PMID- 25231490OWN - NLMSTAT- In-ProcessDA - 20140918IS - 2044-6055 (Electronic)VI - 4IP - 9DP - 2014TI - Estimating the risk of cardiovascular disease using an obese-years metric.PG - e005629LID - 10.1136/bmjopen-2014-005629 [doi]AB - OBJECTIVE: To examine the association between obese-years and the risk of cardiovascular disease (CVD). STUDY DESIGN: Prospective cohort study. SETTING: Boston, USA. PARTICIPANTS: 5036 participants of the Framingham Heart Study were examined. METHODS: Obese-years was calculated by multiplying for each participant the number of body mass index (BMI) units above 29 kg/m(2) by the number of years lived at that BMI during approximately 50 years of follow-up. The association between obese-years and CVD was analysed using time-dependent Cox regression adjusted for potential confounders and compared with other models using the Akaike information criterion (AIC). The lowest AIC indicated better fit. PRIMARY OUTCOME CVD RESULTS: The median cumulative obese-years was 24 (range 2-556 obese-years). During 138,918 person-years of follow-up, 2753 (55%) participants were diagnosed with CVD. The incidence rates and adjusted HR (AHR) for CVD increased with an increase in the number of obese-years. AHR for the categories 1-24.9, 25-49.9, 50-74.9 and >/=75 obese-years were, respectively, 1.31 (95% CI 1.15 to 1.48), 1.37 (95% CI 1.14 to 1.65), 1.62 (95% CI 1.32 to 1.99) and 1.80 (95% CI 1.54 to 2.10) compared with those who were never obese (ie, had zero obese-years). The effect of obese-years was stronger in males than females. For every 10 unit increase in obese-years, the AHR of CVD increased by 6% (95% CI 4% to 8%) for males and 3% (95% CI 2% to 4%) for females. The AIC was lowest for the model containing obese-years compared with models containing either the level of BMI or the duration of obesity alone. CONCLUSIONS: This study demonstrates that obese-years metric conceptually captures the cumulative damage of obesity on body systems, and is found to provide slightly more precise estimation of the risk of CVD than the level or duration of obesity alone.CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.FAU - Abdullah, AsnawiAU - Abdullah AAD - Department of Biostatistics and Population Health, Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Aceh, Indonesia Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.FAU - Amin, Fauzi AliAU - Amin FAAD - Department of Public Health Nutrition, Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Aceh, Indonesia.FAU - Stoelwinder, JohannesAU - Stoelwinder JAD - Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.FAU - Tanamas, Stephanie KAU - Tanamas SKAD - Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.FAU - Wolfe, RoryAU - Wolfe RAD - Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.FAU - Barendregt, JanAU - Barendregt JAD - School of Population Health, University Queensland, Herston, Queensland, Australia.FAU - Peeters, AnnaAU - Peeters AAD - Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.LA - engPT - Journal ArticleDEP - 20140917PL - EnglandTA - BMJ OpenJT - BMJ openJID - 101552874SB - IMPMC - PMC4166414OID - NLM: PMC4166414OTO - NOTNLMOT - EPIDEMIOLOGYOT - NUTRITION & DIETETICSOT - PUBLIC HEALTHOT - VASCULAR MEDICINEEDAT- 2014/09/19 06:00MHDA- 2014/09/19 06:00CRDT- 2014/09/19 06:00AID - bmjopen-2014-005629 [pii]AID - 10.1136/bmjopen-2014-005629 [doi]PST - epublishSO - BMJ Open. 2014 Sep 17;4(9):e005629. doi: 10.1136/bmjopen-2014-005629.PMID- 24097936OWN - NLMSTAT- PublisherDA - 20131007IS - 1941-2479 (Electronic)IS - 1010-5395 (Linking)DP - 2013 Oct 4TI - Health Systems and Noncommunicable Diseases in the Asia-Pacific Region: A Review of the Published Literature.AB - Addressing the growing burden of noncommunicable diseases (NCDs) in countries of the Asia-Pacific region requires well-functioning health systems. In low- and middle-income countries (LMICs), however, health systems are generally characterized by inadequate financial and human resources, unsuitable service delivery models, and weak information systems. The aims of this