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Sökning: db:Swepub > (2010-2011) > Umeå universitet > Byass Peter

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1.
  • Byass, Peter, et al. (författare)
  • Assessing a population's exposure to heat and humidity : an empirical approach
  • 2010
  • Ingår i: Global Health Action. - : CoAction Publishing. - 1654-9716 .- 1654-9880. ; 3, s. Article nr 5421-
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: It is widely accepted that assessing the impact of heat on populations is an important aspect of climate change research. However, this raises questions about how best to measure people’s exposure to heat under everyday living conditions in more detail than is possible by relying on nearby sources of meteorological data. Objective: This study aimed to investigate practical and viable approaches to measuring air temperature and humidity within a population, making comparisons with contemporaneous external data sources. This was done in a rural South African population during the subtropical summer season. Results: Air temperature and humidity were measured indoors and outdoors at three locations over 10 days and the datalogger technology proved reliable and easy to use. There was little variation in measurements over distances of 10 km. Conclusions: Small battery-powered automatic dataloggers proved to be a feasible option for collecting weather data among a rural South African population. These data were consistent with external sources but offered more local detail. Detailed local contemporary data may also allow post hoc modelling of previously unmeasured local weather data in conjunction with global gridded climate models.
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  • Byass, Peter (författare)
  • Integrated multisource estimates of mortality for Thailand in 2005
  • 2010
  • Ingår i: Population Health Metrics. - : BioMed Central (BMC). - 1478-7954. ; 8, s. Article nr 10-
  • Tidskriftsartikel (refereegranskat)abstract
    • Estimates of mortality in Thailand during 2005 have been published, integrating multiple data sources including national vital registration and a national follow-up cluster sample, covering both deaths in health facilities (approximately one-third) and elsewhere. The methodological challenge is to make the best use of the existing data, supplemented by additional data that are feasible to obtain, in order to arrive at the best possible overall estimates of mortality. In this case, information from the national vital registration database was supplemented by a verbal autopsy survey of approximately 2.5% of deaths, the latter being used to validate routine cause-of-death data and information from medical records. This led to a revised national cause-specific mortality envelope for Thailand in 2005, amounting to 447,104 deaths. However, difficulties over standardizing verbal autopsy interpretation may mean that there are still some uncertainties in these revised estimates.
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  • Byass, Peter, et al. (författare)
  • Lessons from History for Designing and Validating Epidemiological Surveillance in Uncounted Populations
  • 2011
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 6:8, s. e22897-
  • Tidskriftsartikel (refereegranskat)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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5.
  • Byass, Peter, et al. (författare)
  • Motherhood, migration and mortality in Dikgale : modelling life events among women in a rural South African community
  • 2011
  • Ingår i: Public Health. - London : Academic P.. - 0033-3506 .- 1476-5616. ; 125:5, s. 318-323
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Although particular types of life events in populations are often studied separately, this study investigated the joint effects of three major event types in South African women’s lives: motherhood, migration and mortality. Study design: Data were taken from a health and demographic surveillance site (HDSS) over an 11-year period, reflecting the entire population of a defined geographic area as an open cohort, in which individuals participated in regular longitudinal surveillance for health and demographic events. This HDSS is a member of the Indepth Network. Methods: Multivariate Poisson regression models were built for each of the three life event types, in which individual person-time observed out of the total possible 11-year period was used as a rate multiplier. These models were used to calculate adjusted incidence rate ratios for each factor. Results: In the 21,587 person–years observed for women aged 15–49 years, from 1996 to 2006, adjusted rate ratios for mortality and migration increased substantially over time, while motherhood remained fairly constant. Women who migrated were less likely to bear children; temporary migrants were at greater risk of dying, while permanent in-migrants had higher survival rates. Women who subsequently died were much less likely to bear children or migrate. Conclusions: The associations between motherhood, migration and mortality among these rural South African women were complex and dynamic. Extremely rapid increases in mortality over the period studied are presumed to reflect the effects of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Understanding these complex interactions between various life events at population level is crucial for effective public health planning and service delivery.
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6.
  • Byass, Peter, et al. (författare)
  • Moving from data on deaths to public health policy in Agincourt, South Africa : approaches to analysing and understanding verbal autopsy findings
  • 2010
  • Ingår i: PLoS Medicine. - : Public Library of Science. - 1549-1277 .- 1549-1676. ; 7:8, s. e1000325-
  • Tidskriftsartikel (refereegranskat)abstract
    • There were no differences between physician interpretation and probabilistic modelling that might have led to substantially different public health policy conclusions at the population level. Physician interpretation was more nuanced than the model, for example in identifying cancers at particular sites, but did not capture the uncertainty associated with individual cases. Probabilistic modelling was substantially cheaper and faster, and completely internally consistent. Both approaches characterised the rise of HIV-related mortality in this population during the period observed, and reached similar findings on other major causes of mortality. For many purposes probabilistic modelling appears to be the best available means of moving from data on deaths to public health actions. Please see later in the article for the Editors' Summary.
