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  • 1. Ahmed, Syed Masud
    et al.
    Hadi, Abdullahel
    Razzaque, Abdur
    Ashraf, Ali
    Juvekar, Sanjay
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Indonesia.
    Kanungsukkasem, Uraiwan
    Soonthornthada, Kusol
    Van Minh, Hoang
    Huu Bich, Tran
    Clustering of chronic non-communicable disease risk factors among selected Asian populations: levels and determinants2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, no 1, p. 68-75Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The major chronic non-communicable diseases (NCDs) operate through a cluster of common risk factors, whose presence or absence determines not only the occurrence and severity of the disease, but also informs treatment approaches. Primary prevention based on mitigation of these common risk factors through population-based programmes is the most cost-effective approach to contain the emerging epidemic of chronic NCDs.

    OBJECTIVES: This study was conducted to explore the extent of risk factors clustering for the major chronic NCDs and its determinants in nine

    INDEPTH Health and Demographic Surveillance System (HDSS) sites of five Asian countries. DESIGN: Data originated from a multi-site chronic NCD risk factor prevalence survey conducted in 2005. This cross-sectional survey used a standardised questionnaire developed by the WHO to collect core data on common risk factors such as tobacco use, intake of fruits and vegetables, physical inactivity, blood pressure levels, and body mass index. Respondents included randomly selected sample of adults (25-64 years) living in nine rural HDSS sites in Bangladesh, India, Indonesia, Thailand, and Vietnam.

    RESULTS: Findings revealed a substantial proportion (>70%) of these largely rural populations having three or more risk factors for chronic NCDs. Chronic NCD risk factors clustering was associated with increasing age, being male, and higher educational achievements. Differences were noted among the different sites, both between and within country.

    CONCLUSIONS: Since there is an extensive clustering of risk factors for the chronic NCDs in the populations studied, the interventions also need to be based on a comprehensive approach rather than on a single factor to forestall its cumulative effects which occur over time. This can work best if it is integrated within the primary health care system and the HDSS can be an invaluable epidemiological resource in this endeavor.

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  • 2. Allotey, P.
    et al.
    Reidpath, D. D.
    Verhoeff, A.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Data driven responses to the management of population based behaviour change: lessons, pitfalls and possibilities from across the GDP wealth divide2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, p. S43-S44Article in journal (Other academic)
  • 3. Arokiasamy, Perianayagam
    et al.
    Uttamacharya, .
    Kowal, Paul
    Capistrant, Benjamin D.
    Gildner, Theresa E.
    Thiele, Elizabeth
    Biritwum, Richard B.
    Yawson, Alfred E.
    Mensah, George
    Maximova, Tamara
    Wu, Fan
    Guo, Yanfei
    Zheng, Yang
    Kalula, Sebastiana Zimba
    Rodriguez, Aaron Salinas
    Espinoza, Betty Manrique
    Liebert, Melissa A.
    Eick, Geeta
    Sterner, Kirstin N.
    Barrett, Tyler M.
    Duedu, Kwabena
    Gonzales, Ernest
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Negin, Joel
    Jiang, Yong
    Byles, Julie
    Madurai, Savathree Lorna
    Minicuci, Nadia
    Snodgrass, J. Josh
    Naidoo, Nirmala
    Chatterji, Somnath
    Chronic Noncommunicable Diseases in 6 Low-and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE)2017In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 185, no 6, p. 414-428Article in journal (Refereed)
    Abstract [en]

    In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged >= 50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low-and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

  • 4. Ashraf, Ali
    et al.
    Quaiyum, M.A.
    Ng, Nawi
    Purworejo Health and Demographic Surveillance System, Indonesia.
    Van Minh, Hoang
    Razzaque, Abdur
    Masud Ahmed, Syed
    Hadi, Abdullahel
    Juvekar, Sanjay
    Kanungsukkasem, Uraiwan
    Soonthornthada, Kusol
    Huu Bich, Tran
    Self-reported use of tobacco products in nine rural INDEPTH Health and Demographic Surveillance Systems in Asia2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 19-27Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Tobacco use is the most preventable cause of premature death and disability. Even though tobacco use is common in many Asian countries, reliable and comparable data on the burden imposed by tobacco use in this region are sparse, and surveillance systems to track trends are in their infancy.

    OBJECTIVE: To assess and compare the prevalence of tobacco use and its associated factors in nine selected rural sites in five Asian countries.

    METHODS: Tobacco use among 9,208 men and 9,221 women aged 25-64 years in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries of the INDEPTH Network were examined in 2005 as part of a broader survey of the major chronic non-communicable disease risk factors. All sites used a standardised protocol based on the WHO STEPS approach to risk factor surveillance; expanded questions of local relevance, including chewing tobacco, were also included. Multivariable logistic regression was used to assess demographic factors associated with tobacco use.

    RESULTS: Tobacco use, whether smoked or chewed, was common across all sites with some notable variations. More than 50% of men smoked daily; this applied to almost all age groups. Few women smoked daily in any of the sites. However, women were more likely to chew tobacco than men in all sites except Vadu in India. Tobacco use in men began in late adolescence in most of the sites and the number of cigarettes smoked daily ranged from three to 15. Use of both forms of tobacco, smoked and chewed, was associated with age, gender and education. Men were more likely to smoke compared to women, smoking increased with age in the four sites in Bangladesh but not in other sites and with low level of education in all the sites.

    CONCLUSION: The prevalence of tobacco use, regardless of the type of tobacco, was high among men in all of these rural populations with tobacco use started during adolescence in all HDSS sites. Innovative communication strategies for behaviour change targeting adolescents in schools and adult men and women at work or at home, may create a mass awareness about adverse health consequences of tobacco smoking or chewing tobacco. Such efforts, to be effective, however, need to be supported by strong legislation and leadership. Only four of the five countries involved in this multi-site study have ratified the Framework Convention on Tobacco Control, and even where it has been ratified, implementation is uneven.

