Using interRAI Assessment for Research: Developing a National Research Agenda in Aotearoa New Zealand.

interRAI provides a suite of standardized, validated instruments used to assess health and psychosocial well-being, and to inform person-centered care planning. Data obtained from these standardized tools can also be used at a population level for research and to inform policy, and interRAI is currently used in more than 40 countries globally. We present a brief overview of the use of interRAI internationally within research and policy settings, and then introduce how interRAI is used within the universal public health system in Aotearoa New Zealand (NZ), including considerations relating to Maori, the Indigenous people of NZ. In NZ, improvement in interRAI data utilization for research purposes was called for from aged care, health providers, and researchers, to better use these data for quality improvement and health advancement for New Zealanders. A national research network has been established, providing a medium for researchers to form relationships and collaborate on interRAI research with a goal of translating routinely collected interRAI data to improve clinical care, patient experience, service development, and quality improvement. In 2023, the network members met (hybrid: in-person and online) and identified research priorities. These were collated and developed into a national interRAI research agenda by the NZ interRAI Research Network Working Group. Research priorities included reviewing the interRAI assessment processes, improving methods for data linkage to national data sets, exploring how Indigenous Data Sovereignty can be upheld, as well as a variety of clinically focused research topics. Implications for Practice, Policy, and Research: This appears to be the first time national interRAI research priorities have been formally identified. Priorities identified have the potential to inform quality and clinical improvement activities and are likely of international relevance. The methodology described to cocreate the research priorities will also be of wider significance for those looking to do so in other countries.

Long-term outcomes and cost savings of office fulguration of papillary Ta low-grade bladder cancer.

OBJECTIVES: To assess whether office-based fulguration (OF) under local anaesthesia for small, recurrent, pathological Ta low-grade (LG) non-muscle-invasive bladder cancer (NMIBC) is an effective alternative to transurethral resection of bladder tumour (TURBT), avoiding the costs and risks of procedure, and anesthesia. PATIENTS AND METHODS: Of 521 patients with primary TaLG NMIBC, this retrospective study included 270 patients who underwent OF during follow-up for recurrent, small, papillary LG-appearing tumours at a university centre (University Health Network, University of Toronto, Canada). We assessed the cumulative incidence of cancer-specific mortality (CSM) and disease progression (to MIBC or metastases), as well as possible direct cost savings. RESULTS: In the 270 patients with recurrent TaLG NMIBC treated with OF, the mean (sd) age was 64.9 (13.3) years, 70.8% were men, and 60.3% had single tumours. The mean (sd, range) number of OF procedures per patient was 3.1 (3.2, 1-22). The median (interquartile range) follow-up was 10.1 (5.8-16.2) years. Patients also underwent a mean (sd) of 3.6 (3.0) TURBTs during follow-up in case of numerous or bulkier recurrence. In all, 44.4% of patients never received intravesical therapy. The 10-year incidence of CSM and progression were 0% and 3.1% (95% confidence interval 0.8-5.4%), respectively. Direct cost savings in Ontario were estimated at $6994.14 (Canadian dollars) per patient over the study follow-up. CONCLUSIONS: This study supports that properly selected patients with recurrent, apparent TaLG NMIBC can be safely managed with OF under local anaesthesia with occasional TURBT for larger or numerous recurrent tumours, without compromising long-term oncological outcomes. This approach could generate substantial cost-saving to healthcare systems, is patient-friendly, and could be adopted more widely.

Potentially inappropriate medications and potential prescribing omissions in hospitalised older adults in New Zealand: A retrospective study.

OBJECTIVE: Medication errors can have detrimental effects on patient outcomes, yet there are limited data on the prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among older adult inpatients in New Zealand (NZ). This study investigated exposure to PIMs and PPOs in older adults in a New Zealand hospital. METHODS: Electronic medical records of 846 older adults (≥ 65 years) discharged from the Auckland District Health Board between June 2020 and May 2021 were retrospectively reviewed to extract data on sociodemographic, medication and diagnostic information. STOPP/START version 2 was used to evaluate PIMs and PPOs on admission and discharge. RESULTS: The mean age was 77.47 ± 8.12 years, and 51% were female. On admission, 48% had ≥1 PIMs and 40% had ≥1 PPOs. On discharge, 45% had ≥1 PIMs and 40% had ≥1 PPOs. Increasing age (adjusted odds ratio [AOR] = 1.02, 95% CI [confidence interval] 1.01, 1.04), number of medicines (AOR = 1.23, CI 1.17, 1.29) and 28-day admission history (AOR = 1.58, CI 1.15, 2.18) were associated with higher odds of PIMs use on admission. At discharge, the number of medicines (AOR = 1.19, CI 1.13, 1.25) and history of readmission (AOR = 1.47, CI 1.08, 2.02) were associated with higher odds of PIMs. Female patients had higher odds of PPOs both on admission (AOR = 1.35, CI 1.02, 1.78) and discharge (AOR = 1.34, CI 1.01, 1.78). Maori, Asian and Pacific patients were more likely to have prescribing omissions compared to NZ Europeans. CONCLUSIONS: Prescribing omissions and inappropriate medications were common in older inpatients. There were differences observed between different ethnic groups, with NZ Europeans having fewer omissions than other ethnic groups. These findings highlight key opportunities for health-care providers to improve medication use in older adults in NZ.

