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Fulltext Community-based blood pressure measurement by non-health workers using electronic devices: a validation study

Reidpath DD, Ling ML, Yasin S, Rajagobal K, Allotey P

Glob Health Action, 2012;5:14876.
PMID: 22761601 DOI: 10.3402/gha.v5i0.14876

INTRODUCTION: Population monitoring and screening of blood pressure is an important part of any population health strategy. Qualified health workers are expensive and often unavailable for screening. Non-health workers with electronic blood pressure monitors are increasingly used in community-based research. This approach is unvalidated. In a poor, urban community we compared blood pressure measurements taken by non-health workers using electronic devices against qualified health workers using mercury sphygmomanometers.
METHOD: Fifty-six adult volunteers participated in the research. Data were collected by five qualified health workers, and six non-health workers. Participants were randomly allocated to have their blood pressure measured on four consecutive occasions by alternating a qualified health worker with a non-health worker. Descriptive statistics and graphs, and mixed effects linear models to account for the repeated measurement were used in the analysis.
RESULTS: Blood pressure readings by non-health workers were more reliable than those taken by qualified health workers. There was no significant difference between the readings taken by qualified health workers and those taken by non-health workers for systolic blood pressure. Non-health workers were, on average, 5-7 mmHg lower in their measures of blood pressure than the qualified health workers (95%HPD: -2.9 to -10.0) for diastolic blood pressure.
CONCLUSION: The results provide empirical evidence that supports the practice of non-health workers using electronic devices for BP measurement in community-based research and screening. Non-health workers recorded blood pressures that differed from qualified health workers by no more than 10 mmHg. The approach is promising, but more research is needed to establish the generalisability of the results.
KEYWORDS: Malaysia; blood pressure; community workers; hypertension; measurement; screening
Study site: urban, low-income community, of the Klang Valley near Kuala Lumpur, Malaysia
Device: Mercury sphygmomanometers (Spirit brand, model number CK-101C), electronic, automatic blood pressure monitors (Omron brand model HEM-7203)
Let's talk about death: data collection for verbal autopsies in a demographic and health surveillance site in Malaysia

Allotey PA, Reidpath DD, Evans NC, Devarajan N, Rajagobal K, Bachok R, et al.

Glob Health Action, 2015 Jan;8(1):28219.
PMID: 28156759 DOI: 10.3402/gha.v8.28219

Background Verbal autopsies have gained considerable ground as an acceptable alternative to medically determined cause of death. Unlike with clinical or more administrative settings for data collection, verbal autopsies require significant involvement of families and communities, which introduces important social and cultural considerations. However, there is very little clear guidance about the methodological issues in data collection. The objectives of this case study were: to explore the range of bereavement rituals within the multi-ethnic, multi-faith population of the district; to investigate the preparedness of communities to talk about death; to describe the verbal autopsy process; to assess the effects of collecting verbal autopsy data on data collectors; and to determine the most accurate sources of information about deaths in the community. Methods A case study approach was used, using focus group discussions, indepth interviews and field notes. Thematic analyses were undertaken using NVivo. Results Consideration of cultural bereavement practices is importance to acceptance and response rates to verbal autopsies. They are also important to the timing of verbal autopsy interviews. Well trained data collectors, regardless of health qualifications are able to collect good quality data, but debriefing is important to their health and well being. This article contributes to guidance on the data collection procedures for verbal autopsies within community settings.
Fulltext Single, community-based blood glucose readings may be a viable alternative for community surveillance of HbA1c and poor glycaemic control in people with known diabetes in resource-poor settings