review were to identify (a) health systems interventions being implemented to deliver NCD programs and services and their outcomes and (b) the health systems bottlenecks impeding access to or delivery of these programs and services in LMICs of the Asia-Pacific region. A search of 4 databases for literature published between 1990 and 2010 retrieved 36 relevant studies. For each study, information on basic characteristics, type of health systems bottleneck/intervention, and outcome was extracted, and methodological quality appraised. Health systems interventions and bottlenecks were classified as per the World Health Organization health systems building blocks framework. The review identified interventions and bottlenecks in the building blocks of service delivery, health workforce, financing, health information systems, and medical products, vaccines, and technologies. Studies, however, were heterogeneous in methodologies used, and the overall quality was generally low. There are several gaps in the evidence base around NCDs in the Asia-Pacific region that require further investigation.FAU - Mannava, PriyaAU - Mannava PAD - 1University of Melbourne, Melbourne, Australia.FAU - Abdullah, AsnawiAU - Abdullah AFAU - James, ChrisAU - James CFAU - Dodd, RebeccaAU - Dodd RFAU - Annear, Peter LeslieAU - Annear PLLA - ENGPT - JOURNAL ARTICLEDEP - 20131004TA - Asia Pac J Public HealthJT - Asia-Pacific journal of public health / Asia-Pacific Academic Consortium for Public HealthJID - 8708538OTO - NOTNLMOT - Asia-Pacific regionOT - cancerOT - cardiovascular diseaseOT - chronic respiratory diseaseOT - diabetesOT - health systemOT - noncommunicable diseaseEDAT- 2013/10/08 06:00MHDA- 2013/10/08 06:00CRDT- 2013/10/08 06:00AID - 1010539513500336 [pii]AID - 10.1177/1010539513500336 [doi]PST - aheadofprintSO - Asia Pac J Public Health. 2013 Oct 4.PMID- 22887349OWN - NLMSTAT- MEDLINEDA - 20120813DCOM- 20130107IS - 1099-1751 (Electronic)IS - 0749-6753 (Linking)VI - 27IP - 3DP - 2012 Jul-SepTI - How much does it cost to achieve coverage targets for primary healthcare services? A costing model from Aceh, Indonesia.PG - 226-45LID - 10.1002/hpm.2099 [doi]AB - Despite significant investment in improving service infrastructure and training of staff, public primary healthcare services in low-income and middle-income countries tend to perform poorly in reaching coverage targets. One of the factors identified in Aceh, Indonesia was the lack of operational funds for service provision. The objective of this study was to develop a simple and transparent costing tool that enables health planners to calculate the unit costs of providing basic health services to estimate additional budgets required to deliver services in accordance with national targets. The tool was developed using a standard economic approach that linked the input activities to achieving six national priority programs at primary healthcare level: health promotion, sanitation and environment health, maternal and child health and family planning, nutrition, immunization and communicable diseases control, and treatment of common illness. Costing was focused on costs of delivery of the programs that need to be funded by local government budgets. The costing tool consisting of 16 linked Microsoft Excel worksheets was developed and tested in several districts enabled the calculation of the unit costs of delivering of the six national priority programs per coverage target of each program (such as unit costs of delivering of maternal and child health program per pregnant mother). This costing tool can be used by health planners to estimate additional money required to achieve a certain level of coverage of programs, and it can be adjusted for different costs and program delivery parameters in different settings.CI - Copyright (c) 2012 John Wiley & Sons, Ltd.FAU - Abdullah, AsnawiAU - Abdullah AAD - Department of Biostatistics and Population Health, Faculty of Public Health, University Muhammadiyah Aceh, Indonesia. Asnawi_Abdullah@yahoo.comFAU - Hort, KrishnaAU - Hort KFAU - Abidin, Azwar