovascular disease in rural Vietnam2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    In the context of transitional Vietnam, although cardiovascular disease (CVD) has been shown to cause a large burden of mortality and morbidity in hospitals, little is known about the magnitude of its burden, risk factor levels and its relationship with socio-demographic status in the overall population. This thesis provides a preliminary insight into population-based knowledge of the CVD epidemiology in rural Vietnam and contributes to the development of methodologies for monitoring it. The ultimate goal of the work is to facilitate the formulation of evidence-based health interventions for reducing the burden of the CVD epidemic in Vietnam and elsewhere.

    This work was located in Bavi district, a rural community in the north of Vietnam. Studies on cause-specific mortality and risk factors were conducted within the framework of an ongoing Demographic Surveillance System (DSS) (called FilaBavi). The cause-specific mortality study used a verbal autopsy (VA) approach to identify causes of death in FilaBavi during 1999-2003. The risk factor study, conducted in 2002, employed the WHO STEPwise approach to surveillance of non-communicable disease (NCD) risk factors (WHO STEPS).

    Findings indicated that Bavi district, as an example of rural Vietnam, was already experiencing high rates of CVD mortality and associated risk factors. Mortality results indicated a substantial proportion of deaths due to CVD, which was the leading cause of death (20% and 25.7% of total mortality in 1999 and 2000, respectively and 32% of adult deaths during 1999-2003), exceeding infectious diseases. Hypertension was found to be a serious problem in terms both of its magnitude (14% of the population) and widespread unawareness (82% of the hypertensives). Smoking prevalence was very high among men (58% current daily smokers) and might be expected to cause a considerable number of future deaths without urgent action. CVD mortality and some risk factors seemed to be rising among disadvantaged groups (women, less educated people and the poor). The combination of DSS and WHO STEPS methodologies was shown to have potential for addressing basic epidemiological questions as to how NCD and CVD mortality and associated risk factors are distributed in populations.

    Given this evidence, actions to prevent CVD in Bavi and similar settings are clearly urgent. Interventions should be comprehensive and integrated, including both primary and secondary approaches, as well as policy-level involvement. Further studies, continuing on similar lines, plus qualitative approaches and deeper cross-site comparisons, are also needed to give further insights into CVD epidemiology in this type of setting.

    Fulltekst (pdf)
    FULLTEXT01
  • 322.
    Minh, Hoang Van
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Chuc, Nguyen Thi Kim
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Gender differences in prevalence and sosioeconomic determinants of hypertension: findings from the WHO STEPs survey in a rural community of Vietnam2006Inngår i: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 20, nr 2, s. 109-115Artikkel i tidsskrift (Fagfellevurdert)
  • 323.
    Minh, Hoang Van
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Ng, Nawi
    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.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Bonita, Ruth
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hakimi, Mohammad
    Byass, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Smoking epidemics and socio-economic predictors of regular use and cessation: Findings from WHO STEPS risk factor surveys in Vietnam and Indonesia2006Inngår i: Internet Journal of Epidemiology, ISSN 1540-2614, Vol. 3, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A population-based surveys were carried out in two demographic surveillance sites (DSSs) in Vietnam and Indonesia using the WHO STEPS approach to surveillance of non-communicable disease risk factors in order to characterize smoking epidemics in rural communities of Vietnam and Indonesia by identifying associations between socio-economic status and changes in smoking status among adult populations. The paper reveals that

    the prevalence of smoking among people aged 25-54 years was higher in Indonesia than in Vietnam. Indonesian men started smoking regularly earlier and ceased less than Vietnamese men. While low income was found to be a significant predictor of becoming regular smokers in Vietnam, old birth cohort and low education significantly increased the probability of being a regular smoker in Indonesia. Economic status was also found to be a significant predictor of smoking cessation in Vietnam while education and occupation played an important role in Indonesia