Reidpath DD, Jahan NK, Mohan D, Allotey P

Glob Health Action, 2016;9:31691.
PMID: 27511810 DOI: 10.3402/gha.v9.31691

BACKGROUND: The term HbA1c (glycated haemoglobin) is commonly used in relation to diabetes mellitus. The measure gives an indication of the average blood sugar levels over a period of weeks or months prior to testing. For most low- and middle-income countries HbA1c measurement in community surveillance is prohibitively expensive. A question arises about the possibility of using a single blood glucose measure for estimating HbA1c and therefore identifying poor glycaemic control in resource-poor settings.
DESIGN: Using data from the 2011-2012 US National Health and Nutrition Examination Surveys, we examined the relationship between HbA1c and a single fasting measure of blood glucose in a non-clinical population of people with known diabetes (n=333). A linear equation for estimating HbA1c from blood glucose was developed. Appropriate blood glucose cut-off values were set for poor glycaemic control (HbA1c≥69.4 mmol/mol).
RESULTS: The HbA1c and blood glucose measures were well correlated (r=0.7). Three blood glucose cut-off values were considered for classifying poor glycaemic control: 8.0, 8.9, and 11.4 mmol/L. A blood glucose of 11.4 had a specificity of 1, but poor sensitivity (0.37); 8.9 had high specificity (0.94) and moderate sensitivity (0.7); 8.0 was associated with good specificity (0.81) and sensitivity (0.75).
CONCLUSIONS: Where HbA1c measurement is too expensive for community surveillance, a single blood glucose measure may be a reasonable alternative. Generalising the specific results from these US data to low resource settings may not be appropriate, but the general approach is worthy of further investigation.
Fulltext Multiple Sclerosis in the Asia Pacific Region: A Systematic Review of a Neglected Neurological Disease

Cheong WL, Mohan D, Warren N, Reidpath DD

Front Neurol, 2018;9:432.
PMID: 29937752 DOI: 10.3389/fneur.2018.00432

Background: Multiple sclerosis is thought to be relatively uncommon in the Asia Pacific region with prevalence estimated between 0 and 20 per 100,000. There is reason to doubt these estimates due to the lack of data from many countries and the growing evidence of variability in prevalence across small geographic areas. This study was conducted to systematically review the population prevalence, incidence, mortality and disability progression estimates of MS within the Asia Pacific region. Methods: The systematic review was conducted on articles from 1985 till 31st July 2017 within the PubMed/MEDLINE, EMBASE, SCOPUS, and The Cochrane Library databases. The review included articles that were population-based studies conducted on patients with MS in the Asia Pacific region that reported either incidence, prevalence, mortality, or disease progression. Hospital-based studies and non-research articles were excluded to ensure that only information representative of the population was included for analysis. Data appraisal and extraction was done by independent reviewers. This review was registered with PROSPERO (ID: CRD42017082760). Findings: Of the 2,757 articles found, 16 studies were included. Information on 6 (18.75%) of 32 Asia Pacific countries was found, with data representing 8% of the total population. Prevalence estimates were available for 6 countries while estimates for incidence (3 countries), mortality (4 countries), and disease progression (2 countries) were limited. Interpretation: The lack of epidemiological data available in the Asia Pacific region creates a blind spot in the surveillance of MS which obscures the true burden of MS, causing patients to struggle to receive the resources and funding that they need.
Fulltext Religiosity and spirituality and the intake of fruit, vegetable, and fat: a systematic review

Tan MM, Chan CK, Reidpath DD

Evid Based Complement Alternat Med, 2013;2013:146214.
PMID: 24319472 DOI: 10.1155/2013/146214

Objectives. To systematically review articles investigating the relationship between religion and spirituality (R/S) and fruit, vegetable, and fat intake. Methods. PubMed, CINAHL, and PsycInfo were searched for studies published in English prior to March 2013. The studies were divided into two categories: denominational studies and degree of R/S studies. The degree of R/S studies was further analyzed to (1) determine the categories of R/S measures and their relationship with fruit, vegetable, and fat intake, (2) evaluate the quality of the R/S measures and the research design, and (3) determine the categories of reported relationship. Results. Thirty-nine studies were identified. There were 14 denominational studies and 21 degree of R/S studies, and 4 studies were a combination of both. Only 20% of the studies reported validity and 52% reported reliability of the R/S measures used. All studies were cross-sectional, and only one attempted mediation analysis. Most studies showed a positive association with fruit and vegetable intake and a mixed association with fat intake. Conclusion. The positive association between R/S and fruit and vegetable intake may be one possible link between R/S and positive health outcome. However, the association with fat intake was mixed, and recommendations for future research are made.
The Association Between Hospital Characteristics and Nonresponse in Organization Survey: An Analysis of the National Healthcare Establishment and Workforce Survey in Malaysia