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  • 5.
    Bengtsson, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Grönlund, Christer
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Lindahl, Bertil
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nyman, Emma
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wester, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    The beneficial effect over 3 years by pictorial information to patients and their physician about subclinical atherosclerosis and cardiovascular risk: results from the VIPVIZA randomized clinical trial2021In: American Journal of Preventive Cardiology, ISSN 2666-6677, Vol. 7, article id 100199Article in journal (Refereed)
    Abstract [en]

    Objective: Non-adherence to guidelines and preventive measures is a major challenge, particularly so to ob- tain long-term adherence to lifestyle changes and recommended medication. The objective was to investigate if pictorial information regarding subclinical carotid atherosclerosis provided to individuals and physicians gave sustained effects on cardiovascular risk beyond the previously reported effect after 1 year and up to 3 years. 

    Methods: A Prospective Randomized Open Blinded End-point (PROBE) trial. Within a CVD prevention program in Västerbotten County, Sweden, 3532 healthy individuals aged 40, 50 or 60 years were enrolled and 1:1 ran- domized to intervention ( n = 1749; pictorial information with additional prevention materials to participants and physicians) or control group ( n = 1783; no pictorial information to participants and physicians). Preventive measures were managed within primary care. Participants were investigated at baseline during 2013–2016 and at follow-up after 1 and 3 years. 

    Results: A beneficial effect on cardiovascular risk was observed at 3-year follow-up; Framingham Risk Score (FRS) was 13.38 for the intervention group and 14.08 for the control group ( p = 0.047) and SCORE was 1.69 vs. 1.82 ( p = 0.022). The effect observed at 1-year was sustained over 3 years after adjustment for sex and education and more pronounced among participants with a severe atherosclerotic picture at baseline.

    Conclusions: This study provides evidence of sustained beneficial effects on the adherence to prevention guidelines over 3 years of pictorial information about subclinical carotid atherosclerosis, resulting in lower cardiovascular risk regardless of sex and educational level. Direct visualization of the underlying still subclinical atherosclerotic disease, rather than just indirect information about risk factors and statistical risk of future myocardial infarction, stroke and death, is one way to tackle the problem of non-adherence to prevention of cardiovascular diseases.

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  • 6.
    Blomstedt, Yulia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Research Unit Medicine-Geriatric Clinic, Skellefteå County Hospital, SE-931 86 Skellefteå, Sweden..
    Lönnberg, Göran
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al2019In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, no 1, article id 1095Article in journal (Refereed)
    Abstract [en]

    An evaluation of Vasterbotten Intervention Programme (VIP) was recently conducted by San Sebastian et al. (BMC Public Health 19:202, 2019). Evaluation of health care interventions of this kind require 1) an understanding of both the design and the nature of the intervention, 2) correct definition of the target population, and 3) careful choice of the appropriate evaluation method. In this correspondence, we review the approach used by San Sebastian et al. as relates to these three criteria. Within this framework, we suggest important explanations for why the conclusions drawn by these authors contradict a large body of research on the effectiveness of the VIP.

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  • 7.
    Brunström, Mattias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Dahlström, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lindholm, Lars H.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lönnberg, Göran
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control2020In: JAMA Network Open, E-ISSN 2574-3805, Vol. 3, no 1, article id e1918625Article in journal (Refereed)
    Abstract [en]

    Importance: Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal.

    Objective: To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates.

    Design, Setting, and Participants: This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019.

    Exposures: An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group).

    Main Outcomes and Measures: Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up.

    Results: A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups.

    Conclusions and Relevance: This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.

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  • 8.
    Brunström, Mattias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dahlström, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lindholm, Lars H.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease2022In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 31, no 1, p. 31-39Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. MATERIALS AND METHODS: Individuals ≥18 years with a blood pressure (BP) recording in Västerbotten or Södermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Västerbotten County (intervention) compared with Södermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. RESULTS: A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. CONCLUSIONS: This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.

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  • 9.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nurturing Global Health Action through its first decade2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1569847Article in journal (Refereed)
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  • 10. Dans, Antonio
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Varghese, Cherian
    Tai, E. Shyong
    Firestone, Rebecca
    Bonita, Ruth
    Non-communicable diseases in southeast Asia – Authors' reply2011In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 377, no 9782, p. 2005-2005Article in journal (Other academic)
  • 11.
    Dans, Antonio
    et al.
    Department of Medicine, College of Medicine, University of the Philippines, Manila, Philippines.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Varghese, Cherian
    Western Pacific Regional Office, WHO, Manila, Philippines.
    Tai, E Shyong
    Division of Endocrinology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
    Firestone, Rebecca
    China Medical Board and Harvard Global Equity Initiative, Cambridge, MA, USA.
    Bonita, Ruth
    School of Population Health, University of Auckland, Auckland, New Zealand.
    The rise of chronic non-communicable diseases in southeast Asia: time for action2011In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 377, no 9766, p. 680-689Article in journal (Refereed)
    Abstract [en]

    Southeast Asia faces an epidemic of chronic non-communicable diseases, now responsible for 60% of deaths in the region. The problem stems from environmental factors that promote tobacco use, unhealthy diet, and inadequate physical activity. Disadvantaged populations are the hardest hit, with death rates inversely proportional to a country's gross national income. Families shoulder the financial burden, but entire economies suffer as well. Although attempts to control non-communicable diseases are increasing, more needs to be done. Health-care systems need to be redesigned to deliver chronic care that is founded on existing primary health-care facilities, but supported by good referral systems. Surveillance of key modifiable risk factors is needed to monitor the magnitude of the problem and to study the effects of interventions. All branches of government and all sectors of society have to get involved in establishing environments that are conducive to healthy living. The Association of Southeast Asian Nations is in a unique position to make a united stand against chronic non-communicable diseases in the region. Inaction will affect millions of lives-often, the lives of those who have the least.