  • 324. Moberg, C
    et al.
    Meding, B
    Stenberg, Berndt
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Dermatologi och venereologi. Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Svensson, A
    Lindberg, M
    Remembering childhood atopic dermatitis as an adult: factors that influence recollection.2006Inngår i: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 155, nr 3, s. 557-60Artikkel i tidsskrift (Fagfellevurdert)
  • 325.
    Modig, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Järvholm, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönnmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Nyström, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lundbäck, B
    Andersson, C
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Vehicle exhaust exposure in an incident case-control study of adult asthma2006Inngår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 28, nr 1, s. 75-81Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of this case–control study was to evaluate whether traffic-related air pollution exposure at home increases the risk of asthma in adults and to compare two commonly used exposure variables and differences between urban and rural living. Incident cases of asthma and matched controls of subjects aged 20–60 yrs were recruited in Luleå, Sweden. In total 203 cases and 203 controls were enrolled in the study. Exposure was estimated by traffic flow and measured levels of outdoor nitrogen dioxide (NO2) in the surrounding environment of each home, respectively. The relationship between measured levels of NO2 and traffic flow was studied using linear regression. The results indicated a nonsignificant tendency between living in a home close to a high traffic flow and an increased risk of asthma. The association between asthma and measured NO2 was weak and not significant, but the skin-prick test result acted as an effect modifier with a borderline significant association among positives. The correlation between traffic flow and outdoor NO2 was low. The results suggest that living close to high traffic flows might increase the asthma incidence in adults, while the tendency for nitrogen dioxide was only seen among atopics. Traffic flow and nitrogen dioxide had a lower than expected correlation.

  • 326.
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Reproductive factors' impact on the health of mother and offspring: an epidemiological study1999Doktoravhandling, med artikler (Annet vitenskapelig)
  • 327.
    Mohamed Ibrahim, Maryam
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Child health in Somalia. An epidemiological assessment i rural communities during a pre-war period1998Doktoravhandling, med artikler (Annet vitenskapelig)
  • 328. Molla, Mitike
    et al.
    Emmelin, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Berhane, Yemane
    Lindtjørn, Bernt
    Readiness of youth in rural Ethiopia to seek health services for sexually transmitted infections2009Inngår i: African Journal of AIDS Research, ISSN 1608-5906, E-ISSN 1727-9445, Vol. 8, nr 2, s. 135-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Studies pertaining to sexually transmitted infections (STIs) among rural young adults in Ethiopia are limited. This study provides information on knowledge about common STIs, and the perceptions, preferences and use of health services for STIs, among youths and healthcare providers in predominately rural Butajira, a town in south-central Ethiopia. We performed mixed-method research, using a cross-sectional survey among 3 743 randomly selected youths aged 15-24 years, in 2004, and in-depth interviews with ten healthcare providers, in 2006. Less than 38% of the youths knew the common STIs. Among the sexually active youths (n = 802), 3.9% reported having at least one STI symptom in the past 12 months, and one-half of those who had had an STI symptom did not seek care from any source. The healthcare providers reported that the stigma associated with premarital sexual activity, the shamefulness of having an STI, and a perceived lack of confidentiality and uneasiness with the public health services were impediments to treatment-seeking in the study area. The youths in this study preferred to consult with healthcare providers of the same gender who were young, friendly and had a reputation for being empathetic. Embarrassment about having an STI and fear of being noticed by a familiar individual were perceived barriers to healthcare-seeking among the youths. The results suggest that young people are vulnerable to HIV exposure due to lack of knowledge about STIs and especially as a result of having an untreated STI. Health services that are uncoordinated and unable to handle youths' sexual and reproductive health problems, as well as judgemental health professionals and prevailing sexual taboos, were also reported as impediments to youths seeking healthcare. Reorientation of the public health services and healthcare providers could improve youths' healthcare-seeking for STIs.

  • 329. Muganyizi, Projestine S
    et al.
    Hogan, Nora
    Emmelin, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindmark, Gunilla
    Massawe, Siriel
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Axemo, Pia
    Social reactions to rape: experiences and perceptions of women rape survivors and their potential support providers in Dar es Salaam, Tanzania2009Inngår i: Violence and Victims, ISSN 0886-6708, E-ISSN 1945-7073, Vol. 24, nr 5, s. 607-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Social reactions to rape are socioculturally determined and have a strong influence on the coping and recovery of the survivor. The existing knowledge on social reactions emanates from Western countries with limited research attention on non-Western populations, particularly sub-Saharan Africa. We aimed to establish the types and perceptions of social reactions that are expressed to rape survivors and people's intentions to express them to survivors of varied social backgrounds in Tanzania. Using triangulation of research methods, experiences of social reactions among rape survivors (n = 50) and nurses (n = 44) from a community in Tanzania were explored, and the intentions to express typical social reactions to rape survivors of different social backgrounds were established from a representative community sample (n = 1,505). Twelve typical social reactions were identified with the positive reactions more commonly mentioned than the negative reactions. Nondisclosure of rape events and distracting the survivor from the event were perceived as both positive and negative. A commercial sex worker was most vulnerable to negative reactions. The cultural influences of social reactions and implications for practical applicability of the results are discussed.