Foo CY, Reidpath DD, Sivasampu S

Eval Health Prof, 2017 Jan 01.
PMID: 29179560 DOI: 10.1177/0163278717713569

In any survey where some of the invited participants fail to respond estimates may be biased. The literature on survey nonresponse is substantial, and the intellectual focus has typically been on the nonresponse of individuals. An important yet less scrutinized area in the analysis of nonresponse is in organizational surveys, particularly surveys of health-care organizations. This study used data from the 2010 National Healthcare Establishment and Workforce Survey in Malaysia to examine the relationship between a set of measurable hospital attributes and their probability of survey response and the relationship between this probability and the differences in survey estimates. We found that readily measurable hospital characteristics such as size and geographical location are useful predictors of survey response likelihood. Larger hospitals and hospitals located in less developed geographical regions responded more favorably than their counterparts. We have also illustrated that the resulting response pattern affected some key survey estimates. These findings have the potential to extend our understanding of nonresponse to organization surveys in the health-care sector, potentially allow for the prediction of nonresponse, and help researchers to identify profiles of "reluctant responders" before a survey commences, so that additional engagement strategies may be used.
Fulltext An overview of health forecasting

Soyiri IN, Reidpath DD

Environ Health Prev Med, 2013 Jan;18(1):1-9.
PMID: 22949173 DOI: 10.1007/s12199-012-0294-6

Health forecasting is a novel area of forecasting, and a valuable tool for predicting future health events or situations such as demands for health services and healthcare needs. It facilitates preventive medicine and health care intervention strategies, by pre-informing health service providers to take appropriate mitigating actions to minimize risks and manage demand. Health forecasting requires reliable data, information and appropriate analytical tools for the prediction of specific health conditions or situations. There is no single approach to health forecasting, and so various methods have often been adopted to forecast aggregate or specific health conditions. Meanwhile, there are no defined health forecasting horizons (time frames) to match the choices of health forecasting methods/approaches that are often applied. The key principles of health forecasting have not also been adequately described to guide the process. This paper provides a brief introduction and theoretical analysis of health forecasting. It describes the key issues that are important for health forecasting, including: definitions, principles of health forecasting, and the properties of health data, which influence the choices of health forecasting methods. Other matters related to the value of health forecasting, and the general challenges associated with developing and using health forecasting services are discussed. This overview is a stimulus for further discussions on standardizing health forecasting approaches and methods that will facilitate health care and health services delivery.
Fulltext A novel nonparametric item response theory approach to measuring socioeconomic position: a comparison using household expenditure data from a Vietnam health survey, 2003

Reidpath DD, Ahmadi K

Emerg Themes Epidemiol, 2014;11:9.
PMID: 25126103 DOI: 10.1186/1742-7622-11-9

BACKGROUND: Measures of household socio-economic position (SEP) are widely used in health research. There exist a number of approaches to their measurement, with Principal Components Analysis (PCA) applied to a basket of household assets being one of the most common. PCA, however, carries a number of assumptions about the distribution of the data which may be untenable, and alternative, non-parametric, approaches may be preferred. Mokken scale analysis is a non-parametric, item response theory approach to scale development which appears never to have been applied to household asset data. A Mokken scale can be used to rank order items (measures of wealth) as well as households. Using data on household asset ownership from a national sample of 4,154 consenting households in the World Health Survey from Vietnam, 2003, we construct two measures of household SEP. Seventeen items asking about assets, and utility and infrastructure use were used. Mokken Scaling and PCA were applied to the data. A single item measure of total household expenditure is used as a point of contrast.
RESULTS: An 11 item scale, out of the 17 items, was identified that conformed to the assumptions of a Mokken Scale. All the items in the scale were identified as strong items (Hi > .5). Two PCA measures of SEP were developed as a point of contrast. One PCA measure was developed using all 17 available asset items, the other used the reduced set of 11 items identified in the Mokken scale analaysis. The Mokken Scale measure of SEP and the 17 item PCA measure had a very high correlation (r = .98), and they both correlated moderately with total household expenditure: r = .59 and r = .57 respectively. In contrast the 11 item PCA measure correlated moderately with the Mokken scale (r = .68), and weakly with the total household expenditure (r = .18).
CONCLUSION: The Mokken scale measure of household SEP performed at least as well as PCA, and outperformed the PCA measure developed with the 11 items used in the Mokken scale. Unlike PCA, Mokken scaling carries no assumptions about the underlying shape of the distribution of the data, and can be used simultaneous to order household SEP and items. The approach, however, has not been tested with data from other countries and remains an interesting, but under researched approach.
Adaptive invention: independence and mobility through modifications