  • 12.
    Degerstedt, Frida
    et al.
    Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS). Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Enberg, Birgit
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Ng, Nawi
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Keisu, Britt-Inger
    Umeå University, Faculty of Social Sciences, Department of Sociology. Umeå University, Faculty of Social Sciences, Umeå Centre for Gender Studies (UCGS).
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Physical activity, sociodemographic factors, and pain in quality of life for youth who have Cerebral palsyManuscript (preprint) (Other academic)
  • 13. Dewi, Fatwa S. T.
    et al.
    Choiriyyah, Ifta
    Indriyani, Citra
    Wahab, Abdul
    Lazuardi, Lutfan
    Nugroho, Agung
    Susetyowati, Susetyowati
    Harisaputra, Rosalia K.
    Santi, Risalia
    Lestari, Septi K.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Sleman HDSS, Universitas Gadjah Mada, Yogyakarta, Indonesia.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hakimi, Mohammad
    Josef, Hari K.
    Utarini, Adi
    Designing and collecting data for a longitudinal study: the Sleman Health and Demographic Surveillance System (HDSS)2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 7, p. 704-710Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 14.
    Edvinsson, Sören
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Häggström Lundevaller, Erling
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Malmberg, Gunnar
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Ng, Nawi
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Institute of Medicine, University of Gothenburg, Sweden.
    Income inequality in Swedish municipalities 1986-2013: Development and regional patterns2021Report (Other academic)
    Abstract [en]

    In the present report, we investigate the patterns and trends of inequality in disposable income in the working-age population in Swedish municipalities 1986-2013. This period coincided with when Sweden changed from very lowlevels of inequality to one with substantially increasing inequality. Incomes has increased in all parts of Sweden, but differences in incomes between municipalities have widened. Asa result, large parts of Sweden have become poorer in a relative, although not in a nominative sense. At the same time, income inequality has increased substantially within as well as between municipalities. Present-day Swedes live in much more unequal environments, both at the national level and in the municipalities. The large city areas, or at least part of them, have had a much more advantageous economic development, but they also became more unequal. We see a division between parts of Sweden; there are clear differentiation tendencies between urban and rural parts, centre and periphery. Another finding is that the relation between mean income and income inequality has changed from the 1980s to the present. This association was negative a couple of decades ago, meaning that inequality was somewhat higher in poorer municipalities. From the 1990s onwards, the association is instead positive – affluent municipalities are more unequal.

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  • 15.
    Edvinsson, Sören
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Häggström Lundevaller, Erling
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Malmberg, Gunnar
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Neighbourhood inequality as a health risk: Empirical evidence from Swedish registers2013Conference paper (Other academic)
    Abstract [en]

    In this paper, we explore the impact on mortality of income inequality in residential neighbourhoods and municipalities among elderly 65-84 years in the year 2004, using Swedish longitudinal micro-data covering the entire Swedish population for the period 1970 – 2006. Preliminary cross-sectional multi-level analyses are now complemented by longitudinal analyses of long-term residential histories with exposure to equal/unequal municipalities and neighbourhoods and the long-term impact on mortality. We investigate the association between mortality and income inequality at place of residence at different time lags and the effect of a summary measure of previous exposures to environments characterised by different inequality levels. We also compare groups that have different experiences of residential characteristics, i.e. those that have resided in unequal or equal places and those that have changed from equal to unequal residences or vice versa. Preliminary results from a cross-sectional analysis on 2006, show that income inequality in the municipality of residence had an independent effect on mortality in the age group 65-74 years

  • 16. Egondi, Thaddaeus
    et al.
    Ettarh, Remare
    Kyobutungi, Catherine
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Exposure to Outdoor Particles (PM2.5) and Associated Child Morbidity and Mortality in Socially Deprived Neighborhoods of Nairobi, Kenya2018In: Atmosphere, ISSN 2073-4433, E-ISSN 2073-4433, Vol. 9, no 9, article id 351Article in journal (Refereed)
    Abstract [en]

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

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  • 17.
    Egondi, Thaddaeus
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kyobutungi, Catherine
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Muindi, Kanyiva
    Oti, Samuel
    van de Vijver, Steven
    Ettarh, Remare
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Community perceptions of air pollution and related health risks in Nairobi slums2013In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 10, no 10, p. 4851-4868Article in journal (Refereed)
    Abstract [en]

    Air pollution is among the leading global risks for mortality and responsible for increasing risk for chronic diseases. Community perceptions on exposure are critical in determining people's response and acceptance of related policies. Therefore, understanding people' perception is critical in informing the design of appropriate intervention measures. The aim of this paper was to establish levels and associations between perceived pollution and health risk perception among slum residents. A cross-sectional study of 5,317 individuals aged 35+ years was conducted in two slums of Nairobi. Association of perceived score and individual characteristics was assessed using linear regression. Spatial variation in the perceived levels was determined through hot spot analysis using ArcGIS. The average perceived air pollution level was higher among residents in Viwandani compared to those in Korogocho. Perceived air pollution level was positively associated with perceived health risks. The majority of respondents were exposed to air pollution in their place of work with 66% exposed to at least two sources of air pollution. Less than 20% of the respondents in both areas mentioned sources related to indoor pollution. The perceived air pollution level and related health risks in the study community were low among the residents indicating the need for promoting awareness on air pollution sources and related health risks.