ZaenalAU - Abidin AZFAU - Amin, Fadilah MAU - Amin FMLA - engPT - Journal ArticlePT - Research Support, Non-U.S. Gov'tPL - EnglandTA - Int J Health Plann ManageJT - The International journal of health planning and managementJID - 8605825SB - HMH - Delivery of Health Care/economics/organization & administrationMH - *Health Care Costs/statistics & numerical dataMH - HumansMH - IndonesiaMH - Insurance Coverage/*economics/statistics & numerical dataMH - Insurance, Health/economics/statistics & numerical dataMH - Models, EconometricMH - Primary Health Care/*economics/organization & administration/statistics & numerical dataEDAT- 2012/08/14 06:00MHDA- 2013/01/08 06:00CRDT- 2012/08/14 06:00AID - 10.1002/hpm.2099 [doi]PST - ppublishSO - Int J Health Plann Manage. 2012 Jul-Sep;27(3):226-45. doi: 10.1002/hpm.2099.PMID- 22759723OWN - NLMSTAT- MEDLINEDA - 20120716DCOM- 20120917IS - 1476-6256 (Electronic)IS - 0002-9262 (Linking)VI - 176IP - 2DP - 2012 Jul 15TI - Epidemiologic merit of obese-years, the combination of degree and duration of obesity.PG - 99-107LID - 10.1093/aje/kwr522 [doi]AB - This study aims to test the effect of combining the degree and the duration of obesity into a single variable-obese-years-and to examine whether obese-years is a better predictor of the risk of diabetes than simply body mass index (BMI) or duration of obesity. Of the original cohort of the Framingham Heart Study, 5,036 participants were followed up every 2 years for up to 48 years (from 1948). The variable, obese-years, was defined by multiplying for each participant the number of BMI units above 30 kg/m(2) by the number of years lived at that BMI. Associations with diabetes were analyzed by using time-dependent Cox proportional hazards regression models adjusted for potential confounders. The incidence of type-2 diabetes increased as the number of obese-years increased, with adjusted hazard ratios of 1.07 (95% confidence interval: 1.06, 1.09) per additional 10 obese-years. The dose-response relation between diabetes incidence and obese-years varied by sex and smoking status. The Akaike Information Criterion was lowest in the model containing obese-years compared with models containing either the degree or duration of obesity alone. A construct of obese-years is strongly associated with risk of diabetes and could be a better indicator of the health risks associated with increasing body weight than BMI or duration of obesity alone.FAU - Abdullah, AsnawiAU - Abdullah AAD - Department of Biostatistics and Population Health, Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Indonesia. Asnawi_Abdullah@yahoo.comFAU - Wolfe, RoryAU - Wolfe RFAU - Mannan, HaiderAU - Mannan HFAU - Stoelwinder, Johannes UAU - Stoelwinder JUFAU - Stevenson, ChristopherAU - Stevenson CFAU - Peeters, AnnaAU - Peeters ALA - engPT - Journal ArticlePT - Research Support, Non-U.S. Gov'tDEP - 20120628PL - United StatesTA - Am J EpidemiolJT - American journal of epidemiologyJID - 7910653SB - IMMH - AdultMH - Age of OnsetMH - *Body Mass IndexMH - Cohort StudiesMH - ComorbidityMH - Diabetes Mellitus, Type 2/*epidemiologyMH - FemaleMH - Follow-Up StudiesMH - HumansMH - IncidenceMH - MaleMH - Middle AgedMH - Models, StatisticalMH - Obesity/classification/*diagnosis/*epidemiologyMH - Risk AssessmentMH - Risk FactorsMH - Sex DistributionMH - Weight GainEDAT- 2012/07/05 06:00MHDA- 2012/09/18 06:00CRDT- 2012/07/05 06:00PHST- 2012/06/28 [aheadofprint]AID - kwr522 [pii]AID - 10.1093/aje/kwr522 [doi]PST - ppublishSO - Am J Epidemiol. 