  • 330.
    Muhe, Lulu
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Departm ent of Paediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia.
    Child health and acute respiratory infections in Ethiopia: epidemiology for prevention and control1994Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    This thesis is based on studies in Butajira district in the south central part of Ethiopia and one study in the Ethio-Swedish Children's Hospital in Addis Ababa. The Butajira project has a continuous demographic surveillance system, established in 1987 in a sample of 10 communities with a total baseline population of about 30,000. The project includes the development and evaluation of a system for continuous registration of vital events and provides a baseline population and sampling frame for health related research activities. The thesis used different study designs within the surveillance system. A carriership study was undertaken to determine the potential bacterial respiratory pathogens among under-five children. A clinical study was done to investigate aetiological agents among young infants (below 3 months) with pneumonia, sepsis and meningitis in a hospital setting. Interview studies were carried out on mothers' perceptions of illness and practices in the care of children with acute respiratory infections. Within the surveillance system, patterns of under-five mortality were analysed. A nested case-referent design was applied to assess public health and behavioural determinants of mortality. A cohort study was performed among under-fives in three communities to estimate the magnitude of illness burden, particularly from ARI, as well as to assess determinants of ARI morbidity.

    Among 1126 under-five children, 85% were found to harbour H. influenzae, 83% M. catarrhalis and 90% S. pneumoniae in the nasopharynx. The hospital-based study isolated S. pneumoniae, Streptococcus group A, Salmonella group B, E. coli and H. influenzae in the age group below 3 months. The study of mothers' perceptions and practices, showed that mothers do know the symptoms of measles and whooping cough, while they do not recognize pneumonia as an illness entity and are not aware of fast breathing as an important sign of pneumonia.

    The mortality studies showed a high infant and under-five mortality rate. ARI was responsible for one fifth of the under-five mortality and almost one third of the infant mortality rate. Cause of death in the case-referent study was determined using a validated verbal autopsy method. Breast-feeding and supplementary feeding were demonstrated to be strongly protective when controlling for parental and environmental determinants of mortality.

    A one year prospective home surveillance study showed that illness was reported in 5.8% of 1,216 person-years. ARI contributed half of this illness load and was particularly associated with parental factors. Among sanitation factors, the absence of piped water was an important determinant of morbidity. Among housing factors, the type of roof and lighting source for the house, and among parental factors, illiteracy of either parents and having a farmer as a father, were found to be independently associated with increased morbidity. Among health and behavioural factors, preterm delivery and lack of immunization were associated with increased morbidity.

    The results of the studies of this thesis have been utilized to design an intervention case management package. The intervention study and evaluation of its impact is now on-going.

    Fulltekst (pdf)
    fulltext
  • 331.
    Myléus, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Webb, Charlotta
    Danielsson, Lars
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Högberg, Lotta
    Karlsson, Eva
    Lagerqvist, Carina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Rosén, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Sandström, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Stenhammar, Lars
    Stenlund, Hans
    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.
    Carlsson, Annelie
    Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic2009Inngår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 49, nr 2, s. 170-176Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objetive: Sweden experienced a marked epidemic of celiac disease between 1984 and 1996 in children younger than 2 years of age, partly explained by changes in infant feeding. The objective of this study was to determine the prevalence of celiac disease in 12-year-olds born during the epidemic (1993), including both symptomatic and screening detected cases.

    Patients and methods: All sixth-grade children in participating schools were invited (n = 10,041). Symptomatic and, therefore, previously diagnosed celiac disease cases were ascertained through the National Swedish Childhood Celiac Disease Register and/or medical records. All serum samples were analyzed for antihuman tissue transglutaminase (tTG)-IgA (Celikey), and serum-IgA, and some for tTG-IgG and endomysial antibodies. A small intestinal biopsy was recommended for all children with suspected undiagnosed celiac disease.

    Results: Participation was accepted by 7567 families (75%). Previously diagnosed celiac disease was found in 67 children; 8.9/1000 (95% confidence interval [CI] 6.7-11). In another 192 children, a small intestinal biopsy was recommended and was performed in 180. Celiac disease was verified in 145 children, 20/1000 (95% CI 17-23). The total prevalence was 29/1000 (95% CI 25-33).

