Comparison of four analytic strategies for complex survey data: a case-study of Spanish data

Purpose: The aim of this secondary data analysis was to investigate the effect of four different analytical strategies: Model Based Analysis (MBA), Design Based Analysis (DBA), Multilevel Model Based Analysis (MMBA), and Multilevel Design Based Analysis (MDBA), on the model estimates for complex survey data. Methods: Using data from the World Health Survey-Spain explanatory models for the outcome Metabolic Equivalent of Task (METs) were calculated using MBA, DBA, MMBA, and MDBA. Regression coefficients, standard errors (SE) and the Akaike Information Criterion (AIC) from all the models were compared. Results: DBA showed highest estimates for most of the variables, including consistently higher SE than all other model - 20% to 48% higher than estimates for MBA, 10% to 37% for MMBA and 23% to 35% for MDBA. The SE for MDBA were 2.5% to 13% higher than estimates derived from MMBA in level 1 predictors, but SE in MMBA was higher by 18% for level 2 predictors. Values of AIC suggested the model derived by MDBA was the best fit and DBA the poorest fit of the four models. Conclusion: With minimum AIC, MDBA appeared to be the most appropriate approach to analyze complex survey data. To confirm the finding of present study a future work on a simulation data would be required

Thermographic Investigation of Osseous Stress Pathology

The debilitating pathology of stress fracture accounts for 10% of all athletic injuries[2], with prevalence as high as 20% in modern military basic training cohorts [3]. Increasing concerns surrounding adverse effects of radiology [5],combined with the 12.5% contribution of diagnostic imaging to Australian Medicare benefits paid in 2009-10 [6], have prompted the search for alternative/adjunct electronic decision support systems[7]. Within conducive physioanatomic milieu, thermal infrared imaging (TIRI) may feasibly be used to remotely detect and topographically map diagnostically useful signs of suprathreshold thermodynamic pathophysiology. This paper details a three month clinical pilot study into TIRI-based detection of osseous stress pathology in the lower legs of Australian Army basic trainees. A dataset of over 500 TIRI’s was amassed. The apparent ‘normal’ thermal profile of the anterior aspect of the asymptomatic lower leg is topographically defined and validated against current thermophysiological theory [8] via cadaveric dissection

Image Processing for Pathological Visualization in Multitemporal Convoluted TIRI

The convoluted nature of thermal infrared radiation and poor understanding of the physical mechanismsof human emittance, make objective image acquisition and processing protocols prerequisite for meaningful diagnostic specificity. A longitudinal dataset of clinical thermal infrared images was objectively processed to facilitate visualization of osseous stress pathology in the lower limbs.. This paper details processing of 500+ thermal infrared images acquired during a recent three month clinical study into osseous stress pathology in the lower limbs of Australian Army basic trainees. The use ofthermal chroma-keying in segmentation and multitemporal image calibration is demonstrated. The ‘OpenSURF’ implementation of the scale and rotation-invariant interest point detector and escriptor are shown to be performant in registration of multitemporal clinical thermal infrared image data. Thermal ‘signs’ observed in longitudinal images appear to be revealing detectable changes in osseous stress pathophysiology

Effect of national wealth on BMI: An analysis of 206,266 individuals in 70 low-, middle- and high-income countries

