1,721,116 research outputs found
Epidemiology and social determinants of chronic diseases attributed adult mortality and its influence on maternal and young child nutrition in Tigray, 2009-2015: evidence from Kilte Awlaelo- Health and Demographic Surveillance Site
No full textIn Ethiopia, the burden of disease related to communicable diseases has recently decreased significantly, while morbidity and mortality due to non-communicable diseases (NCDs) have increased. At the same, maternal and child malnutrition remained a major public health problem of Ethiopia. In developing countries, where health insurance is largely unavailable, individual medical conditions can also affect the overall and nutritional well-being of household members. In particular, the occurrence of disease and adult mortality in households can affect the nutritional well-being of the most vulnerable household members, especially lactating mothers and their young children. If the diseases are of chronic nature, which usually are costly and adult household members die from it in the long-term, this can be devastating for the family.
The aim of this Ph.D. project was to investigate the epidemiology and social determinants of NCDs-attributed adult mortality, and to examine the association of chronic diseases attributed adult mortality with undernutrition of lactating mothers and their young children in rural population of Kilte Awlaelo-Health and Demographic Surveillance Site (KA-HDSS), Eastern Zone of Tigray, Ethiopia.
During the data analysis, causes of death in adults were classified into chronic and non-chronic causes. The category of adult mortality due to chronic diseases refers to all causes that may be characterized by a long duration of illness. This group includes all deaths caused by NCDs and chronic communicable diseases such as tuberculosis and HIV/AIDS.
The thesis has three articles, all published in peer-reviewed journals. The first article reports findings on the epidemiology and social-determinants of adult mortality caused by NCDs among 45,982 adult residents of KA-HDSS using population-based longitudinal data collected from 2009 to 2015. The second article tested whether the burden of undernutrition was higher among lactating mothers who were living in households with adult mortality from chronic diseases than among lactating mothers living in households with no adult mortality from chronic diseases. The third article examined whether there was an association between undernutrition of children and adult mortality from chronic diseases. Both longitudinal and cross-sectional data were used in the second and third articles. To our knowledge, this study showed for the first time that adult mortality caused by NCDs varied according household members’ relationship to their household head: extended family and non-family members of the household head had higher hazard of mortality compared to the household heads. In addition, this work can be considered as the first study from a low-income setting to examine whether mortality of an adult household member from chronic diseases is associated with undernutrition of lactating mothers and their young children.
The results of the first study indicate a double mortality burden from both communicable diseases and NCDs in the study population. Between 2009 and 2015, the leading causes of NCDs-attributed adult mortality were cardiovascular diseases, cancer and renal failure. Compared to heads of households, extended family and non-family co-residents had an increased hazard of mortality from NCDs. Literacy and younger age were protective factors against adult mortality caused by NCDs. However, the protective role of literacy against adult mortality from NCDs decreased with increasing age.
Next, we assessed the level of undernutrition among the lactating mothers and examined its association with household-level occurrence of adult mortality from chronic diseases by controlling the effect of a wide range of epi-demographic and agro-ecological variables. Nearly two-fifths (38%; 95% CI: 36.1, 40.1%) of the mothers were undernourished. We found an increased risk of maternal undernutrition for lactating mothers who were living in households which experienced adult mortality from chronic diseases. In addition, maternal undernutrition was strongly associated with recent history of household-level morbidity, poor health-seeking practice, lack of diverse food crops, and a low index score for housing and environmental factors.
In the third article, we determined the burden of undernutrition among children of complementary feeding age (6 to 23 months) and its factors within the context of nutrition-specific and -sensitive drivers of young child undernutrition. Here, mortality from chronic diseases were constructed as a nutrition-specific factor. We found high prevalence of wasting (13.7%; 95% CI: 12.1, 15.5%) and inadequate child dietary diversity (81.3%; 95%CI: 79.2, 83.1%). Adult mortality history from chronic diseases was not associated with young child undernutrition and child dietary diversity. However, child undernutrition was strongly associated with recent history of household-level morbidity, maternal undernutrition, low child dietary diversity, poverty, larger family size, insecure employment of household heads, and living in highland areas. Poor household wealth status and lack of diverse food crops production, particularly in highland areas, were also strongly associated with lower child dietary diversity.