2012 Jul 15;176(2):99-107. doi: 10.1093/aje/kwr522. Epub 2012 Jun 28.PMID- 21357186OWN - NLMSTAT- MEDLINEDA - 20110817DCOM- 20120125IS - 1464-3685 (Electronic)IS - 0300-5771 (Linking)VI - 40IP - 4DP - 2011 AugTI - The number of years lived with obesity and the risk of all-cause and cause-specific mortality.PG - 985-96LID - 10.1093/ije/dyr018 [doi]AB - BACKGROUND: The role of the duration of obesity as an independent risk factor for mortality has not been investigated. The aim of this study was to analyse the association between the duration of obesity and the risk of mortality. METHODS: A total of 5036 participants (aged 28-62 years) of the Framingham Cohort Study were followed up every 2 years from 1948 for up to 48 years. The association between obesity duration and all-cause and cause-specific mortality was analysed using time-dependent Cox models adjusted for body mass index. The role of biological intermediates and chronic diseases was also explored. RESULTS: The adjusted hazard ratio (HR) for mortality increased as the number of years lived with obesity increased. For those who were obese for 1-4.9, 5-14.9, 15-24.9 and >/= 25 years of the study follow-up period, adjusted HRs for all-cause mortality were 1.51 [95% confidence interval (CI) 1.27-1.79], 1.94 (95% CI 1.71-2.20), 2.25 (95% CI 1.89-2.67) and 2.52 (95% CI 2.08-3.06), respectively, compared with those who were never obese. A dose-response relation between years of duration of obesity was also clear for all-cause, cardiovascular, cancer and other-cause mortality. For every additional 2 years of obesity, the HRs for all-cause, cardiovascular disease, cancer and other-cause mortality were 1.06 (95% CI 1.05-1.07), 1.07 (95% CI 1.05-1.08), 1.03 (95% CI 1.01-1.05) and 1.07 (95% CI 1.05-1.11), respectively. CONCLUSIONS: The number of years lived with obesity is directly associated with the risk of mortality. This needs to be taken into account when estimating its burden on mortality.FAU - Abdullah, AsnawiAU - Abdullah AAD - Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Asnawi_Abdullah@yahoo.comFAU - Wolfe, RoryAU - Wolfe RFAU - Stoelwinder, Johannes UAU - Stoelwinder JUFAU - de Courten, MaximilianAU - de Courten MFAU - Stevenson, ChristopherAU - Stevenson CFAU - Walls, Helen LAU - Walls HLFAU - Peeters, AnnaAU - Peeters ALA - engPT - Journal ArticlePT - Research Support, Non-U.S. Gov'tDEP - 20110227PL - EnglandTA - Int J EpidemiolJT - International journal of epidemiologyJID - 7802871SB - IMCIN - Int J Epidemiol. 2011 Aug;40(4):996-7. PMID: 21471021MH - AdultMH - Cardiovascular Diseases/complications/mortalityMH - Cause of DeathMH - Cohort StudiesMH - Confounding Factors (Epidemiology)MH - FemaleMH - HumansMH - MaleMH - Massachusetts/epidemiologyMH - Middle AgedMH - Neoplasms/complications/mortalityMH - Obesity/complications/*mortalityMH - Proportional Hazards ModelsMH - Risk FactorsMH - Time FactorsMH - Young AdultEDAT- 2011/03/02 06:00MHDA- 2012/01/26 06:00CRDT- 2011/03/02 06:00PHST- 2011/02/27 [aheadofprint]AID - dyr018 [pii]AID - 10.1093/ije/dyr018 [doi]PST - ppublishSO - Int J Epidemiol. 2011 Aug;40(4):985-96. doi: 10.1093/ije/dyr018. Epub 2011 Feb 27.PMID- 20587115OWN - NLMSTAT- MEDLINEDA - 20110107DCOM- 20110211IS - 1475-2727 (Electronic)IS - 1368-9800 (Linking)VI - 14IP - 1DP - 2011 JanTI - The duration of obesity and the risk of type 2 diabetes.PG - 119-26LID - 10.1017/S1368980010001813 [doi]AB - OBJECTIVE: The evidence for the association between obesity and the risk of type 2 diabetes has been derived mainly from the analysis of the degree of obesity. The role of the duration of obesity as an independent risk has not been fully explored. The objective of the present study was to investigate the association between the duration of obesity and the risk of type 2 diabetes. DESIGN: Prospective cohort study. SETTING: The Framingham Heart Study (FHS), follow-up from 1948 to 1998. SUBJECTS: A total of 1256 FHS participants who were free from type 2 diabetes at baseline, but were obese on at least two consecutive of the study's twenty-four biennial examinations, were included. Type 2 diabetes status was collected throughout the 48 years of follow-up of the study. The relationship between duration of obesity and type 2 diabetes was analysed using time-dependent Cox models, adjusting for a number of covariates. RESULTS: The unadjusted hazard ratio (HR) for the risk of type 2 diabetes for men was 1.13 (95 % CI 1.09, 1.17) and for women was 1.12 (95 % CI 1.08, 1.16) per additional 2-year increase in the duration of obesity. Adjustment for sociodemographic variables, family history of diabetes, health