Formal and informal venous thromboembolism risk assessment and impact on prescribing of thromboprophylaxis: a retrospective cohort study.

BACKGROUND: Hospital-acquired thrombosis (HAT) is a leading cause of preventable death and disability worldwide. HAT includes any venous thromboembolic (VTE) event occurring in-hospital or within 90-days of hospitalisation. Despite availability of evidence-based guidelines for HAT risk assessment and prophylaxis, guidelines are still underutilised. AIM: To determine the proportion of patients who developed HAT that could have been potentially prevented with appropriate VTE risk assessment and prophylaxis at a large public hospital in New Zealand. Additionally, the predictors of VTE risk assessment and thromboprophylaxis were examined. METHOD: VTE patients admitted under general medicine, reablement, general surgery, or orthopaedic surgery service were identified using ICD-10-AM codes. Data were collected on patient characteristics, VTE risk factors, and the thromboprophylaxis regimen prescribed. The hospital VTE guidelines were used to determine rates of VTE risk assessment and the appropriateness of thromboprophylaxis. RESULTS: Of 1302 VTE patients, 213 HATs were identified. Of these, 116 (54%) received VTE risk assessment, and 98 (46%) received thromboprophylaxis. Patients who received VTE risk assessment were 15 times more likely to receive thromboprophylaxis (odds ratio [OR] = 15.4; 95% CI 7.65-30.98) and 2.8 times more likely to receive appropriate thromboprophylaxis (OR = 2.79; 95% CI 1.59-4.89). CONCLUSION: A large proportion of high-risk patients who were admitted to medical, general surgery and reablement services and who developed HAT did not receive VTE risk assessment and thromboprophylaxis during their index admission, demonstrating a significant gap between guideline recommendations and clinical practice. Implementing mandatory VTE risk assessment and adherence to guidelines to improve thromboprophylaxis prescription in hospitalised patients may help reduce the burden of HAT.

Scoping of pharmacists' health leadership training needs for effective antimicrobial stewardship in Africa.

BACKGROUND: Antimicrobial resistance (AMR) is a global public health concern currently mitigated by antimicrobial stewardship (AMS). Pharmacists are strategically placed to lead AMS actions that contribute to responsible use of antimicrobials; however, this is undermined by an acknowledged health leadership skills deficit. Learning from the UK's Chief Pharmaceutical Officer's Global Health (ChPOGH) Fellowship programme, the Commonwealth Pharmacists Association (CPA) is focused to develop a health leadership training program for pharmacists in eight sub-Saharan African countries. This study thus explores need-based leadership training needs for pharmacists to provide effective AMS and inform the CPA's development of a focused leadership training programme, the 'Commonwealth Partnerships in AMS, Health Leadership Programme' (CwPAMS/LP). METHODS: A mixed methods approach was undertaken. Quantitative data were collected via a survey across 8 sub-Saharan African countries and descriptively analysed. Qualitative data were collected through 5 virtual focus group discussions, held between February and July 2021, involving stakeholder pharmacists from different sectors in the 8 countries and were analysed thematically. Data were triangulated to determine priority areas for the training programme. RESULTS: The quantitative phase produced 484 survey responses. Focus groups had 40 participants from the 8 countries. Data analysis revealed a clear need for a health leadership programme, with 61% of respondents finding previous leadership training programmes highly beneficial or beneficial. A proportion of survey participants (37%) and the focus groups highlighted poor access to leadership training opportunities in their countries. Clinical pharmacy (34%) and health leadership (31%) were ranked as the two highest priority areas for further training of pharmacists. Within these priority areas, strategic thinking (65%), clinical knowledge (57%), coaching and mentoring (51%), and project management (58%) were selected as the most important. CONCLUSIONS: The study highlights the training needs of pharmacists and priority focus areas for health leadership to advance AMS within the African context. Context-specific identification of priority areas supports a needs-based approach to programme development, maximising African pharmacists' contribution to AMS for improved and sustainable patient outcomes. This study recommends incorporating conflict management, behaviour change techniques, and advocacy, amongst others, as areas of focus to train pharmacist leaders to contribute to AMS effectively.

A comparative analysis of pharmaceutical workforce development needs across the commonwealth.