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    Community Perceptions of Air Pollution and Related Health Risks in Nairobi Slums
  • 18.
    Eriksson, Malin
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lindgren, Urban
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Child health and place: How is neighborhood social capital associated with child health injuries?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 41-41Article in journal (Other academic)
    Abstract [en]

    Background: Child health inequalities can be explained by social determinants of health, including neighborhood social capital. Swedish research about place effects on children's health is limited. This project aims to contribute to knowledge on how neighborhood social capital may influence child health in the Swedish context. The overall research questions were: What is the incidence rate of child injuries in the living environments among boys and girls? What are the associations between neighborhood social capital and child injuries?

    Methods: Child injury data from the Umeå SIMSAM Lab were utilized, with data from all children 0-12 years of age, living in Umeå municipality during 2006-2009. Individual child injury and residential area data were linked to a neighborhood social capital index, where 49 defined neighborhoods were assigned a score from low- high in social capital, based on people’s perceptions about their neighborhoods. Individual, household and neighborhood demographic and socioeconomic variables (country of birth, educational level, income and family type) were also extracted from the Umeå SIMSAM lab. Logistic regression analyses were conducted to analyze factors associated with child injury.

    Results: We observed 3930 injury events that occurred in the living environments, experienced by 24 000 children who lived in 14 767 households within 49 neighborhoods. The incidence rate of child injuries was about 72.5/1000 for boys and 60/1000 for girls. The odds for child injures was lower in neighborhoods with high social capital compared to neighborhoods with low social capital (OR 0.87 95%CI 0.80-0.95) after controlling for demographic and socioeconomic factors at individual, household and neighborhood level. The protective effects of neighborhood social capital were stronger for girls than boys.

    Conclusions: Neighborhood social capital may have a protective effect on child injuries and especially so for girls.

    Key messages:

    • Neighborhood conditions have a significant influence on child health inequalities in the Swedish context, including inequalities in child injuries.
    • Mobilization of neighborhood social capital might be good investment for reducing child injuries.
  • 19.
    Eriksson, Malin
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lindgren, Urban
    Umeå University, Faculty of Social Sciences, Department of Geography.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The effect of neighbourhood social capital on child injuries: a gender-stratified analysis2019In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 60, article id 102205Article in journal (Refereed)
    Abstract [en]

    We designed a longitudinal retrospective cohort study to analyse the associations between neighbourhood social capital and child injures. Register data from the Umeå Simsam Lab in Sweden was used to measure child injuries and demographic and socioeconomic factors at individual, household and neighbourhood level. A social capital score from a previous survey was used to measure neighbourhood social capital. We conducted a three-level multilevel negative binomial regression analysis, with children (level 1, N = 77,193) nested within households (level 2, N = 10,465), and households nested within neighbourhoods (level 3, N = 49). The incidence rate of child injuries was lower in high social capital neighbourhoods. When controlling for factors at individual, household and neighbourhood levels, living in a high social capital neighbourhood was protective of injuries among girls, but not among boys. Promoting social capital in local neighbourhoods could be seen as a prevention strategy for injuries among girls.

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  • 20.
    Eriksson, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Changes in access to structural social capital and its influence on self-rated health over time for middle-aged men and women: a longitudinal study from northern Sweden.2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 130, p. 250-258Article in journal (Refereed)
    Abstract [en]

    Until recently, most studies on social capital and health have been cross-sectional making it difficult to draw causal conclusions. This longitudinal study used data from 33,621 individuals (15,822 men and 17,799 women) from the Vasterbotten Intervention Program, to analyse how changes in access to individual social capital influence self-rated health (SRH) over time. Two forms of structural social capital, i.e. informal socializing and social participation, were measured. Age, sex, education, marital status, smoking, snuff, physical activity, alcohol consumption, high blood pressure, and body mass index were analysed as potential confounders. The association between changes in access to structural social capital and SRH in the follow-up was adjusted for SRH at baseline, as well as for changes in the socio-demographic and health-risk variables over time. The results support that changes in access to structural social capital over time impact on SRH. Remaining with no/low level of informal socializing over time increased the odds ratio for poor SRH for both men and women (OR of 1.45; 95%CI = 1.22-1.73 among men and OR of 1.56; 95%CI = 1.33-1.84 among women). Remaining with no/low levels of social participation was also detrimental to SRH in men and women (OR 1.14; 95%CI = 1.03-1.26 among men and OR 1.18; 95% Cl = 1.08-1.29 among women). A decrease in informal socializing over time was associated with poor SRH for women and men (OR of 135; 95%CI = 1.16-1.58 among men and OR of 1.57; 95%Cl = 1.36-1.82 among women). A loss of social participation had a negative effect on SRH among men and women (OR of 1.16; 95%Cl = 1.03-130 among men and OR of 1.15; 95%CI = 1.04-1.27 among women). Gaining access to social participation was harmful for SRH for women (OR 1.17; 95%CI = 1.05-131). Structural social capital has complex and gendered effects on SRH and interventions aiming to use social capital for health promotion purposes require an awareness of its gendered nature.

  • 21.
    Eriksson, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Neighborhood social capital and women's self-rated health - is there an age pattern?: A multi-level study from Northern Sweden2015In: Social capital as a health resource in later life: the relevance of context / [ed] Fredrika Nyqvist, Anna K. Forsman, Dordrecht: Springer Netherlands, 2015, p. 127-143Chapter in book (Refereed)
  • 22.
    Eriksson, Malin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Emmelin, Maria
    The importance of gender and conceptualization for understanding the association between collective social capital and health: a multilevel analysis from northern Sweden2011In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 73, no 2, p. 264-273Article in journal (Refereed)
    Abstract [en]