behaviour and physical activity made little difference to these HR. For women the evidence of a dose-response relationship was less clear than for men, particularly for women with an older age at obesity onset. CONCLUSIONS: The duration of obesity is a relevant risk factor for type 2 diabetes, independent of the degree of BMI.FAU - Abdullah, AsnawiAU - Abdullah AAD - Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Victoria, Australia. Asnawi.Abdullah@med.monash.edu.auFAU - Stoelwinder, JohannesAU - Stoelwinder JFAU - Shortreed, SusanAU - Shortreed SFAU - Wolfe, RoryAU - Wolfe RFAU - Stevenson, ChristopherAU - Stevenson CFAU - Walls, HelenAU - Walls HFAU - de Courten, MaximilianAU - de Courten MFAU - Peeters, AnnaAU - Peeters ALA - engPT - Journal ArticlePT - Research Support, Non-U.S. Gov'tDEP - 20100629PL - EnglandTA - Public Health NutrJT - Public health nutritionJID - 9808463SB - IMMH - AdultMH - AgedMH - Aged, 80 and overMH - Body Mass IndexMH - Cohort StudiesMH - Diabetes Mellitus, Type 2/*epidemiology/etiologyMH - FemaleMH - Follow-Up StudiesMH - HumansMH - MaleMH - Middle AgedMH - Obesity/complications/*epidemiology/pathologyMH - Proportional Hazards ModelsMH - Prospective StudiesMH - Risk FactorsMH - Severity of Illness IndexMH - Time FactorsMH - United States/epidemiologyEDAT- 2010/07/01 06:00MHDA- 2011/02/12 06:00CRDT- 2010/07/01 06:00PHST- 2010/06/29 [aheadofprint]AID - S1368980010001813 [pii]AID - 10.1017/S1368980010001813 [doi]PST - ppublishSO - Public Health Nutr. 2011 Jan;14(1):119-26. doi: 10.1017/S1368980010001813. Epub 2010 Jun 29.PMID- 20559295OWN - NLMSTAT- MEDLINEDA - 20101228DCOM- 20110504LR - 20120813IS - 1930-739X (Electronic)IS - 1930-7381 (Linking)VI - 19IP - 1DP - 2011 JanTI - Comparing trends in BMI and waist circumference.PG - 216-9LID - 10.1038/oby.2010.149 [doi]AB - The nature of excess body weight may be changing over time to one of greater central adiposity. The aim of this study is to determine whether BMI and waist circumference (WC) are increasing proportionately among population subgroups and the range of bodyweight, and to examine the public health implications of the findings. Our data are from two cross-sectional surveys (the US National Health and Nutrition Examination Studies (NHANES) in 1988-1994 (NHANES III) and 2005-2006), from which we have used samples of 15,349 and 4,176 participants aged >/=20 years. Between 1988-1994 and 2005-2006 BMI increased by an average of 1.8 kg/m(2) and WC by 4.7 cm (adjusted for sex, age, race-ethnicity, and education). The increase in WC was more than could be attributed simply to increases in BMI. This independent increase in WC (of on average, 0.9 cm) was consistent across the different BMI categories, sexes, education levels, and race-ethnicity groups. It occurred in younger but not older age groups. Overall in each BMI category, the prevalence of low-risk WC decreased and the prevalence of increased-risk or substantially increased-risk WC increased. These results suggest that the adverse health consequences associated with obesity may be increasingly underestimated by trends in BMI alone. Since WC is closely linked to adverse cardiovascular outcomes, it is important to know the prevailing trends in both of these parameters.FAU - Walls, Helen LAU - Walls HLAD - Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Victoria, Australia. helen.walls@med.monash.edu.auFAU - Stevenson, Christopher EAU - Stevenson CEFAU - Mannan, Haider RAU - Mannan HRFAU - Abdullah, AsnawiAU - Abdullah AFAU - Reid, Christopher MAU - Reid CMFAU - McNeil, John JAU - McNeil JJFAU - Peeters, AnnaAU - Peeters ALA - engPT - Comparative StudyPT - Journal ArticleDEP - 20100617PL - United StatesTA - Obesity (Silver Spring)JT - Obesity (Silver Spring, Md.)JID - 101264860SB - IMMH - AdultMH - *Body Mass IndexMH - Body Weights and Measures/*trendsMH - Cross-Sectional StudiesMH - Diagnostic Techniques, Endocrine/trendsMH - FemaleMH - HumansMH - MaleMH - Middle AgedMH - Nutrition SurveysMH - Obesity/*diagnosis/*epidemiologyMH - PrevalenceMH - Waist Circumference/*physiologyMH - Young AdultEDAT- 2010/06/19 06:00MHDA- 2011/05/05 06:00CRDT- 2010/06/19 06:00PHST- 2010/06/17 [aheadofprint]AID - oby2010149 [pii]AID - 10.1038/oby.2010.149 [doi]PST - ppublishSO - Obesity (Silver Spring). 