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7.
  • Byass, Peter, et al. (författare)
  • Spatio-temporal clustering of mortality in Butajira HDSS, Ethiopia, from 1987 to 2008
  • 2010
  • Ingår i: Global Health Action. - : CoAction Publishing. - 1654-9716 .- 1654-9880. ; 3, s. 26-31
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Mortality in a population may be clustered in space and time for a variety of reasons, including geography, socio-economics, environment and demographics. Analysing mortality clusters can therefore reveal important insights into patterns and risks of mortality in a particular setting. Objective and design: To investigate the extent of spatio-temporal clustering of mortality in the Butajira District, Ethiopia, from 1987 to 2008. The Health and Demographic Surveillance System (HDSS) dataset recorded 10,696 deaths among 951,842 person-years of observation, with each death located by household, in which population time at risk was also recorded. The surveyed population increased from 28,614 in 1987 to 62,322 in 2008, in an area approximately 25 km in diameter. Spatio-temporal clustering analyses were conducted for overall mortality and by specific age groups, grouping the population into a 0.01° latitude-longitude grid. Results: A number of significantly high- and low-mortality clusters were identified at various times and places. Butajira town was characterised by significantly low mortality throughout the period. A previously documented major mortality crisis in 1998-1999, largely resulting from malaria and diarrhoea, dominated the clustering analysis. Other local high-mortality clusters, appreciably attributable to meningitis, malaria and diarrhoea, occurred in the earlier part of the period. In the later years, a more homogeneous distribution of mortality at lower rates was observed. Conclusions: Mortality was by no means randomly distributed in this community during the period of observation. The clustering analyses revealed a clear epidemiological transition, away from localised infectious epidemics, over a generation.
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  • Byass, Peter (författare)
  • The democratic fallacy in matters of clinical opinion : implications for analysing cause-of-death data
  • 2011
  • Ingår i: Emerging Themes in Epidemiology. - : BioMed Central (BMC). - 1742-7622. ; 8:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Arriving at a consensus between multiple clinical opinions concerning a particular case is a complex issue - and may give rise to manifestations of the democratic fallacy, whereby a majority opinion is misconstrued to represent some kind of "truth" and minority opinions are somehow "wrong". Procedures for handling multiple clinical opinions in epidemiological research are not well established, and care is needed to avoid logical errors. How to handle physicians' opinions on cause of death is one important domain of concern in this respect. Whether multiple opinions are a legal requirement, for example ahead of cremating a body, or used for supposedly greater rigour, for example in verbal autopsy interpretation, it is important to have a clear understanding of what unanimity or disagreement in findings might imply, and of how to aggregate case data accordingly.In many settings where multiple physicians have interpreted verbal autopsy material, an over-riding goal of arriving at a single cause of death per case has been applied. In many instances this desire to constrain findings to a single cause per case has led to methodologically awkward devices such as "TB/AIDS" as a single cause. This has also usually meant that no sense of disagreements or uncertainties at the case level is taken forward into aggregated data analyses, and in many cases an "indeterminate" cause may be recorded which actually reflects a lack of agreement rather than a lack of data on possible cause(s).In preparing verbal autopsy material for epidemiological analyses and public health interpretations, the possibility of multiple causes of death per case, and some sense of any disagreement or uncertainty encountered in interpretation at the case level, need to be captured and incorporated into overall findings, if evidence is not to be lost along the way. Similar considerations may apply in other epidemiological domains.
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9.
  • Byass, Peter, et al. (författare)
  • The global burden of childhood coeliac disease : a neglected component of diarrhoeal mortality?
  • 2011
  • Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 6:7, s. e22774-
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives Coeliac disease has emerged as an increasingly recognised public health problem over the last half-century, and is now coming to be seen as a global phenomenon, despite a profound lack of globally representative epidemiological data. Since children with coeliac disease commonly present with chronic diarrhoea and malnutrition, diagnosis is often overlooked, particularly in poorer settings where children often fail to thrive and water-borne infectious diarrhoeas are common. This is the first attempt to make global estimates of the burden of coeliac disease in childhood.Methods We built a relatively crude model of childhood coeliac disease, incorporating estimates of population prevalence, probability of non-diagnosis, and likelihood of mortality among the undiagnosed across all countries from 1970 to 2010, based around the few available data. All our assumptions are stated in the paper and the model is available as a supplementary file.Findings Our model suggests that in 2010 there were around 2.2 million children under 5 years of age living with coeliac disease. Among these children there could be 42,000 deaths related to coeliac disease annually. In 2008, deaths related to coeliac disease probably accounted for approximately 4% of all childhood diarrhoeal mortality.Conclusions Although coeliac disease may only account for a small proportion of diarrhoeal mortality, these deaths are not preventable by applying normal diarrhoea treatment guidelines, which may even involve gluten-based food supplements. As other causes of diarrhoeal mortality decline, coeliac disease will become a proportionately increasing problem unless consideration is given to trying gluten-free diets for children with chronic diarrhoea and malnutrition.
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