    Growing research on social capital and health has fuelled the debate on whether there is a place effect on health. A central question is whether health inequality between places is due to differences in the composition of people living in these places (compositional effect) or differences in the local social and physical environments (contextual effects). Despite extensive use of multilevel approaches that allows controlling for whether the effects of collective social capital are confounded by access to social capital at the individual level, the picture remains unclear. Recent studies indicate that contextual effects on health may vary for different population subgroups and measuring "average" contextual effects on health for a whole population might therefore be inappropriate. In this study from northern Sweden, we investigated the associations between collective social capital and self-rated health for men and women separately, to understand if health effects of collective social capital are gendered. Two measures of collective social capital were used: one conventional measure (aggregated measures of trust, participation and voting) and one specific place-related (neighbourhood) measure. The results show a positive association between collective social capital and self-rated health for women but not for men. Regardless of the measure used, women who live in very high social capital neighbourhoods are more likely to rate their health as good-fair, compared to women who live in very low social capital neighbourhoods. The health effects of collective social capital might thus be gendered in favour for women. However, a more equal involvement of men and women in the domestic sphere would potentially benefit men in this matter. When controlling for socioeconomic, sociodemographic and social capital attributes at the individual level, the relationship between women's health and collective social capital remained statistically significant when using the neighbourhood-related measure but not when using the conventional measure. Our results support the view that a neighbourhood-related measure provides a clearer picture of the health effects of collective social capital, at least for women.

  • 23.
    Fottrell, Edward
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sartorius, Benn
    Huong, Dao Lan
    Van Minh, Hoang
    Fantahun, Mesganaw
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mortality measurement in transition: proof of principle for standardised multi-country comparisons2010In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 15, no 10, p. 1256-1265Article in journal (Refereed)
    Abstract [en]

    Given the standardised method of VA interpretation, the observed differences in mortality cannot be because of local differences in assigning cause of death. Standardised, fit-for-purpose methods are needed to measure population health and changes in mortality patterns so that appropriate health policy and programmes can be designed, implemented and evaluated over time and place. The InterVA approach overcomes several longstanding limitations of existing methods and represents a valuable tool for health planners and researchers in resource-poor settings.

  • 24.
    Gangane, Nitin
    et al.
    Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India.
    Anshu, Anshu
    Manvatkar, Shiva
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastián, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Prevalence and Risk Factors for Patient Delay Among Women With Breast Cancer in Rural India2016In: Asia-Pacific journal of public health, ISSN 1941-2479, Vol. 28, no 1, p. 72-82Article in journal (Refereed)
    Abstract [en]

    Delay in seeking health care by women with breast cancer increases mortality risk. This study was conducted in rural India to identify risk factors associated with patient delay. A total of 212 women with primary breast cancer diagnosed between 2010 and 2012 were interviewed. Sociodemographic characteristics, time interval between seeking medical attention and appearance of symptoms, and reasons for delay were inquired. Patient delay was defined as more than 3 months between date of first symptoms and medical consultation. Logistic regression was applied to assess associations between potential risk factors and patient delay. Almost half the women with breast cancer experienced patient delay. Age more than 60 years (odds ratio = 4.9, 95% confidence interval = 1.3-18.0) was significantly associated with patient delay. Only 6.6% of patients had heard about breast self-examination. Significantly higher number of patients with delay presented with advanced clinical stage (P = .000). Health education programs should be introduced with specific strategies to shorten patient delay.

  • 25.
    Gangane, Nitin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastián, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    System delay of diagnosis and treatment experienced by women with breast cancer in rural IndiaManuscript (preprint) (Other academic)
  • 26.
    Gangane, Nitin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sebastian, Miguel San
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Women's Knowledge, Attitudes, and Practices about Breast Cancer in a Rural District of Central India2015In: Asian Pacific Journal of Cancer Prevention, ISSN 1513-7368, Vol. 16, no 16, p. 6863-6870Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Breast cancer accounted for almost 25% of all cancers in women globally in 2012. Although breast cancer is the most prevalent cancer in India, there is no organised national breast cancer screening programme. Local studies on the burden of breast cancer are essential to develop effective context-specific strategies for an early detection breast cancer programme, considering the cultural and ethnic heterogeneity in India. This study examined the knowledge, attitudes, and practices about breast cancer in rural women in Central India.

    MATERIALS AND METHODS: This community-based cross sectional study was conducted in Wardha district, located in Maharashtra state in Central India in 2013. The sample included 1000 women (609 rural, 391 urban) aged 13-50 years, selected as representative from each of the eight development blocks in the district, using stratified cluster sampling. Trained social workers interviewed women and collected demographic and socio-economic data. The instrument also assessed respondents' knowledge about breast cancer and its symptoms, risks, methods of screening, diagnosis and treatment, as well as their attitudes towards breast cancer and self- reported practices of breast cancer screening. Chi-square and t-test were applied to assess differences in the levels of knowledge, attitude, and practice (the outcome variables) between urban and rural respondents. Multivariable linear regression was conducted to analyse the relationship between socio-demographic factors and the outcome variables.

    RESULTS: While about two-thirds of rural and urban women were aware of breast cancer, less than 7% in rural and urban areas had heard about breast self-examination. Knowledge about breast cancer, its symptoms, risk factors, diagnostic modalities, and treatment was similarly poor in both rural and urban women. Urban women demonstrated more positive attitudes towards breast cancer screening practices than their rural counterparts. Better knowledge of breast cancer symptoms, risk factors, diagnosis, and treatment correlated significantly with older age, higher levels of education, and being office workers or in business.

    CONCLUSIONS: Women in rural Central India have poor knowledge about breast cancer, its symptoms and risk factors. Breast self-examination is hardly practiced, though the willingness to learn is high. Positive attitudes towards screening provide an opportunity to promote breast self-examination.