2011 Jan;19(1):216-9. doi: 10.1038/oby.2010.149. Epub 2010 Jun 17.PMID- 20493574OWN - NLMSTAT- MEDLINEDA - 20100810DCOM- 20101123IS - 1872-8227 (Electronic)IS - 0168-8227 (Linking)VI - 89IP - 3DP - 2010 SepTI - The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies.PG - 309-19LID - 10.1016/j.diabres.2010.04.012 [doi]AB - The objectives of this meta-analysis were to examine the magnitude of the relative risk (RR) of developing type 2 diabetes for overweight and obese populations, compared to those with normal weight, and to determine causes of the variation in RR between various cohort studies. The magnitude of the RR was analyzed by combining 18 prospective cohort studies that matched defined criteria. The variance in RR between studies was explored. The overall RR of diabetes for obese persons compared to those with normal weight was 7.19, 95% CI: 5.74, 9.00 and for overweight was 2.99, 95% CI: 2.42, 3.72. The variation in RR among studies was explored and it was found that the effect of heterogeneity was highly related with sample size, method of assessment of body mass index (BMI) and method of ascertainment of type 2 diabetes. By combining only cohort studies with more than 400 cases of incident diabetes (>median), adjusted by at least three main confounding variables (age, family history of type 2 diabetes, physical activity), measured BMI, and diabetes determined by clinical diagnosis, the RR was 7.28, 95% CI: 6.47, 8.28 for obesity and 2.92, 95% CI: 2.57, 3.32 for overweight.CI - Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.FAU - Abdullah, AsnawiAU - Abdullah AAD - Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia. Asnawi.Abdullah@med.monash.edu.auFAU - Peeters, AnnaAU - Peeters AFAU - de Courten, MaximilianAU - de Courten MFAU - Stoelwinder, JohannesAU - Stoelwinder JLA - engPT - Journal ArticlePT - Meta-AnalysisPT - Research Support, Non-U.S. Gov'tDEP - 20100520PL - IrelandTA - Diabetes Res Clin PractJT - Diabetes research and clinical practiceJID - 8508335SB - IMMH - AdolescentMH - AdultMH - AgedMH - Aged, 80 and overMH - Body Mass IndexMH - Diabetes Mellitus, Type 2/*epidemiology/etiologyMH - FemaleMH - HumansMH - MaleMH - Middle AgedMH - Obesity/complications/*epidemiologyMH - Overweight/complications/*epidemiologyMH - Prospective StudiesMH - Young AdultEDAT- 2010/05/25 06:00MHDA- 2010/12/14 06:00CRDT- 2010/05/25 06:00PHST- 2009/09/28 [received]PHST- 2010/04/09 [revised]PHST- 2010/04/15 [accepted]PHST- 2010/05/20 [aheadofprint]AID - S0168-8227(10)00194-4 [pii]AID - 10.1016/j.diabres.2010.04.012 [doi]PST - ppublishSO - Diabetes Res Clin Pract. 2010 Sep;89(3):309-19. doi: 10.1016/j.diabres.2010.04.012. Epub 2010 May 20.PMID- 18700274OWN - NLMSTAT- MEDLINEDA - 20080813DCOM- 20080923IS - 1710-2774 (Print)IS - 1710-2774 (Linking)VI - 11IP - 2DP - 2008TI - Decentralization and health resource allocation: a case study at the district level in Indonesia.PG - 117-25AB - Health resource allocation has been an issue of political debate in many health systems. However, the debate has tended to concentrate on vertical allocation from the national to regional level. Allocation within regions or institutions has been largely ignored. This study was conducted to contribute analysis to this gap. The objective was to investigate health resource allocation within District Health Offices (DHOs) and to compare the trends and patterns of several budget categories before and after decentralization. The study was conducted in three districts in the Province of Nanggroe Aceh Darussalam. Six fiscal year budgets, two before decentralization and four after, were studied. Data was collected from the Local Government Planning Office and DHOs. Results indicated that in the first year of implementing a decentralization policy, the local government budget rose sharply, particularly in the wealthiest