    Conclusions: The celiac disease prevalence of 29/1000 (3%)-with two thirds of cases undiagnosed before screening-is 3-fold higher than the usually suggested prevalence of 1%. When these 12-year-olds were infants, the prevailing feeding practice was to introduce gluten abruptly, often without ongoing breast-feeding, which might have contributed to this unexpectedly high prevalence.

  • 332.
    Månsdotter, Anna
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Health, economics, and feminism: on judging fairness and reform2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Introduction: The point of departure in this thesis is that women live longer than men, while men have more power, influence and resources, and probably better health-related quality of life, than women. In order to judge and act from this situation, the classical idea that both facts and values are needed for conclusion is adopted. The diverse positions of the sexes are mainly assumed to depend on the gender system, i.e. the societal structure organising human activities and relations, ultimately privileges and burdens, by sex. Hence, abolition of gender is held to be associated with decreased differences in health. The handling of facts and values is divided into two principal questions: 1) how to compare women and men within a particular state of the world, and 2) how to choose from their positions between states.

    Aims: The overall aim is to propose a public health framework for judging fairness and change from the positions of women and men. The specific aims are to: illustrate how the choice of normative approach affects judgements on fairness and resource allocation (I), explor public health views regarding various ethical principles (II), study the relationship between aspects of gender equality in public/domestic and health (III), estimate costs, savings and health gains, associated with the Swedish parental insurance reform (IV).

    Methods: The methods used are: ethical analysis based on the normative theories of welfarism, extrawelfarism, egalitarianism, and feminism; and the notions of justice by separate spheres, equity as choice and attainment/shortfall principles (I), survey among public health workers regarding within-state and between-states ethical views (II), epidemiologic study on death and sickness leave among traditional, equal, and untraditional Swedish couples who had their first child in 1978 (III), cost-effectiveness analysis based on men who took paternity leave 1978-1979 (IV).

    Results: The selected normative theories are likely to claim different opinions on fairness regarding women and men, and different proposals on resource allocations (I). Most public health workers support the idea of judging fairness by separate spheres, end-points, and shortfall equity. The rejection of health maximisation, and support for equality in life span and income, are convincing; although females and males differ significantly in judging societal change (II). In comparison to being equal in the public sphere, traditional women have lower risks of death and sickness, while traditional men tend to have higher risks. Being equal in the domestic sphere seems to be associated with lower risks among both sexes (III). Men who took paternity leave run significant lower death risks than other men. Base case cost-effectiveness of the reform is 6,000 EUR, and worst case 40,000 EUR, per gained QALY (IV).

    Conclusions: A public health framework for judging fairness and reform by women and men could look as follows: 1) identify facts at present and from past, 2) ask whether the situation is fair by within-state rules, 3) claim or refuse change, 4) identify consequences from reform, 5) consider whether the change was satisfying by between-states rules. The gains from more ethical analyses of public health based on sex/gender should overcome the many tricky issues involved. Since there is no common understanding on how to judge fairness and change from female/male differences in health and wealth, added research and exchange of views are called for. At Swedish state of gender (in)equality, it seems public health relevant to support further similarity in child-care. Provided an effective fraction of 25 percent, the entitlement to paternity leave is probably approved of by common welfarist, egalitarian, and feminist goals.