  • 27.
    Genbäck, Minna
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stanghellini, Elena
    de Luna, Xavier
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Predictors of decline in self-reported health: addressing non-ignorable dropout in longitudinal studies of ageing2018In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 15, no 2, p. 211-220Article in journal (Refereed)
    Abstract [en]

    Predictors of decline in health in older populations have been investigated in multiple studies before. Most longitudinal studies of aging, however, assume that dropout at follow-up is ignorable (missing at random) given a set of observed characteristics at baseline. The objective of this study was to address non-ignorable dropout in investigating predictors of declining self-reported health (SRH) in older populations (50 years or older) in Sweden, the Netherlands, and Italy. We used the SHARE panel survey, and since only 2895 out of the original 5657 participants in the survey 2004 were followed up in 2013, we studied whether the results were sensitive to the expectation that those dropping out have a higher proportion of decliners in SRH. We found that older age and a greater number of chronic diseases were positively associated with a decline in self-reported health in the three countries studies here. Maximum grip strength was associated with decline in self-reported health in Sweden and Italy, and self-reported limitations in normal activities due to health problems were associated with decline in self-reported health in Sweden. These results were not sensitive to non-ignorable dropout. On the other hand, although obesity was associated with decline in a complete case analysis, this result was not confirmed when performing a sensitivity analysis to non-ignorable dropout. The findings, thereby, contribute to the literature in understanding the robustness of longitudinal study results to non-ignorable dropout while considering three different population samples in Europe.

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  • 28. Gildner, Theresa E.
    et al.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Wu, Fan
    Guo, Yanfei
    Snodgrass, J. Josh
    Kowal, Paul
    Ideal Cardiovascular Health and Cognitive Test Performance: Testing a Modified Index of Life's Simple 7 Among Older Chinese Adults2018In: Frontiers In Public Health, ISSN 2296-2565, Vol. 6, article id 352Article in journal (Refereed)
    Abstract [en]

    Evidence suggests that cognitive decline in older adults is influenced by cardiovascular health (CVH), with metabolic and vascular mechanisms hypothesized to underlie the etiology of cognitive impairment. Research in high-income nations suggests that improved CVH is linked with decreased cognitive impairment risk, but it is unclear if this pattern is evident in low-income countries. Nationally-representative data collected in China were drawn from the World Health Organization's Study on global AGing and adult health Wave 1 (2007-2010; n = 11,295). Seven CVH factors were classified as "ideal" or "not ideal": smoking and drinking frequency, body mass index, physical activity level, blood pressure, diet, and self-reported anxiety. Additionally, scores from five cognitive performance tests (immediate and delayed verbal recall, forward and backward digit span, verbal fluency) were used to create a composite cognitive function variable. Linear regression analyses tested whether ideal CVH measures were associated with higher composite cognitive performance, controlling for sociodemographic factors. As hypothesized, ideal CVH was generally associated with higher cognitive performance. Low anxiety levels and reliable access to sufficient food (including produce) were particularly associated with higher cognitive function. These results suggest early detection and controlling modifiable CVH risks may protect aging individuals in China from cognitive decline.

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  • 29. Gomez-Olive, Francesc Xavier
    et al.
    Schröders, Julia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Aboderin, Isabella
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Chatterji, Somnath
    Davies, Justine I.
    Debpuur, Cornelius
    Hirve, Siddhivinayak
    Hodgson, Abraham
    Juvekar, Sanjay
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Kowal, Paul
    Nathan, Rose
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Razzaque, Abdur
    Sankoh, Osman
    Streatfield, Peter K.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Wilopo, Siswanto A.
    Witham, Miles D.
    Variations in disability and quality of life with age and sex between eight lower income and middle-income countries: data from the INDEPTH WHO-SAGE collaboration2017In: BMJ Global Health, E-ISSN 2059-7908, Vol. 2, no 4, article id e000508Article in journal (Refereed)
    Abstract [en]

    Background: Disability and quality of life are key outcomes for older people. Little is known about how these measures vary with age and gender across lower income and middle-income countries; such information is necessary to tailor health and social care policy to promote healthy ageing and minimise disability.

    Methods: We analysed data from participants aged 50 years and over from health and demographic surveillance system sites of the International Network for the Demographic Evaluation of Populations and their Health Network in Ghana, Kenya, Tanzania, South Africa, Vietnam, India, Indonesia and Bangladesh, using an abbreviated version of the WHO Study on global AGEing survey instrument. We used the eight-item WHO Quality of Life (WHOQoL) tool to measure quality of life and theWHO Disability Assessment Schedule, version 2 (WHODAS-II) tool to measure disability. We collected selected health status measures via the survey instrument and collected demographic and socioeconomic data from linked surveillance site information. We performed regression analyses to quantify differences between countries in the relationship between age, gender and both quality of life and disability, and we used anchoring vignettes to account for differences in interpretation of disability severity.

    Results: We included 43 935 individuals in the analysis. Mean age was 63.7 years (SD 9.7) and 24 434 (55.6%) were women. In unadjusted analyses across all countries, WHOQoL scores worsened by 0.13 points (95% CI 0.12 to 0.14) per year increase in age and WHODAS scores worsened by 0.60 points (95% CI 0.57 to 0.64). WHODAS-II and WHOQoL scores varied markedly between countries, as did the gradient of scores with increasing age. In regression analyses, differences were not fully explained by age, socioeconomic status, marital status, education or health factors. Differences in disability scores between countries were not explained by differences in anchoring vignette responses.

    Conclusions: The relationship between age, sex and both disability and quality of life varies between countries. The findings may guide tailoring of interventions to individual country needs, although these associations require further study.