district. In contrast, in relatively poor districts the budget was only boosted slightly. Increasing total local government budgets had a positive impact on increasing the health budget. The absolute amount of health budgets increased significantly, but by percentage did not change very much. Budgets for several projects and budget items increased significantly, but others, such as health promotion, monitoring and evaluation, and public-goods-related activities, decreased. This study concluded that decentralization in Indonesia had made a positive impact on district government fiscal capacity and had affected DHO budgets positively. However, an imbalanced budget allocation between projects and budget items was obvious, and this needs serious attention from policy makers. Otherwise, decentralization will not significantly improve the health system in Indonesia.FAU - Abdullah, AsnawiAU - Abdullah AFAU - Stoelwinder, JohannesAU - Stoelwinder JLA - engPT - Journal ArticlePL - CanadaTA - Healthc QJT - Healthcare quarterly (Toronto, Ont.)JID - 101208192SB - HMH - Health Care Rationing/economics/*organization & administrationMH - HumansMH - IndonesiaMH - *Local GovernmentMH - Organizational Case StudiesMH - *PoliticsMH - Private SectorMH - Public SectorEDAT- 2008/08/14 09:00MHDA- 2008/09/24 09:00CRDT- 2008/08/14 09:00PST - ppublishSO - Healthc Q. 2008;11(2):117-25.PMID- 18567948OWN - NLMSTAT- MEDLINEDA - 20080623DCOM- 20080729LR - 20100114IS - 1718-3340 (Electronic)VI - 9IP - 4DP - 2007 DecTI - Decentralization and health resource allocation: a case study at the district level in Indonesia.PG - 5-16AB - Health resource allocation has been an issue of political debate in many health systems. However, the debate has tended to concentrate on vertical allocation from the national to regional level. Allocation within regions or institutions has been largely ignored. This study was conducted to contribute analysis to this gap. The objective was to investigate health resource allocation within District Health Offices (DHOs) and to compare the trends and patterns of several budget categories before and after decentralization. The study was conducted in three districts in the Province of Nanggroe Aceh Darussalam. Six fiscal year budgets, two before decentralization and four after, were studied. Data was collected from the Local Government Planning Office and DHOs. Results indicated that in the first year of implementing a decentralization policy, the local government budget rose sharply, particularly in the wealthiest district. In contrast, in relatively poor districts the budget was only boosted slightly. Increasing total local government budgets had a positive impact on increasing the health budget. The absolute amount of health budgets increased significantly, but by percentage did not change very much. Budgets for several projects and budget items increased significantly, but others, such as health promotion, monitoring and evaluation, and public-goods-related activities, decreased. This study concluded that decentralization in Indonesia had made a positive impact on district government fiscal capacity and had affected DHO budgets positively. However, an imbalanced budget allocation between projects and budget items was obvious, and this needs serious attention from policy makers. Otherwise, decentralization will not significantly improve the health system in Indonesia.FAU - Abdullah, AsnawiAU - Abdullah AAD - Department Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. Asnawi.Abdullah@med.monash.edu.auFAU - Stoelwinder, JohannesAU - Stoelwinder JLA - engPT - Journal ArticlePT - Research Support, Non-U.S. Gov'tPL - CanadaTA - World Health PopulJT - World health & populationJID - 101307691SB - IMMH - Budgets/*trendsMH - Delivery of Health Care/economics/trendsMH - Financing, Government/economics/*trendsMH - Health Care Rationing/*trendsMH - HumansMH - IndonesiaMH - Regional Health Planning/economics/*trendsEDAT- 2008/06/24 09:00MHDA- 2008/07/30 09:00CRDT- 2008/06/24 09:00PST - ppublishSO - World Health Popul. 2007 Dec;9(4):5-16.