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Background This study explores the relationship between BMI and national-wealth and the cross-level interaction effect of national-wealth and individual household-wealth using multilevel analysis. Methods Data from the World Health Survey conducted in 2002–2004, across 70 low-, middle- and high-income countries was used. Participants aged 18 years and over were selected using multistage, stratified cluster sampling. BMI was used as outcome variable. The potential determinants of individual-level BMI were participants’ sex, age, marital-status, education, occupation, household-wealth and location(rural/urban) at the individual-level. The country-level factors used were average national income (GNI-PPP) and income inequality (Gini-index). A two-level random-intercepts and fixed-slopes model structure with individuals nested within countries was fitted, treating BMI as a continuous outcome. Results The weighted mean BMI and standard-error of the 206,266 people from 70-countries was 23.90 (4.84). All the low-income countries were below the 25.0 mean BMI level and most of the high-income countries were above. All wealthier quintiles of household-wealth had higher scores in BMI than lowest quintile. Each USD10000 increase in GNI-PPP was associated with a 0.4 unit increase in BMI. The Gini-index was not associated with BMI. All these variables explained 28.1% of country-level, 4.9% of individual-level and 7.7% of total variance in BMI. The cross-level interaction effect between GNI-PPP and household-wealth was significant. BMI increased as the GNI-PPP increased in first four quintiles of household-wealth. However, the BMI of the wealthiest people decreased as the GNI-PPP increased. Conclusion Both individual-level and country-level factors made an independent contribution to the BMI of the people. Household-wealth and national-income had significant interaction effects.https://doi.org/10.1371/journal.pone.017892812pubpub

Intraclass correlation and design effect in BMI, physical activity and diet: a cross-sectional study of 56 countries

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Objectives Measuring the intraclass correlation coefficient (ICC) and design effect (DE) may help to modify the public health interventions for body mass index (BMI), physical activity and diet according to geographic targeting of interventions in different countries. The purpose of this study was to quantify the level of clustering and DE in BMI, physical activity and diet in 56 low-income, middle-income and high-income countries. Design Cross-sectional study design. Setting Multicountry national survey data. Methods The World Health Survey (WHS), 2003, data were used to examine clustering in BMI, physical activity in metabolic equivalent of task (MET) and diet in fruits and vegetables intake (FVI) from low-income, middle-income and high-income countries. Multistage sampling in the WHS used geographical clusters as primary sampling units (PSU). These PSUs were used as a clustering or grouping variable in this analysis. Multilevel intercept only regression models were used to calculate the ICC and DE for each country. Results The median ICC (0.039) and median DE (1.82) for BMI were low; however, FVI had a higher median ICC (0.189) and median DE (4.16). For MET, the median ICC was 0.141 and median DE was 4.59. In some countries, however, the ICC and DE for BMI were large. For instance, South Africa had the highest ICC (0.39) and DE (11.9) for BMI, whereas Uruguay had the highest ICC (0.434) for MET and Ethiopia had the highest ICC (0.471) for FVI. Conclusions This study shows that across a wide range of countries, there was low area level clustering for BMI, whereas MET and FVI showed high area level clustering. These results suggested that the country level clustering effect should be considered in developing preventive approaches for BMI, as well as improving physical activity and healthy diets for each country.http://dx.doi.org/10.1136/bmjopen-2015-0081736pubpub

Effect of national culture on BMI: a multilevel analysis of 53 countries

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Background To investigate the association between national culture and national BMI in 53 low-middle- and high-income countries. Methods Data from World Health Survey conducted in 2002–2004 in low-middle- and high-income countries were used. Participants aged 18 years and over were selected using multistage, stratified cluster sampling. BMI was used as an outcome variable. Culture of the countries was measured using Hofstede’s cultural dimensions: Uncertainty avoidance, individualism, Power Distance and masculinity. The potential determinants of individual-level BMI were participants’ sex, age, marital status, education, occupation as well as household-wealth and location (rural/urban) at the individual-level. The country-level factors used were average national income (GNI-PPP), income inequality (Gini-index) and Hofstede’s cultural dimensions. A two-level random-intercepts and fixed-slopes model structure with individuals nested within countries were fitted, treating BMI as a continuous outcome variable. Results A sample of 156,192 people from 53 countries was included in this analysis. The design-based (weighted) mean BMI (SE) in these 53 countries was 23.95(0.08). Uncertainty avoidance (UAI) and individualism (IDV) were significantly associated with BMI, showing that people in more individualistic or high uncertainty avoidance countries had higher BMI than collectivist or low uncertainty avoidance ones. This model explained that one unit increase in UAI or IDV was associated with 0.03 unit increase in BMI. Power distance and masculinity were not associated with BMI of the people. National level Income was also significantly associated with individual-level BMI. Conclusion National culture has a substantial association with BMI of the individuals in the country. This association is important for understanding the pattern of obesity or overweight across different cultures and countries. It is also important to recognise the importance of the association of culture and BMI in developing public health interventions to reduce obesity or overweight.https://doi.org/10.1186/s12889-019-7536-019pubpub