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  • 30.
    Guo, Yanfei F.
    et al.
    Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China; School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kowal, Paul
    International Health Transitions, ACT, Canberra, Australia; University of Newcastle, School of Medicine and Public Health, NSW, Newcastle, Australia.
    Lin, Hualiang
    Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
    Ruan, Ye
    Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China.
    Shi, Yan
    Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China.
    Wu, Fan
    Shanghai Municipal Centre for Disease Control and Prevention, Shanghai Medical College, Fudan University, Shanghai, China.
    Frailty Risk in Older Adults Associated With Long-Term Exposure to Ambient PM2.5 in 6 Middle-Income Countries2022In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 77, no 5, p. 970-976Article in journal (Refereed)
    Abstract [en]

    Background: A series of studies have explored the health effects of long-term exposure to ambient PM2.5 among older adults. However, few studies have investigated the adverse effect of long-term exposure to ambient PM2.5 on frailty, and the results are inconclusive. This study sought to investigate the associations between long-term exposure to ambient PM2.5 and frailty in 6 low- and middle-income countries.

    Methods: We included an analytical sample of 34 138 individuals aged 50 and older from the Study on global AGEing and adult health Wave 1 (2007/2010). Air pollution estimates were generated using a standard methodology derived from Moderate Resolution Imaging Spectroradiometer observations and Multiangle Imaging Spectroradiometer instruments from the Terra satellite, along with simulations from the GEOS-Chem chemical transport model. A 3-level hierarchical logistic model was used to evaluate the association between frailty index and long-term PM2.5 exposure at 3 levels (individual, province, and country).

    Results: In rural areas, each 10 μg/m3 increase in ambient PM2.5 was associated with a 30% increase in the odds of frailty (OR = 1.30, 95% CI: 1.21-1.39) after adjusting for various potential confounding factors. The gender-stratified analysis showed that the association seemed to be slightly stronger in men (OR = 1.31, 95% CI: 1.18-1.46) than in women (OR = 1.21, 95% CI: 1.07-1.36) in rural areas.

    Conclusion: In a large sample of community-based older adults from 6 middle-income countries, we found evidence that long-term PM2.5 exposure was associated with frailty in rural areas.

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  • 31.
    Hii, Yien Ling
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Short term effects of weather on hand, foot and mouth disease2011In: PLOS ONE, E-ISSN 1932-6203, Vol. 6, no 2, p. e16796-Article in journal (Refereed)
    Abstract [en]

    Background: Hand, foot, and mouth disease (HFMD) outbreaks leading to clinical and fatal complications have increased since late 1990s; especially in the Asia Pacific Region. Outbreaks of HFMD peaks in the warmer season of the year, but the underlying factors for this annual pattern and the reasons to the recent upsurge trend have not yet been established. This study analyzed the effect of short-term changes in weather on the incidence of HFMD in Singapore.

    Methods: The relative risks between weekly HFMD cases and temperature and rainfall were estimated for the period 20012008 using time series Poisson regression models allowing for over-dispersion. Smoothing was used to allow non-linear relationship between weather and weekly HFMD cases, and to adjust for seasonality and long-term time trend. Additionally, autocorrelation was controlled and weather was allowed to have a lagged effect on HFMD incidence up to 2 weeks.

    Results: Weekly temperature and rainfall showed statistically significant association with HFMD incidence at time lag of 1-2 weeks. Every 1 degrees C increases in maximum temperature above 32 degrees C elevated the risk of HFMD incidence by 36% (95% CI = 1.341-1.389). Simultaneously, one mm increase of weekly cumulative rainfall below 75 mm increased the risk of HFMD by 0.3% (CI = 1.002-1.003). While above 75 mm the effect was opposite and each mm increases of rainfall decreased the incidence by 0.5% (CI = 0.995-0.996). We also found that a difference between minimum and maximum temperature greater than 7 degrees C elevated the risk of HFMD by 41% (CI = 1.388-1.439).

    Conclusion: Our findings suggest a strong association between HFMD and weather. However, the exact reason for the association is yet to be studied. Information on maximum temperature above 32 degrees C and moderate rainfall precede HFMD incidence could help to control and curb the up-surging trend of HFMD.

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    Short term effects of weather on hand, foot and mouth disease
  • 32.
    Hii, Yien Ling
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tang, Choon Siang
    Environment Health Department, National Environment Agency, Singapore.
    Pang, Fung Yin
    Environment Health Department, National Environment Agency, Singapore.
    Sauerborn, Rainer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Climate variability and increase in intensity and magnitude of dengue incidence in Singapore2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2, p. 124-132Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Dengue is currently a major public health burden in Asia Pacific Region. This study aims to establish an association between dengue incidence, mean temperature and precipitation, and further discuss how weather predictors influence the increase in intensity and magnitude of dengue in Singapore during the period 2000-2007.

    MATERIALS AND METHODS: Weekly dengue incidence data, daily mean temperature and precipitation and the midyear population data in Singapore during 2000-2007 were retrieved and analysed. We employed a time series Poisson regression model including time factors such as time trends, lagged terms of weather predictors, considered autocorrelation, and accounted for changes in population size by offsetting.

    RESULTS: The weekly mean temperature and cumulative precipitation were statistically significant related to the increases of dengue incidence in Singapore. Our findings showed that dengue incidence increased linearly at time lag of 5-16 and 5-20 weeks succeeding elevated temperature and precipitation, respectively. However, negative association occurred at lag week 17-20 with low weekly mean temperature as well as lag week 1-4 and 17-20 with low cumulative precipitation.

    DISCUSSION: As Singapore experienced higher weekly mean temperature and cumulative precipitation in the years 2004-2007, our results signified hazardous impacts of climate factors on the increase in intensity and magnitude of dengue cases. The ongoing global climate change might potentially increase the burden of dengue fever infection in near future.