Mairami FF, Allotey P, Warren N, Mak JS, Reidpath DD

Disabil Rehabil Assist Technol, 2018 10;13(7):658-664.
PMID: 28836873 DOI: 10.1080/17483107.2017.1369586

BACKGROUND: Stroke is a leading cause of disability that limits everyday activities and reduces social participation. Provision of assistive devices helps to achieve independence and social inclusion. However, due to limited resources or a lack of suited objects for their needs, individuals with disabilities in low and middle income countries (LMIC) often do not have access to assistive devices. This has resulted in the creation of purpose built innovative solutions. Methodology and case content: This paper uses a single case derived from a larger ethnographic study of stroke survivors in rural Malaysia to demonstrate the role of assistive devices in shaping stroke recovery and how existing structures can be modified. Second, the concept of affordances in relation to structures within the environment, issues of affordability and accessibility of assistive devices for individuals in LMIC are discussed.
FINDINGS AND CONCLUSIONS: Stroke recovery involves adapting to new limitations and discovering the support necessary to live life. These changes are influenced by a range of environmental factors. Healthcare professionals need to support stroke patients in identifying challenges and work to find innovative ways to address them. Stroke survivors may benefit from the use of an assistive device beyond its clinical function to participate purposefully in activities of daily living. Implications for Rehabilitation Stroke is a cause of disability that limits everyday activities and reduces social participation. Assistive devices help achieve independence, social inclusion and shape stroke recovery. Individuals with disabilities in low and middle income countries often do not have access to assistive devices and resort to innovative solutions that are purpose built. Stroke recovery involves adapting to new limitations and discovering the support necessary to live life as best as possible.
Living with a neglected neurological disease: a qualitative study of patients with multiple sclerosis in Malaysia

Cheong WL, Mohan D, Warren N, Reidpath DD

Disabil Rehabil, 2021 07;43(15):2184-2190.
PMID: 31769306 DOI: 10.1080/09638288.2019.1695000

BACKGROUND: The needs of patients with multiple sclerosis have been well-studied in high-income, high-prevalence countries but few studies have been based in low- and middle-income countries where resources are relatively scarce. As such, little is known about the needs of patients living in these countries.
OBJECTIVE: The study seeks to develop an understanding of the needs of patients with multiple sclerosis living in Malaysia in order to generate insights and contribute to a global database of patients' experience.
METHOD: 12 patients with multiple sclerosis participated in this qualitative study and took part in a semi-structured interview. The interviews were transcribed and analysed using an iterative thematic analysis approach.
RESULTS: The experiences, challenges and needs of the patients were reported. Five themes were developed (Daily living, Financial, Emotional and psychological, Healthcare, and Family). These predominantly revolved around the struggles of coping and adapting to the symptoms and disabilities imposed by multiple sclerosis, their heavy reliance on personal finances to cope with the increased costs of living for themselves and their families, as well as the limited healthcare services and treatments available to help them to manage the physical and emotional symptoms of multiple sclerosis.
CONCLUSION: Patients with multiple sclerosis in Malaysia have complex needs that are neglected due perceived lack of importance of the disease and the poor understanding of multiple sclerosis in general. Patients rely heavily on their finances to improve their quality of life. This perpetuates health inequities and reform of the national health financing system is needed to provide patients with the healthcare and support they need.Implications for rehabilitationPatients with multiple sclerosis in Malaysia prioritize being able to cope and adapt to their disabilities in order to continue performing their activities of daily living.There is a need to increase the availability and accessibility of healthcare professionals that are experienced with the management of multiple sclerosis.Healthcare professionals need to improve their understanding of the patients' needs and what they consider to be important in order to provide therapy that is effective and relevant.Patients also require financial support to help them with the increased costs of living associated with MS as well as the costs of healthcare services such as physiotherapy and rehabilitation.
Contextual factors that shape recovery after stroke in Malaysia

Mairami FF, Warren N, Allotey PA, Reidpath DD

Disabil Rehabil, 2020 11;42(22):3189-3198.
PMID: 30950658 DOI: 10.1080/09638288.2019.1588399