    Fulltekst (pdf)
    FULLTEXT01
  • 333. Månsdotter, Anna
    et al.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lundberg, Michael
    Health, wealth and fairness based on gender: the support for ethical principles.2006Inngår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, ISSN 0277-9536, Vol. 62, nr 9, s. 2327-2335Artikkel i tidsskrift (Fagfellevurdert)
  • 334. Månsdotter, Anna
    et al.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lundberg, Michael
    Winkvist, Anna
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Parental share in public and domestic spheres: a population study on gender equality, death, and sickness.2006Inngår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 60, nr 7, s. 616-620Artikkel i tidsskrift (Fagfellevurdert)
  • 335.
    Månsdotter, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Winkvist, Anna
    Paternity leave in Sweden: costs, savings and health gains.2007Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 82, nr 1, s. 102-115Artikkel i tidsskrift (Fagfellevurdert)
  • 336.
    Månsdotter, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Women, men and public health - how the choice of normative theory affects resource allocation.2004Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 69, nr 3, s. 351-364Artikkel i tidsskrift (Fagfellevurdert)
  • 337. Månsdotter, Anna M
    et al.
    Rydberg, Malin K
    Wallin, Eva
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Andréasson, Sven
    A cost-effectiveness analysis of alcohol prevention targeting licensed premises.2007Inngår i: Eur J Public Health, ISSN 1101-1262Artikkel i tidsskrift (Fagfellevurdert)
  • 338.
    Nafziger, AN
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Jenkins, PL
    Stenlund, H
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Wall, S
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Pearson, TA
    Lundberg, V
    Weinehall, L
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Newly Diagnosed Type 2 Diabetics Have the Lowest Body Mass Index Change among Rural Populations of Sweden and the United States.2006Inngår i: The Internet journal of health, ISSN 1528-8315, Vol. 5, nr 1Artikkel i tidsskrift (Fagfellevurdert)
  • 339. Nafziger, AN
    et al.
    Stenlund, Hans
    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.
    Jenkins, PL
    Lundberg, Vivan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Pearson, TA
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    High obesity incidence in northern Sweden: how will Sweden look by 2009?2006Inngår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 21, nr 5, s. 377-382Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The study objective was to evaluate the incidence of overweight and obesity in two rural areas of Sweden and the U.S. Previously collected data were used from 1990 to 1999 Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) studies in northern Sweden. Health censuses of adults in Otsego County, New York were collected in 1989 and 1999. Adults aged 25-64 year in 1989 with reports from both surveys were included. The 10-year change in body mass index (BMI), overweight (BMI 25-29.9 kg/m2) and obesity (BMI>or=30) were obtained from panel studies. Incidences of overweight and obesity were calculated and compared between countries. The 10-year incidence of obesity was 120/1000 in Sweden and 173/1000 in the U.S. (p<0.001 for difference between countries). In 1999, prevalence of obesity rose to 18.4% (Sweden) and 32.3% (U.S.). Cumulative distribution curves show that the BMI distribution in Sweden during 1999 is nearly identical to the U.S. during 1989. The obese proportions of these rural populations increased from 1989 to 1999. Sweden's obesity epidemic has a progression similar to that of the U.S., implying that by 2009, the prevalence of obesity in rural northern Sweden may mimic that present in rural New York during 1999. Attention should be paid to the increased obesity rates in rural areas.

  • 340.
    Nafziger, AN
    et al.
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin.
    Weinehall, L
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lewis, C
    Jenkins, PL
    Erb, TA
    Pearson, TA
    Wall, S
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Design Issues in the Combination of International Data from Two Rural Community Cardiovascular Intervention Programs.2001Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 29, nr suppl. 56, s. 33-39Artikkel i tidsskrift (Fagfellevurdert)
  • 341.
    Nafziger, Anne
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    A population perspective on obesity prevention: lessons learned from Sweden and the U.S.2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Obesity prevalences are increasing in Sweden and the US. Obesity has many health consequences and health risks are associated with small increases in weight and marked obesity. Cross-sectional and panel surveys from northern Sweden and upstate NY provide the basis for furthering understanding of body mass index (BMI) development. BMI and weight change (+/-3%) were used to evaluate obesity and weight loss, maintenance, or gain. The 1989 prevalences of obesity were 9.6% and 21.3% in Sweden and the US; 1999 prevalences were 18.4% and 32.3%. Ten-year incidences (1989-1999) of overweight and obesity were 337/1000 and 120/1000 for Sweden and 336/1000 and 173/1000 for the US. Cross-sectional data suggest obesity is a problem of older age while panel data show that the young are gaining weight most rapidly. Individual changes in BMI have similar trends for Sweden and the US; the majority of adults are gaining weight. Older age, being a woman, higher BMI, and type 2 diabetes were associated with higher odds of weight non-gain. Younger age, being a man, being married and using snuff (snus) increased the odds of weight gain. The obese were 2-7 times more likely to report self-rated poor health. Healthy behaviours explain more of the person-to-person variability in BMI than do unhealthy behaviours or chronic diseases. Encouraging trends were found among Västerbotten Intervention Programme participants: a higher proportion of adults maintained weight in more recent survey years. The proportion of weight-gaining adults with identified health risk factors is smaller than those without risk factors. Frequently weight maintenance is felt to be important only for those identified as having a problem with weight or an obesity-related health condition. The largest proportion of those gaining weight are those with a normal BMI. Obesity prevention should target those usually considered low-risk (young, without cardiovascular risk factors, normal BMI).