Overall, this thesis has shown that an epidemiological transition is ongoing in the surveillance population. Population-based intervention measures are recommended that aim to reduce NCD-related adult mortality by targeting the leading causes of death and focusing on vulnerable population subgroups, such as the extended family and nonfamily household members. In this study, there was no association between the occurrence of chronic diseases attributed adult mortality and young child undernutrition. However, adult mortality from chronic diseases was associated with maternal undernutrition. Our findings appear to call for multi-sectoral interventions, mainly by the agriculture, nutrition and health sectors, to promote nutritional well-being of lactating mothers and their dyads in the long-term.In Äthiopien ist die Krankheitslast im Zusammenhang mit übertragbaren Erkrankungen zuletzt deutlich zurückgegangen, während die Morbidität und Mortalität aufgrund nicht übertragbarer Krankheiten (NCDs) angestiegen ist. Gleichzeitig blieb die Unterernährung von Müttern und Kindern weiterhin ein großes Problem der öffentlichen Gesundheit in Äthiopien. In Entwicklungsländern, in denen es größtenteils keine Krankenversicherung gibt, können individuelle Erkrankungen auch das allgemeine Wohlbefinden und das Ernährungswohl der Haushaltsmitglieder beeinträchtigen. So kann das Auftreten von Krankheiten und die Erwachsenensterblichkeit in Haushalten insbesondere das Ernährungswohl der am stärksten gefährdeten Haushaltsmitglieder beeinträchtigen – vor allem stillende Mütter und ihre kleinen Kinder. Wenn es sich um chronische Erkrankungen handelt, die meist hohe Kosten verursachen und erwachsene Haushaltsmitglieder langfristig daran versterben, kann dies für den Familienverband bedrohlich werden.
Das Ziel dieses Ph.D. Projekts war es, die Epidemiologie und die sozialen Determinanten der durch nichtübertragbare Krankheiten verursachten Erwachsenensterblichkeit zu untersuchen und den Zusammenhang zur Unterernährung stillender Mütter und ihrer Kinder in der ländlichen Bevölkerung von Kilte Awlaelo – der Gesundheits- und demografischen Überwachungsstelle (KA-HDSS) in der Ostzone von Tigray, Äthiopien - zu untersuchen.
Während der Datenauswertung wurden die Todesursachen bei Erwachsenen in chronische und nichtchronische Ursachen eingeteilt. Die Kategorie der Erwachsenensterblichkeit aufgrund chronischer Todesursachen bezieht sich auf alle Ursachen, die durch eine lange Krankheitsdauer gekennzeichnet sein können. Diese Gruppe umfasst alle Todesfälle, die durch nichtübertragbare Krankheiten und chronisch übertragbare Krankheiten wie Tuberkulose und HIV/AIDS verursacht werden.
Die Dissertation umfasst drei Artikel, die alle in peer-reviewten Fachzeitschriften veröffentlicht wurden. Der erste Artikel berichtet über Erkenntnisse zur Epidemiologie und den sozialen Determinanten der durch nichtübertragbare Krankheiten verursachten Erwachsenensterblichkeit bei 45.982 erwachsenen Einwohnern von KA-HDSS unter Verwendung bevölkerungsbasierter Längsschnittdaten, die von 2009 bis 2015 gesammelt wurden. Im zweiten Artikel wurde untersucht, ob die Prävalenz von Unterernährung bei stillenden Müttern, die in Haushalten leben, in denen eine durch chronische Krankheiten verursachte Erwachsenensterblichkeit auftrat, höher war als bei Müttern, in deren Haushalten keine Erwachsenensterblichkeit durch chronische Krankheiten erhoben wurde. Im dritten Artikel wurde der Frage nachgegangen, ob es einen Zusammenhang gab zwischen der Unterernährung von Kleinkindern und der durch chronische Krankheiten verursachten Erwachsenensterblichkeit. Im zweiten und dritten Artikel wurden sowohl Längsschnitt- als auch Querschnittsdaten verwendet. Unseres Wissens nach hat diese Studie zum ersten Mal gezeigt, dass die durch nichtübertragbare Krankheiten verursachte Sterblichkeit je nach Beziehung der Haushaltsmitglieder zu ihrem Haushaltsvorstand variiert: Erweiterte Familienangehörige und Nicht-Familienmitglieder hatten im Vergleich zum Haushaltsvorstand selbst ein höheres Sterberisiko. Darüber hinaus kann diese Arbeit als die erste Studie aus einem Umfeld mit niedrigem Einkommen betrachtet werden, in der untersucht wurde, ob die Sterblichkeit erwachsener Haushaltsmitglieder aufgrund chronischer Krankheiten mit der Unterernährung stillender Mütter und ihrer jungen Kinder zusammenhängt.