Purpose: A stroke is a sudden event which may leave individuals and their families ill-prepared to deal with the resultant disability. Several contextual factors can influence the recovery process. These factors, internal and external, exist interactively in the lived experiences of the survivors. The limited availability of rehabilitation centres that are located in urban centres meant that recovery predominately occurred outside of the biomedical health and instead relied upon the resources available to individuals and their families.Methods: A qualitative approach with data from in-depth interviews and observations were used to identify contextual factors that shaped recovery following stroke in a community. Twenty-seven individuals with stroke were drawn from a health and demographic surveillance system in Malaysia.Results: Hope and optimism, coping strategies, motivation and support from family and friends, and the use of alternative and complementary medicine shaped the process of recovery within a context where infrastructure is extremely limited.Conclusion: The identification of factors that facilitate the recovery process provides a background in which health care providers can utilise to improve their understanding of the stroke experience. Such understanding could be instrumental in aiding health professionals to offer the most effective help to their clients.Implications for rehabilitationIdentification of contextual factors provides a background for the understanding of the stroke experience.Incorporation of religion into rehabilitation could support and maintain hope in recovery for the survivors and aid acceptance.A collaboration of healthcare professionals with traditional medicine therapists may prove beneficial for the rehabilitation of stroke survivors in Malaysia.
Understandings of stroke in rural Malaysia: ethnographic insights

Yap KH, Warren N, Allotey P, Reidpath DD

Disabil Rehabil, 2021 02;43(3):345-353.
PMID: 31169419 DOI: 10.1080/09638288.2019.1624841

BACKGROUND: Stroke is a public health concern in Malaysia but local beliefs and lay understandings of stroke have not been examined before. Explanatory models provide a way for people to make sense of their illness and influence health seeking behaviors, in a locally relevant way.
METHODS: Drawing on ethnographic research from rural Malaysia, this descriptive article explores ethnic Malaysian-Chinese stroke survivors' lay understandings of stroke. Eighteen community-dwelling stroke survivors aged 50-83 took part in the study.
RESULTS: Causation of stroke was derived from cultural, biomedical and social sources. Participants also drew simultaneously from both biomedical and traditional explanations of stroke to develop their own understanding of etiology. Similarities with biomedical causation and other studies from different cultures were found. Participants' typically focused on the more immediate effects of stroke and often do not attribute causation and association with their comorbid conditions which are also risk factors of stroke.
CONCLUSION: Lack of knowledge about stroke and its symptoms was evident in participants' account. Findings emphasize the importance of knowledge based health interventions, especially in health education strategies for stroke survivors to reduce delays to diagnosis and potentially improve health outcomes post-stroke. Implications for rehabilitation Stroke survivors often form explanatory models of stroke that draw from both biomedical and traditional explanations of stroke. Understanding how people derive lay understandings of stroke can contribute towards developing the goals and activities that facilitate recovery and rehabilitation in similar settings. Health practitioners in the community should strengthen communication regarding the identification, etiology and risk factors of stroke with stroke survivors and their carers to improve compliance to medication, exercise and diet for better recovery. Sustained health education which is culturally relevant is recommended. Communication should also include non-physical impact of stroke (such as cognitive deficits and emotional difficulties) as the stroke survivors were unlikely to relate such symptoms to stroke.
Documenting the impact of stroke in a middle-income country: a Malaysian case study

Mairami FF, Warren N, Allotey PA, Mak JS, Reidpath DD

Disabil Rehabil, 2020 01;42(1):102-113.
PMID: 30183424 DOI: 10.1080/09638288.2018.1493544

Purpose: Stroke is an abrupt event that often leaves survivors with long term disabilities, causing role changes, and financial strains on households. The profound impact of stroke on survivors may lead to a decline in quality of life due to the physical, psychological, and social difficulties they experience. Taking Malaysia as an example, this study aimed to explore the impact of stroke on survivors and how health services influence their recovery in low and middle-income countries (LMIC).Method: An ethnographic approach with data obtained primarily through in-depth interviews was used. Twenty-seven participants identified as having suffered a stroke were drawn from a health and demographic surveillance system in Malaysia.Results: The physical and social disruption of the lives of stroke survivors was intensified by the resultant financial constraints placed upon individuals, families and households, compounded by inadequate support from the health, and welfare systems. Despite the disruption to their lives, most participants were, at least in part, able to reestablish their lives through various factors that include a strong family support and active coping strategies.Conclusion: In LMIC, recovery can be shaped by the family unit and through active coping strategies especially those in relation to spirituality.Implications for rehabilitationThe impact of stroke on survivors and lack of specialized stroke care compromise the recovery process and quality of life for stroke survivors in low and middle-income countries.Support from the family and reinforcement of religious coping were judged to successfully aid recovery.Physical and emotional impairments as well as psychosocial wellbeing of survivors in the context of environmental factors need to be addressed.
Multi-country health surveys: are the analyses misleading?