    Fulltekst (pdf)
    FULLTEXT01
  • 342.
    Nafziger, Anne N
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindvall, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Norberg, Margareta
    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.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Jenkins, Paul L
    Pearson, Thomas A
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Who is maintaining weight in a middle-aged population in Sweden? A longitudinal analysis over 10 years.2007Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 7, s. 108-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Obesity has primarily been addressed with interventions to promote weight loss and these have been largely unsuccessful. Primary prevention of obesity through support of weight maintenance may be a preferable strategy although to date this has not been the main focus of public health interventions. The aim of this study is to characterize who is not gaining weight during a 10 year period in Sweden.

    METHODS: Cross-sectional and longitudinal studies were conducted in adults aged 30, 40, 50 and 60 years during the Västerbotten Intervention Programme in Sweden. Height, weight, demographics and selected cardiovascular risk factors were collected on each participant. Prevalences of obesity were calculated for the 40, 50 and 60 year olds from the cross-sectional studies between 1990 and 2004. In the longitudinal study, 10-year non-gain (lost weight or maintained body weight within 3% of baseline weight) or weight gain (&gt; or = 3%) was calculated for individuals aged 30, 40, or 50 years at baseline. A multivariate logistic regression model was built to predict weight non-gain.

    RESULTS: There were 82,927 adults included in the cross-sectional studies which had an average annual participation rate of 63%. Prevalence of obesity [body mass index (BMI) in kg/m2 &gt; or = 30] increased from 9.4% in 1990 to 17.5% in 2004, and 60 year olds had the highest prevalence of obesity. 14,867 adults with a BMI of 18.5-29.9 at baseline participated in the longitudinal surveys which had a participation rate of 74%. 5242 adults (35.3%) were categorized as non-gainers. Older age, being female, classified as overweight by baseline BMI, later survey year, baseline diagnosis of diabetes, and lack of snuff use increased the chances of not gaining weight.

    CONCLUSION: Educational efforts should be broadened to include those adults who are usually considered to be at low risk for weight gain--younger individuals, those of normal body weight, and those without health conditions (e.g. diabetes type 2) and cardiovascular risk factors--as these are the individuals who are least likely to maintain their body weight over a 10 year period. The importance of focusing obesity prevention efforts on such individuals has not been widely recognized.

    Fulltekst (pdf)
    fulltext
  • 343. Neuman, Asa
    et al.
    Gunnbjörnsdottir, María
    Tunsäter, Alf
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Franklin, Karl A
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Norrman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Janson, Christer
    Dyspnea in relation to symptoms of anxiety and depression: A prospective population study.2006Inngår i: Respir Med, ISSN 0954-6111, Vol. 100, nr 10, s. 1843-9Artikkel i tidsskrift (Fagfellevurdert)
  • 344.
    Neumann, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Germany.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Schoffer, Olaf
    Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Germany.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Klug, Stefanie J.
    Cancer Epidemiology, University Cancer Center, University Hospital, Technische Universität Dresden, Germany.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Risk equations for the development of worsened glucose status and type 2 diabetes mellitus in a Swedish intervention program2013Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, artikkel-id 1014Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Several studies investigated transitions and risk factors from impaired glucose tolerance (IGT) to type 2 diabetes mellitus (T2D). However, there is a lack of information on the probabilities to transit from normal glucose tolerance (NGT) to different pre-diabetic states and from these states to T2D. The objective of our study is to estimate these risk equations and to quantify the influence of single or combined risk factors on these transition probabilities. Methods: Individuals who participated in the VIP program twice, having the first examination at ages 30, 40 or 50 years of age between 1990 and 1999 and the second examination 10 years later were included in the analysis. Participants were grouped into five groups: NGT, impaired fasting glucose (IFG), IGT, IFG&IGT or T2D. Fourteen potential risk factors for the development of a worse glucose state (pre-diabetes or T2D) were investigated: sex, age, education, perceived health, triglyceride, blood pressure, BMI, smoking, physical activity, snus, alcohol, nutrition and family history. Analysis was conducted in two steps. Firstly, factor analysis was used to find candidate variables; and secondly, logistic regression was employed to quantify the influence of the candidate variables. Bootstrap estimations validated the models. Results: In total, 29 937 individuals were included in the analysis. Alcohol and perceived health were excluded due to the results of the factor analysis and the logistic regression respectively. Six risk equations indicating different impacts of different risk factors on the transition to a worse glucose state were estimated and validated. The impact of each risk factor depended on the starting or ending pre-diabetes state. High levels of triglyceride, hypertension and high BMI were the strongest risk factors to transit to a worsened glucose state. Conclusions: The equations could be used to identify individuals with increased risk to develop any of the three pre-diabetic states or T2D and to adapt prevention strategies.

