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Search Results: 1 - 10 of 739 matches for " Stig Wall "
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Population based prevalence of high blood pressure among adults in Addis Ababa: uncovering a silent epidemic
Fikru Tesfaye, Peter Byass, Stig Wall
BMC Cardiovascular Disorders , 2009, DOI: 10.1186/1471-2261-9-39
Abstract: Addis Ababa is the largest urban centre and national capital of Ethiopia, hosting about 25% of the urban population in the country. A probabilistic sample of adult males and females, 25–64 years of age residing in Addis Ababa city participated in structured interviews and physical measurements. We employed a population based, cross sectional survey, using the World Health Organization instrument for stepwise surveillance (STEPS) of chronic disease risk factors. Data on selected socio-demographic characteristics and lifestyle behaviours, including physical activity, as well as physical measurements such as weight, height, waist and hip circumference, and blood pressure were collected through standardized procedures. Multiple linear regression analysis was performed to estimate the coefficient of variability of blood pressure due to selected socio-demographic and behavioural characteristics, and physical measurements.A total of 3713 adults participated in the study. About 20% of males and 38% of females were overweight (body-mass-index ≥ 25 kg/m2), with 10.8 (9.49, 12.11)% of the females being obese (body-mass-index ≥ 30 kg/m2). Similarly, 17% of the males and 31% of the females were classified as having low level of total physical activity. The age-adjusted prevalence (95% confidence interval) of high blood pressure, defined as systolic blood pressure (SBP) ≥ 140 mmHg (millimetres of mercury) or diastolic blood pressure (DBP) ≥ 90 mmHg or reported use of anti-hypertensive medication, was 31.5% (29.0, 33.9) among males and 28.9% (26.8, 30.9) among females.High blood pressure is widely prevalent in Addis Ababa and may represent a silent epidemic in this population. Overweight, obesity and physical inactivity are important determinants of high blood pressure. There is an urgent need for strategies and programmes to prevent and control high blood pressure, and promote healthy lifestyle behaviours primarily among the urban populations of Ethiopia.Hypertension is an import
To be seen, confirmed and involved - a ten year follow-up of perceived health and cardiovascular risk factors in a Swedish community intervention programme
Maria Emmelin, Lars Weinehall, Hans Stenlund, Stig Wall, Lars Dahlgren
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-190
Abstract: Both quantitative and qualitative approaches were used to address the interaction between changes in self-rated health and risk factor load. Qualitative interviews contributed to an analysis of how the outcome was influenced by health related norms and attitudes.Most people maintained a low risk factor load and a positive perception of health. However, more people improved than deteriorated their situation regarding both perceived health and risk factor load. "Ideal types" of attitude sets towards the programme, generated from the interviews, helped to interpret an observed polarisation for men and the lower educated.Our observation of a socially and gender differentiated intervention effect suggests a need to test new intervention strategies. Future community interventions may benefit from targeting more directly those who in combination with high risk factor load perceive their health as bad and to make all participants feel seen, confirmed and involved.Public health interventions are directed towards social systems trying to influence people's attitudes and actual behaviours. They aim to create a positive infrastructure for change and a will to initiate action on both community and individual level [1]. However, social systems are vulnerable and it is difficult to foresee all consequences of an intervention. While targeted outcomes may be positively influenced, intervention strategies may also have unintended consequences and at worst be counterproductive for example by increasing the risk of stigmatisation, labelling or discrimination [2]. The effects can also differ unfairly by age, gender and educational level. To include self-reported outcome measures of health is one way of addressing these possible side-effects.Through a few simple questions self-rated health indicate how respondents perceive their health in general and/or in comparison with other people of their own age. Self-rated health is known to be a multi-dimensional concept including not only physic
Gender, literacy, and survival among Ethiopian adults, 1987 - 96
Berhane,Yemane; H?gberg,Ulf; Byass,Peter; Wall,Stig;
Bulletin of the World Health Organization , 2002, DOI: 10.1590/S0042-96862002000900007
Abstract: objective: to examine relationships between gender, literacy and survival among adults in meskan and mareko district, ethiopia. methods: on the basis of an established demographic surveillance system, an open-cohort analysis of 172 726 person-years covering the period january 1987 to december 1996 was conducted in 10 randomly selected local communities. findings: the crude mortality rate was 11.2 per 1000 person-years among adults aged 315 years; the values for males and females were 11.9 and 10.6 per 1000 person-years, respectively. kaplan - meier estimates showed that literacy and being female were both favourable for survival throughout adulthood. cox's regression models showed that age, gender, literacy and area (rural lowland, rural highland and urban) were significant factors in survival: younger, female, literate urban dwellers were the most favoured. gender differences in mortality were small in the rural areas, possibly because of the harsh living conditions and the marginalization of women. literacy was a more significant factor for survival in the rural areas, where mortality was highest, while gender was more important in the one urban area studied. the levels of literacy were lowest among rural females. conclusion: special attention should be given to raising literacy levels among rural women with a view to improving their survival.