Masood M, Reidpath DD

Curr Med Res Opin, 2014 May;30(5):857-63.
PMID: 24328497 DOI: 10.1185/03007995.2013.875466

BACKGROUND: The aim of this paper was to review the types of approaches currently utilized in the analysis of multi-country survey data, specifically focusing on design and modeling issues with a focus on analyses of significant multi-country surveys published in 2010.
METHODS: A systematic search strategy was used to identify the 10 multi-country surveys and the articles published from them in 2010. The surveys were selected to reflect diverse topics and foci; and provide an insight into analytic approaches across research themes. The search identified 159 articles appropriate for full text review and data extraction.
RESULTS: The analyses adopted in the multi-country surveys can be broadly classified as: univariate/bivariate analyses, and multivariate/multivariable analyses. Multivariate/multivariable analyses may be further divided into design- and model-based analyses. Of the 159 articles reviewed, 129 articles used model-based analysis, 30 articles used design-based analyses. Similar patterns could be seen in all the individual surveys.
CONCLUSION: While there is general agreement among survey statisticians that complex surveys are most appropriately analyzed using design-based analyses, most researchers continued to use the more common model-based approaches. Recent developments in design-based multi-level analysis may be one approach to include all the survey design characteristics. This is a relatively new area, however, and there remains statistical, as well as applied analytic research required. An important limitation of this study relates to the selection of the surveys used and the choice of year for the analysis, i.e., year 2010 only. There is, however, no strong reason to believe that analytic strategies have changed radically in the past few years, and 2010 provides a credible snapshot of current practice.
Forecasting asthma-related hospital admissions in London using negative binomial models

Soyiri IN, Reidpath DD, Sarran C

Chron Respir Dis, 2013 May;10(2):85-94.
PMID: 23620439 DOI: 10.1177/1479972313482847

Health forecasting can improve health service provision and individual patient outcomes. Environmental factors are known to impact chronic respiratory conditions such as asthma, but little is known about the extent to which these factors can be used for forecasting. Using weather, air quality and hospital asthma admissions, in London (2005-2006), two related negative binomial models were developed and compared with a naive seasonal model. In the first approach, predictive forecasting models were fitted with 7-day averages of each potential predictor, and then a subsequent multivariable model is constructed. In the second strategy, an exhaustive search of the best fitting models between possible combinations of lags (0-14 days) of all the environmental effects on asthma admission was conducted. Three models were considered: a base model (seasonal effects), contrasted with a 7-day average model and a selected lags model (weather and air quality effects). Season is the best predictor of asthma admissions. The 7-day average and seasonal models were trivial to implement. The selected lags model was computationally intensive, but of no real value over much more easily implemented models. Seasonal factors can predict daily hospital asthma admissions in London, and there is a little evidence that additional weather and air quality information would add to forecast accuracy.
Effects of Statin Treatment on Inflammation and Cardiac Function in Heart Failure: An Adjusted Indirect Comparison Meta-Analysis of Randomized Trials

Bonsu KO, Reidpath DD, Kadirvelu A

Cardiovasc Ther, 2015 Dec;33(6):338-46.
PMID: 26280110 DOI: 10.1111/1755-5922.12150

Statins are known to prevent heart failure (HF). However, it is unclear whether statins as class or type (lipophilic or hydrophilic) improve outcomes of established HF.
Lipophilic Statin Versus Rosuvastatin (Hydrophilic) Treatment for Heart Failure: a Meta-Analysis and Adjusted Indirect Comparison of Randomised Trials

Bonsu KO, Reidpath DD, Kadirvelu A

Cardiovasc Drugs Ther, 2016 Apr;30(2):177-88.
PMID: 26780905 DOI: 10.1007/s10557-015-6636-z