    Fulltekst (pdf)
    fulltext
  • 345.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Chronic disease risk factors in a transitional country: the case of rural Indonesia2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: The epidemic of chronic diseases is largely neglected. Although a threatening burden of chronic diseases is emerging, developing public health efforts for their prevention and control is not yet a priority for trans-national and national health policy makers. Understanding the population burden of risk factors which predict chronic diseases is an important step in reducing the impact of the diseases themselves.

    Objective: This thesis responds to the increasing burden of chronic diseases worldwide, and aims to illustrate the gap in chronic disease risk factor research in developing countries. The thesis describes and analyses the distribution of chronic disease risk factors in a rural setting in Indonesia. It also describes how smoking, one of the most common risk factors, is viewed by rural Javanese boys. Ultimately, therefore, this thesis aims to contribute to policy and programme recommendations for community interventions in a rural setting in Indonesia

    Methods: The studies were conducted in Purworejo District, where a Demographic Surveillance System (DSS) has been running since 1994. The Purworejo DSS is part of the INDEPTH network (International Network of field sites for continuous Demographic Evaluation of Populations and Their Health in developing countries). Two representative cross-sectional studies (in 2001 and 2005) were conducted to assess the chronic disease risk factors (including smoking, elevated blood pressure, and overweight and obesity). The first cross-sectional study was followed up in 2002 and 2004. In each study, a total of 3 250 participants (approximately 250 individuals in each sex and age group among 15–74 year olds stratified into 10-year intervals) were randomly selected from the surveillance database from each enumeration area in the surveillance area. Instruments were adopted from the WHO STEPS survey and adapted to local setting. Since many Indonesians start to smoke at an earlier age, a qualitative study using a focus group discussion approach was conducted among school boys aged 13-17 years old to describe and explore beliefs, norms, and values about smoking in a rural setting in Java.

    Result: Both the rural and urban populations in Purworejo face an unequal distribution of risk factors for chronic diseases. The burden among the most well-off group in the rural area has already reached a level similar to that found in the urban area. Most of the risk factors increased in all age, sex and socioeconomic groups during the period of 2001 to 2005. However, women and the poorest group experienced the greatest increase in risk factor prevalence. The qualitative study showed that cultural resistance against women smoking in Indonesia remains strong. Smoking is being viewed as a culturally internalised habit that signifies transition into maturity and adulthood for boys. Smoking is utilised as a means for socialisation and signifies better socioeconomic status. The use of tobacco in the construction of masculinity underlines the importance of gender specific interventions. National tobacco control policy should emphasise a smoking free society as the norm, especially among boys and men, and regulations regarding the banning of smoking should be enforced at all levels and areas of the community.

    Within the demographic surveillance setting, it is possible to assess the population and health dynamics. Utilisation of a standardised methodology across sites in INDEPTH will produce comparable population-based data in developing countries. Such comparisons are important in global health. A comparison of smoking transition patterns between a Vietnamese DSS and an Indonesian DSS shows that Indonesian men started smoking regularly earlier and ceased less than Vietnamese men. Compared with Vietnam, which has already signed and ratified the Framework Convention on Tobacco Control, tobacco control activities in Indonesia are still deficient.

    Conclusion: The thesis concludes that the rural population is not spared from the emerging burden of chronic disease risk factors. The patterning of risks across different socioeconomic groups provides a macro picture of the vicious cycle between poverty and chronic diseases. Understanding of risk factors in a local context through a qualitative study provides insight into cultural aspects relating to risk factor adoption, and will allow the fostering and tailoring of culturally appropriate interventions. Combining data from demographic surveillance sites with the WHO STEP approach to chronic disease risk factor Surveillance addresses basic epidemiological questions on chronic diseases. The use of such data is a powerful advocacy tool in public health decision-making for chronic disease prevention in developing countries. With substantial existing evidence on the effectiveness of chronic disease prevention and intervention programmes, it is vital that Indonesia to starts planning intervention programmes to control the impending chronic disease epidemic, and most importantly, to translate all this evidence into public health action.