The V sterbotten Intervention Programme: background, design and implications
Margareta Norberg,Stig Wall,Kurt Boman,Lars Weinehall
Global Health Action , 2010, DOI: 10.3402/gha.v3i0.4643
Abstract: Background and objective: In Sweden, mortality from cardiovascular diseases (CVD) increased steadily during the 20th century and in the mid-1980s it was highest in the county of V sterbotten. Therefore, a community intervention programme was launched – the V sterbotten Intervention Programme (VIP) – with the aim of reducing morbidity and mortality from CVD and diabetes. Design: The VIP was first developed in the small municipality of Norsj in 1985. Subsequently, it was successively implemented across the county and is now integrated into ordinary primary care routines. A population-based strategy directed towards the public is combined with a strategy to reach all middle-aged persons individually at ages 40, 50 and 60 years, by inviting them to participate in systematic risk factor screening and individual counselling about healthy lifestyle habits. Blood samples for research purposes are stored at the Ume University Medical Biobank. Results: Overall, 113,203 health examinations have been conducted in the VIP and 6,500–7,000 examinations take place each year. Almost 27,000 subjects have participated twice. Participation rates have ranged between 48 and 67%. A dropout rate analysis in 1998 indicated only a small social selection bias. Cross-sectional, nested case-control studies and prospective studies have been based on the VIP data. Linkages between the VIP and local, regional and national databases provide opportunities for interdisciplinary research, as well as national and international collaborations on a wide range of disease outcomes. A large number of publications are based on data that are collected in the VIP, many of which also use results from analysed stored blood samples. More than 20 PhD theses have been based primarily on the VIP data. Conclusions: The concept of the VIP, established as a collaboration between politicians and health care providers on the one hand and primary care, functioning as the operating machinery, and the public on the other, forms the basis for effective implementation and endurance over time. After more than 20 years of the VIP, there is a large comprehensive population-based database, a stable organisation to conduct health surveys and collect data, and a solid structure to enable widespread multidisciplinary and scientific collaborations.
Beyond 2015: time to reposition Scandinavia in global health?
Peter Byass,Peter Friberg,Yulia Blomstedt,Stig Wall
Global Health Action , 2013, DOI: 10.3402/gha.v6i0.20903
Abstract:
Assessing a new approach to verbal autopsy interpretation in a rural Ethiopian community: the InterVA model
Fantahun Mesganaw,Fottrell Edward,Berhane Yemane,Wall Stig
Bulletin of the World Health Organization , 2006,
Abstract: OBJECTIVE: Verbal autopsy (VA)- the interviewing of family members or caregivers about the circumstances of a death after the event- is an established tool in areas where routine death registration is non-existent or inadequate. We assessed the performance of a probabilistic model (InterVA) for interpreting community-based VA interviews, in order to investigate patterns of cause-specific mortality in a rural Ethiopian community. We compared results with those obtained after review of the VA by local physicians, with a view to validating the model as a community-based tool. METHODS: Two-hundred and eighty-nine VA interviews were successfully completed; these included most deaths occurring in a defined community over a 1-year period. The VA interviews were interpreted by physicians and by the model, and cause-specific mortality fractions were derived for the whole community and for particular age groups using both approaches. FINDINGS: The results of the two approaches to interpretation correlated well in this example from Ethiopia. Four major cause groups accounted for over 60% of all mortality, and patterns within specific age groups were consistent with expectations for an underdeveloped high-mortality community in sub-Saharan Africa. CONCLUSION: Compared with interpretation by physicians, the InterVA model is much less labour intensive and offers 100% consistency. It is a valuable new tool for characterizing patterns of cause-specific mortality in communities without death registration and for comparing patterns of mortality in different populations.