OBJECTIVES: This study aims to compare lipophilic and hydrophilic statin therapy on clinical outcomes of heart failure (HF) using a systematic review and an adjusted indirect comparison meta-analysis. Outcomes were all-cause mortality, cardiovascular mortality, cardiovascular hospitalization and hospitalization for worsening HF.
METHODS: We conducted a search of PubMed, EMBASE and Cochrane databases until 31st December 2014 for randomized control trials (RCTs) in HF evaluating statins versus placebo. Identified RCTs and their respective abstracted information were grouped according to statin type evaluated and analyzed separately. Outcomes were initially pooled with the Peto's one-step method, producing odd ratios (OR) and 95 % confidence intervals (CI) for each statin type. Using these pooled estimates, we performed adjusted indirect comparisons of lipophilic versus hydrophilic statin for each outcome.
RESULTS: Thirteen studies involving 10,966 patients were identified and analyzed. Lipophilic statins were superior to hydrophilic rosuvastatin regarding all-cause mortality (OR 0 · 50; 95 % CI, 0 · 11-0 · 89; p = 0 · 01), cardiovascular mortality (OR 0 · 61; 0 · 25-0 · 97; p = 0 · 009), and hospitalization for worsening HF (OR 0 · 52; 0 · 21-0 · 83; p = 0 · 0005). However, both statins were comparable with regards to cardiovascular hospitalization [OR 0 · 80 (0 · 31, 1 · 28); p = 0 · 36].
CONCLUSIONS: Lipophilic statin treatment shows significant decreases in all-cause mortality, cardiovascular mortality and hospitalization for worsening HF compared with rosuvastatin treatment. This meta-analysis provides preliminary evidence that lipophilic statins offer better clinical outcomes in HF till data from head to head comparisons are available.
Fulltext Behaviour Change in Public Health: Evidence and Implications

Pokhrel S, Anokye NK, Reidpath DD, Allotey P

Biomed Res Int, 2015;2015:598672.
PMID: 26380284 DOI: 10.1155/2015/598672
Fulltext Intraclass correlation and design effect in BMI, physical activity and diet: a cross-sectional study of 56 countries

Masood M, Reidpath DD

BMJ Open, 2016 Jan 07;6(1):e008173.
PMID: 26743697 DOI: 10.1136/bmjopen-2015-008173

OBJECTIVES: 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.
KEYWORDS: Body Mass Index (BMI); Intraclass correlation coefficient (ICC); Physical activity (METs)
Study name: World Health Survey (Malaysia is a study site)
Fulltext Feasibility and acceptability of a dietary intervention study to reduce salt intake and increase high-nitrate vegetable consumption among middle-aged and older Malaysian adults with elevated blood pressure: a study protocol

McGrattan A, Mohan D, Chua PW, Mat Hussin A, Soh YC, Alawad M, et al.

BMJ Open, 2020 08 27;10(8):e035453.
PMID: 32859661 DOI: 10.1136/bmjopen-2019-035453

INTRODUCTION: Global population ageing is one of the key factors linked to the projected rise of dementia incidence. Hence, there is a clear need to identify strategies to overcome this expected health burden and have a meaningful impact on populations' health worldwide. Current evidence supports the role of modifiable dietary and lifestyle risk factors in reducing the risk of dementia. In South-East Asia, changes in eating and lifestyle patterns under the influence of westernised habits have resulted in significant increases in the prevalence of metabolic, cardiovascular and neurodegenerative non-communicable diseases (NCDs). Low vegetable consumption and high sodium intake have been identified as key contributors to the increased prevalence of NCDs in these countries. Therefore, nutritional and lifestyle strategies targeting these dietary risk factors are warranted. The overall objective of this randomised feasibility trial is to demonstrate the acceptability of a dietary intervention to increase the consumption of high-nitrate green leafy vegetables and reduce salt intake over 6 months among Malaysian adults with raised blood pressure.
METHODS AND ANALYSIS: Primary outcomes focus on feasibility measures of recruitment, retention, implementation and acceptability of the intervention. Secondary outcomes will include blood pressure, cognitive function, body composition and physical function (including muscle strength and gait speed). Adherence to the dietary intervention will be assessed through collection of biological samples, 24-hour recall and Food Frequency Questionnaire. A subgroup of participants will also complete postintervention focus groups to further explore the feasibility considerations of executing a larger trial, the ability of these individuals to make dietary changes and the barriers and facilitators associated with implementing these changes.
ETHICS AND DISSEMINATION: Ethical approval has been obtained from Monash University Human Research Ethics Committee and Medical Research and Ethics Committee of Malaysia. Results of the study will be disseminated via peer-reviewed publications and presentations at national and international conferences.ISRCTN47562685; Pre-results.

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