    Keywords: chronic disease, risk factor, demographic surveillance system, smoking, elevated blood pressure, overweight and obesity, population-based intervention

    Fulltekst (pdf)
    FULLTEXT01
  • 346.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Padmawati, R S
    Prabandari, Y S
    Nichter, M
    Smoking behavior among former tuberculosis patients in Indonesia: intervention is needed.2008Inngår i: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 12, nr 5, s. 567-72Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    SETTING: Five lung clinics in Jogjakarta Province, Indonesia. OBJECTIVE: To document smoking patterns among tuberculosis (TB) patients before diagnosis and following treatment, to identify smoking-related messages given by health professionals and DOTS providers and to identify predictors of smoking relapse. DESIGN: A cross-sectional survey of 239 male TB patients completed DOTS-based treatment during 2005-2006. Subjects were interviewed at home using a semi-structured questionnaire. Female patients were excluded, as very few smoke. RESULTS: Most TB patients quit smoking when under treatment, but over one third relapsed at 6 months post-treatment. About 30% were never asked about their smoking behavior or advised about quitting. Of relapsed smokers, 60% received only general health messages and not TB-specific smoking messages. DOTS providers are not currently involved in cessation activities. The perception that any level of smoking is harmless for ex-TB patients was a significant predictor for smoking relapse. CONCLUSION: Physicians and DOTS providers should be actively involved in smoking cessation activities among TB and ex-TB patients. Based on these data, the Quit Tobacco Indonesia Project is mounting a pilot intervention to train DOTS providers, who are mostly family members of patients, to deliver smoking cessation messages and reinforce the cessation advice provided by physicians during and following TB treatment.

  • 347.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Prabandari, Yayi Suryo
    Padmawati, Retna Siwi
    Okah, Felix
    Haddock, C Keith
    Nichter, Mark
    Nichter, Mimi
    Muramoto, Myra
    Poston, Walker SC
    Pyle, Sara A
    Mahardinata, Nurazid
    Lando, Harry A
    Physician assessment of patient smoking in Indonesia: a public health priority2007Inngår i: Tobacco Control, ISSN 0964-4563, E-ISSN 1468-3318, Vol. 16, nr 3, s. 190-196Artikkel i tidsskrift (Fagfellevurdert)
  • 348.
    Ng, Nawi
    et al.
    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.
    Bonita, Ruth
    Hakimi, Mohammad
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Preventable risk factors for noncommunicable diseases in rural Indonesia: prevalence study using WHO STEPS approach.2006Inngår i: Bulletin of the World Health Organization, ISSN 0042-9686, E-ISSN 1564-0604, Vol. 84, nr 4, s. 305-313Artikkel i tidsskrift (Fagfellevurdert)
  • 349.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Van Minh, Hoang
    Tesfaye, Fikru
    Bonita, Ruth
    Byass, Peter
    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.
    Weinehall, Lars
    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.
    Combining risk factors and demographic surveillance: potentials of WHO STEPS and INDEPTH methodologies for assessing epidemiological transition.2006Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 34, nr 2, s. 199-208Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: Demographic surveillance systems (DSSs) create platforms to monitor population dynamics. This paper discusses the potential of combining the WHO STEPwise approach to Surveillance (STEPS) within ongoing DSSs, to assess changes in non-communicable disease (NCD) risk factors. METHODS: Three DSSs in Ethiopia, Vietnam, and Indonesia have collected NCD risk factors using WHO STEPS, focusing on self-reported lifestyle risk factors (Step 1) and measurement of blood pressure and anthropometric parameters (Step 2). RESULTS: DSSs provide sampling frames for NCD risk factor surveillance, which reveals the distribution of risk factors and their dynamics at the population level. The WHO STEPS approach with its add-on modules is feasible and adaptable in DSS settings. Available mortality data in the DSSs enable mortality assessment by cause of death using verbal autopsy, which is relevant in estimating the impact of NCDs. DSSs as well as risk factor surveillance data may potentially be a lever for hypothesis-driven research to address specific a priori hypotheses or research questions. CONCLUSION: Combining DSSs with the WHO STEPS approach can potentially address basic epidemiological questions on NCDs, which can be used as a powerful advocacy tool in public health decision-making for NCD prevention.

  • 350.
    Ng, Nawi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Öhman, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    'If I don't smoke, I'm not a real man'--Indonesian teenage boys' views about smoking.2007Inngår i: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 22, nr 6, s. 794-804Artikkel i tidsskrift (Fagfellevurdert)
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