Bactrim, Spironolactone and Lisinopril. Stay Away! A Dangerous Cocktail for Hyperkalemia

Introduction: Hyperkalemia is a potentially life-threatening complication of several medications, particularly in situations of polypharmacy. Trimethoprim/sulfamethoxazole (TMP-SMX) is a first line antibiotic for outpatient treatment of MRSA for skin and soft tissue infections that can enhance the hyperkalemic effects of spironolactone and Angiotensin receptor inhibitors (ACEI). Case Presentation: A 53-year-old female with history of HTN, stage 3 CKD, CHF, hypercholesterolemia and DM II, chronic left foot ulcer presented to our local hospital with generalized malaise, severe lower extremity weakness and heaviness of 2 days duration. She normally uses a walker but has had increasing difficulty standing from a seated position. Her medications included: spironolactone, carvedilol, lisinopril, amlodipine, aspirin, atorvastatin, and insulin and had been started on TMP-SMX for the management of an infected chronic ulcer. Physical exam was significant for a blood pressure of 182/87 mm Hg, BMI of 52, lethargy, dry oral mucous membranes, and nonsignificant musculoskeletal examination. The laboratory results revealed significantly elevated potassium levels at 8.6 mmol/L; GFR of 31 and creatinine: 1.79 mg/dL. EKG revealed tall, peaked T-waves with widened QRS complexes in the precordial leads and a right BBB. TMP-SMX, spironolactone and lisinopril were discontinued, and the patient was started on a hyperkalemia treatment protocol. The patient improved rapidly over the next 3 days with resolution of the ECG changes, improved muscle strength and the potassium level was back to normal limits by the time of discharge. Conclusion: Clinicians and pharmacists should be aware of the enhanced hyperkalemic effects of TMP-SMX, spironolactone and lisinopril and should avoid this combination

Effect of Substituting Soybean Meal with Moringa oleifera Meal on the Growth and Body Composition of Labeo rohita Fingerlings

Peer reviewedPublisher PD

Health-related quality of life variations by sociodemographic factors and chronic conditions in three metropolitan cities of South Asia: The CARRS study

Objectives: Health-related quality of life (HRQOL) is a key indicator of health. However, HRQOL data from representative populations in South Asia are lacking. This study aims to describe HRQOL overall, by age, gender and socioeconomic status, and examine the associations between selected chronic conditions and HRQOL in adults from three urban cities in South Asia.Methods: We used data from 16 287 adults aged ≥20 years from the baseline survey of the Centre for Cardiometabolic Risk Reduction in South Asia cohort (2010-2011). HRQOL was measured using the European Quality of Life Five Dimension-Visual Analogue Scale (EQ5D-VAS), which measures health status on a scale of 0 (worst health status) to 100 (best possible health status).Results: 16 284 participants completed the EQ5D-VAS. Mean age was 42.4 (±13.3) years and 52.4% were women. 14% of the respondents reported problems in mobility and pain/discomfort domains. Mean VAS score was 74 (95% CI 73.7 to 74.2). Significantly lower health status was found in elderly (64.1), women (71.6), unemployed (68.4), less educated (71.2) and low-income group (73.4). Individualswith chronic conditions reported worse health status than those without (67.4 vs 76.2): prevalence ratio, 1.8 (95% CI 1.61 to 2.04).Conclusions: Our data demonstrate significantly lower HRQOL in key demographic groups and those with chronic conditions, which is consistent with previous studies. These data provide insights on inequalities in population health status, and potentially reveal unmet needs in the community to guide health policies