Gender, literacy, and survival among Ethiopian adults, 1987 - 96
Berhane Yemane,H?gberg Ulf,Byass Peter,Wall Stig
Bulletin of the World Health Organization , 2002,
Abstract: OBJECTIVE: To examine relationships between gender, literacy and survival among adults in Meskan and Mareko district, Ethiopia. METHODS: On the basis of an established demographic surveillance system, an open-cohort analysis of 172 726 person-years covering the period January 1987 to December 1996 was conducted in 10 randomly selected local communities. FINDINGS: The crude mortality rate was 11.2 per 1000 person-years among adults aged > or = 15 years; the values for males and females were 11.9 and 10.6 per 1000 person-years, respectively. Kaplan - Meier estimates showed that literacy and being female were both favourable for survival throughout adulthood. Cox's regression models showed that age, gender, literacy and area (rural lowland, rural highland and urban) were significant factors in survival: younger, female, literate urban dwellers were the most favoured. Gender differences in mortality were small in the rural areas, possibly because of the harsh living conditions and the marginalization of women. Literacy was a more significant factor for survival in the rural areas, where mortality was highest, while gender was more important in the one urban area studied. The levels of literacy were lowest among rural females. CONCLUSION: Special attention should be given to raising literacy levels among rural women with a view to improving their survival.
Optimal Lead Time for Dengue Forecast
Yien Ling Hii ,Joacim Rockl?v,Stig Wall,Lee Ching Ng,Choon Siang Tang,Nawi Ng
PLOS Neglected Tropical Diseases , 2012, DOI: 10.1371/journal.pntd.0001848
Abstract: 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.
Is Self-Rated Health an Independent Index for Mortality among Older People in Indonesia?
Nawi Ng, Mohammad Hakimi, Ailiana Santosa, Peter Byass, Siswanto Agus Wilopo, Stig Wall
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0035308
Abstract: Background Empirical studies on the association between self-rated health (SRH) and subsequent mortality are generally lacking in low- and middle-income countries. The evidence on whether socio-economic status and education modify this association is inconsistent. This study aims to fill these gaps using longitudinal data from a Health and Demographic Surveillance System (HDSS) site in Indonesia. Methods In 2010, we assessed the mortality status of 11,753 men and women aged 50+ who lived in Purworejo HDSS and participated in the INDEPTH WHO SAGE baseline in 2007. Information on self-rated health, socio-demographic indicators, disability and chronic disease were collected through face-to-face interview at baseline. We used Cox-proportional hazards regression for mortality and included all variables measured at baseline, including interaction terms between SRH and both education and socio-economic status (SES). Results During an average of 36 months follow-up, 11% of men and 9.5% of women died, resulting in death rates of 3.1 and 2.6 per 1,000 person-months, respectively. The age-adjusted Hazard Ratio (HR) for mortality was 17% higher in men than women (HR = 1.17; 95% CI = 1.04–1.31). After adjustment for covariates, the hazard ratios for mortality in men and women reporting bad health were 3.0 (95% CI = 2.0–4.4) and 4.9 (95% CI = 3.2–7.4), respectively. Education and SES did not modify this association for either sex. Conclusions This study supports the predictive power of bad self-rated health for subsequent mortality in rural Indonesian men and women 50 years old and over. In these analyses, education and household socio-economic status do not modify the relationship between SRH and mortality. This means that older people who rate their own health poorly should be an important target group for health service interventions.
Lessons from History for Designing and Validating Epidemiological Surveillance in Uncounted Populations
Peter Byass, Osman Sankoh, Stephen M. Tollman, Ulf H?gberg, Stig Wall
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0022897
Abstract: Background Due to scanty individual health data in low- and middle-income countries (LMICs), health planners often use imperfect data sources. Frequent national-level data are considered essential, even if their depth and quality are questionable. However, quality in-depth data from local sentinel populations may be better than scanty national data, if such local data can be considered as nationally representative. The difficulty is the lack of any theoretical or empirical basis for demonstrating that local data are representative where data on the wider population are unavailable. Thus these issues can only be explored empirically in a complete individual dataset at national and local levels, relating to a LMIC population profile. Methods and Findings Swedish national data for 1925 were used, characterised by relatively high mortality, a low proportion of older people and substantial mortality due to infectious causes. Demographic and socioeconomic characteristics of Sweden then and LMICs now are very similar. Rates of livebirths, stillbirths, infant and cause-specific mortality were calculated at national and county levels. Results for six million people in 24 counties showed that most counties had overall mortality rates within 10% of the national level. Other rates by county were mostly within 20% of national levels. Maternal mortality represented too rare an event to give stable results at the county level. Conclusions After excluding obviously outlying counties (capital city, island, remote areas), any one of the remaining 80% closely reflected the national situation in terms of key demographic and mortality parameters, each county representing approximately 5% of the national population. We conclude that this scenario would probably translate directly to about 40 LMICs with populations under 10 million, and to individual states or provinces within about 40 larger LMICs. Unsubstantiated claims that local sub-national population data are “unrepresentative” or “only local” should not therefore predominate over likely representativity.
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