Die Ergebnisse der ersten Studie weisen auf eine doppelte Sterblichkeitsbelastung sowohl durch übertragbare Krankheiten als auch durch nicht übertragbare Krankheiten in der Untersuchungspopulation hin. Zwischen 2009 und 2015 waren Herz-Kreislauf-Erkrankungen, Krebs und Nierenversagen die häufigsten durch nichtübertragbare Krankheiten verursachten Todesfälle bei Erwachsenen. Im Vergleich zum Haushaltsvorstand hatten Großfamilien- und familienfremde Mitbewohner ein erhöhtes Risiko, an NCDs zu sterben. Alphabetisierung und jüngeres Alter waren schützende Faktoren gegen die durch nichtübertragbare Krankheiten verursachte Mortalität. Allerdings nimmt die schützende Rolle der Alphabetisierung bei der Erwachsenensterblichkeit aufgrund nichtübertragbarer Krankheiten mit zunehmendem Alter ab.
Als nächstes analysierten wir den Grad der Unterernährung bei stillenden Müttern und untersuchten den Zusammenhang zwischen mütterlicher Unterernährung und Sterblichkeit auf Haushaltsebene aufgrund chronischer Todesursachen bei Erwachsenen, indem wir ein breites Spektrum epidemiografischer und agrarökologischer Variablen anwandten. Knapp zwei Fünftel (38 %; 95 %-KI: 36,1, 40,1 %) der Mütter waren unterernährt. Wir fanden ein erhöhtes Risiko für mütterliche Unterernährung bei stillenden Frauen, die in Haushalten lebten, in denen es in der Vergangenheit zu einer Erwachsenensterblichkeit aufgrund chronischer Krankheiten kam. Darüber hinaus war die Unterernährung der Mütter stark mit der Morbidität auf Haushaltsebene in der jüngeren Vergangenheit, unzureichender Inanspruchnahme von Gesundheitsdiensten, Mangel an Zugang zu vielfältigen Nahrungsmittelpflanzen und einem niedrigen Indexwert für Wohnverhältnisse und Umweltfaktoren verbunden.
Im dritten Artikel haben wir die Belastung durch Unterernährung bei Kindern im Beikostalter (6 bis 23 Monate) und ihre Faktoren im Kontext ernährungsspezifischer und ernährungssensibler Indikatoren ermittelt. Dabei wurde die Erwachsenensterblichkeit aufgrund chronischer Todesursachen als ernährungsspezifischer Faktor konstruiert. Wir fanden eine hohe Prävalenz von Auszehrung (13,7 %; 95 % CI: 12,1, 15,5 %) und eine unzureichende Ernährungsvielfalt bei Kindern (81,3 %; 95 %CI: 79,2, 83,1 %). Die Sterblichkeit aufgrund chronischer Todesursachen war nicht mit der Unterernährung und der mangelhaften Ernährungsvielfalt für Kinder assoziiert. Die Unterernährung von Kindern war jedoch stark mit der Morbidität auf Haushaltsebene in der jüngeren Vergangenheit, Unterernährung der eigenen Mutter, geringer Ernährungsvielfalt für Kinder, Armut, umfangreicher Familiengröße, unsicherer Beschäftigung der Haushaltsvorstände und dem Leben im Hochland verbunden. Ein ungenügender Wohlstandsstatus der Haushalte und der Mangel an vielfältigem Nahrungsmittelanbau, insbesondere in Hochlandgebieten, waren ebenfalls stark mit einer geringeren Ernährungsvielfalt bei Kindern assoziiert.