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    Climate variability and increase in intensity and magnitude of dengue incidence in Singapore
  • 33.
    Hii, Yien Ling
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Lee Ching
    Tang, Choon Siang
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Optimal lead time for dengue forecast2012In: PLoS Neglected Tropical Diseases, ISSN 1935-2727, E-ISSN 1935-2735, Vol. 6, no 10, p. e1848-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A dengue early warning system aims to prevent a dengue outbreak by providing an accurate prediction of a rise in dengue cases and sufficient time to allow timely decisions and preventive measures to be taken by local authorities. This study seeks to identify the optimal lead time for warning of dengue cases in Singapore given the duration required by a local authority to curb an outbreak.

    METHODOLOGY AND FINDINGS: We developed a Poisson regression model to analyze relative risks of dengue cases as functions of weekly mean temperature and cumulative rainfall with lag times of 1-5 months using spline functions. We examined the duration of vector control and cluster management in dengue clusters > = 10 cases from 2000 to 2010 and used the information as an indicative window of the time required to mitigate an outbreak. Finally, we assessed the gap between forecast and successful control to determine the optimal timing for issuing an early warning in the study area. Our findings show that increasing weekly mean temperature and cumulative rainfall precede risks of increasing dengue cases by 4-20 and 8-20 weeks, respectively. These lag times provided a forecast window of 1-5 months based on the observed weather data. Based on previous vector control operations, the time needed to curb dengue outbreaks ranged from 1-3 months with a median duration of 2 months. Thus, a dengue early warning forecast given 3 months ahead of the onset of a probable epidemic would give local authorities sufficient time to mitigate an outbreak.

    CONCLUSIONS: Optimal timing of a dengue forecast increases the functional value of an early warning system and enhances cost-effectiveness of vector control operations in response to forecasted risks. We emphasize the importance of considering the forecast-mitigation gaps in respective study areas when developing a dengue forecasting model.

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  • 34.
    Hii, Yien Ling
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Zhu, Huaiping
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Lee Ching
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Forecast of dengue incidence using temperature and rainfall2012In: PLoS Neglected Tropical Diseases, ISSN 1935-2727, E-ISSN 1935-2735, Vol. 6, no 11, p. e1908-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: An accurate early warning system to predict impending epidemics enhances the effectiveness of preventive measures against dengue fever. The aim of this study was to develop and validate a forecasting model that could predict dengue cases and provide timely early warning in Singapore.

    METHODOLOGY AND PRINCIPAL FINDINGS: We developed a time series Poisson multivariate regression model using weekly mean temperature and cumulative rainfall over the period 2000-2010. Weather data were modeled using piecewise linear spline functions. We analyzed various lag times between dengue and weather variables to identify the optimal dengue forecasting period. Autoregression, seasonality and trend were considered in the model. We validated the model by forecasting dengue cases for week 1 of 2011 up to week 16 of 2012 using weather data alone. Model selection and validation were based on Akaike's Information Criterion, standardized Root Mean Square Error, and residuals diagnoses. A Receiver Operating Characteristics curve was used to analyze the sensitivity of the forecast of epidemics. The optimal period for dengue forecast was 16 weeks. Our model forecasted correctly with errors of 0.3 and 0.32 of the standard deviation of reported cases during the model training and validation periods, respectively. It was sensitive enough to distinguish between outbreak and non-outbreak to a 96% (CI = 93-98%) in 2004-2010 and 98% (CI = 95%-100%) in 2011. The model predicted the outbreak in 2011 accurately with less than 3% possibility of false alarm.

    SIGNIFICANCE: We have developed a weather-based dengue forecasting model that allows warning 16 weeks in advance of dengue epidemics with high sensitivity and specificity. We demonstrate that models using temperature and rainfall could be simple, precise, and low cost tools for dengue forecasting which could be used to enhance decision making on the timing, scale of vector control operations, and utilization of limited resources.

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  • 35.
    Hirve, Siddhivinayak
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gomez-Olive, Xavier
    Oti, Samuel
    Debpuur, Cornelius
    Juvekar, Sanjay
    Tollman, Stephen
    Blomstedt, Yulia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Use of anchoring vignettes to evaluate health reporting behavior amongst adults aged 50 years and above in Africa and Asia: testing assumptions2013In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Background: Comparing self-rating health responses across individuals and cultures is misleading due to different reporting behaviors. Anchoring vignettes is a technique that allows identifying and adjusting self-rating responses for reporting heterogeneity (RH). Objective: This article aims to test two crucial assumptions of vignette equivalence (VE) and response consistency (RC) that are required to be met before vignettes can be used to adjust self-rating responses for RH. Design: We used self-ratings, vignettes, and objective measures covering domains of mobility and cognition from the WHO study on global AGEing and adult health, administered to older adults aged 50 years and above from eight low-and middle-income countries in Africa and Asia. For VE, we specified a hierarchical ordered probit (HOPIT) model to test for equality of perceived vignette locations. For RC, we tested for equality of thresholds that are used to rate vignettes with thresholds derived from objective measures and used to rate their own health function. Results: There was evidence of RH in self-rating responses for difficulty in mobility and cognition. Assumptions of VE and RC between countries were violated driven by age, sex, and education. However, within a country context, assumption of VE was met in some countries (mainly in Africa, except Tanzania) and violated in others (mainly in Asia, except India). Conclusion: We conclude that violation of assumptions of RC and VE precluded the use of anchoring vignettes to adjust self-rated responses for RH across countries in Asia and Africa.

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  • 36.
    Hirve, Siddhivinayak
    et al.
    Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India.
    Juvekar, Sanjay
    Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India.
    Sambhudas, Somnath
    Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India.
    Lele, Pallavi
    Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India.
    Blomstedt, Yulia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Berkman, Lisa
    3 Harvard Center for Population and Development Studies, Harvard University, Boston, MA, USA.
    Tollman, Steve
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Does self-rated health predict death in adults aged 50 years and above in India? Evidence from a rural population under health and demographic surveillance.2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 6, p. 1719-1727