Insgesamt hat diese Arbeit gezeigt, dass der epidemiologische Wandel in der Untersuchungsbevölkerung noch nicht abgeschlossen ist. Bevölkerungsbezogene Interventionsmaßnahmen sind zu empfehlen, die darauf abzielen, die NCD-bedingte Erwachsenensterblichkeit zu senken, indem sie auf die führenden Todesursachen abzielen und den Schwerpunkt auf die gefährdeten Bevölkerungsuntergruppen legen, wie die Großfamilie und die familienfremden Haushaltsmitbewohner. In dieser Studie gab es keinen Zusammenhang zwischen Unterernährung bei Kleinkindern und der Erwachsenensterblichkeit aufgrund chronischer Krankheiten. Die Erwachsenensterblichkeit aufgrund chronischer Krankheiten war jedoch mit der Unterernährung der Mütter verbunden. Unsere Ergebnisse erfordern offenbar sektorübergreifende Interventionen, vor allem in den Bereichen Landwirtschaft, Ernährung und Gesundheit, um das Ernährungswohl stillender Mütter und ihrer Kinder langfristig zu fördern
Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013
No full textIn 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and
3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular
monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information
about levels and trends is essential to quantify population health eff ects and to prompt decision makers to prioritise
action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults
during 1980–2013.
Methods We systematically identifi ed surveys, reports, and published studies (n=1769) that included data for height and
weight, both through physical measurements and self-reports. We used mixed eff ects linear regression to correct for
bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19 244)
with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs).
Findings Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m2 or greater increased between
1980 and 2013 from 28·8% (95% UI 28·4–29·3) to 36·9% (36·3–37·4) in men, and from 29·8% (29·3–30·2) to 38·0%
(37·5–38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries;
23·8% (22·9–24·7) of boys and 22·6% (21·7–23·6) of girls were overweight or obese in 2013. The prevalence of
overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7–8·6)
to 12·9% (12·3–13·5) in 2013 for boys and from 8·4% (8·1–8·8) to 13·4% (13·0–13·9) in girls. In adults, estimated
prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia,
Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down.
Interpretation Because of the established health risks and substantial increases in prevalence, obesity has become a
major global health challenge. Not only is obesity increasing, but no national success stories have been reported in
the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
One-fourth of the prisoners are underweight in Northern Ethiopia: a cross-sectional study
No full textAbstract Background Despite the fact that prisoners are exposed to different health problems, prison health problems are often overlooked by researchers and no previous study has investigated nutritional problems of prisoners in Ethiopia. Methods Cross-sectional data were collected from 809 prisoners from nine major prison setups in the Tigray region of Ethiopia. A proportional stratified sampling technique was used to select the total number of participants needed from each prison site. The outcome of this study was underweight defined as body mass index (BMI) of less than 18.5 kg/m2. Multivariable binary logistic regression was performed to identify determinants of underweight at a p-value of less than 0.05. Results The prevalence of underweight was 25.2% (95% CI; 22.3%- 28.3%). Khat Chewing (OR = 2.08; 95% CI = 1.17, 3.70) and longer duration of incarceration (OR = 1.07; 95% CI = 1.01, 1.14) were associated with a significantly increased risk of underweight. Additionally, previous incarceration (OR = 1.54; 95% CI = 0.99, 2.42) was a relevant determinant of underweight with a borderline significance. In contrast, family support (OR = 0.61; 95% CI = 0.43, 0.85) and farmer occupation (OR = 0.59; 95% CI = 0.36, 0.98) compared to those who were unemployed were important protective determinants significantly associated with lower risk of underweight. Conclusion In summary, the burden of underweight was higher among prisoners in Tigray region who had respiratory tract infections. The study has enhanced our understanding of the determinants of underweight in the prison population. We strongly recommend that nutritional support, such as therapeutic feeding programs for severely or moderately underweight prisoners, and environmental health interventions of the prison setups should be urgently implemented to correct the uncovered nutritional problem and its associated factors for improving the health status of prisoners
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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