BACKGROUND: Increasing demographic healthcare challenges, such as increased life expectancy coupled with increased use of medicines for complex morbidities, point to the need for globally applicable transformative policies in health workforce development. The International Pharmaceutical Federation (FIP) has established a set of 21 Global Development Goals (FIP DGs) to strengthen pharmacy workforce and benchmark professional developmental needs. OBJECTIVE: This study aimed to identify policy directions and factors affecting pharmacy workforce development across the Commonwealth, and to examine country progress made towards implementing workforce oriented FIP DGs. METHODS: The study involved a literature review and a global survey of commonwealth countries professional leadership bodies. The literature database search included PubMed/Medline, CINAHL, Scopus and PsychINFO databases as well as the websites of the respective national pharmacy organisations of Commonwealth countries. A global survey was also conducted to assess country-level alignment with the workforce component of FIP DGs. RESULTS: Thirty-one articles representing 21 Commonwealth countries were included in the literature overview. The development needs identified were workforce shortages and inequitable distribution across practice areas and geographical regions, low workforce supply capacity, workforce feminisation, lack of professional recognition, limited training opportunities, low job satisfaction, high workload and attrition. The survey showed disparities in country-level progress and alignment with the FIP DGs. High-income countries in the survey sample reported alignment with most of the FIP DGs, while the low-income countries reported alignment with fewer DGs. More than two-thirds of the countries showed alignment with the FIP DGs related to academic capacity, early career training, quality assurance and advancing integrated services. About half reported alignment with the FIP DGs related to competency and leadership development, respectively, while only a third aligned with the equity and equality DG. CONCLUSION: This study identified realistic pharmacy workforce developmental needs across a range of Commonwealth countries. Addressing these needs through appropriate policy interventions will be essential for increasing the pharmacy workforce capacity and assuring the delivery of high-quality pharmaceutical care and medicines expertise in these countries.

Maori Experiences and Beliefs about Antibiotics and Antimicrobial Resistance for Acute Upper Respiratory Tract Symptoms: A Qualitative Study.

Antimicrobial resistance (AMR) is a threat to public health. Addressing unnecessary antibiotic use provides an opportunity to reduce antibiotic consumption and to slow AMR. Understanding people's beliefs is important for informing antimicrobial stewardship (AMS) initiatives. Within New Zealand, health inequities exist between Maori and non-Maori; however, no research has examined Maori beliefs about antibiotics and AMR. The aim of this study was to explore the experiences related to antibiotic use of Maori in New Zealand. In-depth, semi-structured interviews were conducted with 30 Maori adults recruited from primary care to explore the experiences, perceptions and beliefs that Maori have about antibiotics, and about AMR. Overall, 30 Maori adults (23% male; age range from 20 to 77 years) participated. Three themes emerged: systemic-, social-, and individual-related factors. From these themes, seven subthemes explained the factors that influenced antibiotic use and their perceptions of AMR in Maori: general practitioner (GP) times and ratios, effect of colonisation, lack of knowledge and information, access and poverty barriers, relationship with health professionals, illness perceptions, treatment beliefs and Whaakaro (thoughts), and beliefs pertaining to natural (rongoa) and Western medicine. Participants identified potential solutions to improve antibiotic use such as cultural support and involving Te Ao Maori; recognising these can inform future AMS initiatives.

Pharmacogenomics and clinical cultural competency: pathway to overcome the limitations of race.

Global migration trends are accelerating population admixture. Increasing population diversity met with minority health disparities necessitates thoughtful training of health professional students. Health professional accreditation standards emphasize pharmacogenomics and clinical cultural competency (CCC); however, published studies focus on students' knowledge in pharmacogenomics alone. This report reviews considerations for integrating CCC into required pharmacogenomic education in pharmacy and other health disciplines. By coupling both topics during didactic training and active learning exercises repeated throughout the existing curriculum, students can become adept at these individualized patient care skills and retain their knowledge into their careers. Moving beyond race as a proxy for healthcare decision-making, the CCC of clinicians coupled with patients' genetic test results could empower clinicians to address health disparities and facilitate discussions about the role of race in clinical practice. Ultimately, an integrated approach of teaching pharmacogenomics and CCC could dismantle race-norming or race-based clinical practices.

Exploring medicines information needs of mental health service users at a New Zealand hospital.

Providing effective medicines information to individuals can improve outcomes, yet little is known about what information mental health service users need and want about their medicines, and how best to deliver this. The aim of this study was to explore the medicines information needs of mental health service users. Adults (n=30) under the care of acute mental health services in a New Zealand hospital were invited to take part in semi-structured interviews or a focus group to explore preferences for medicines information. Interview data were analysed using an inductive thematic approach. Six key themes were identified: 1) personalisation of information, 2) adverse and beneficial effects, 3) relationships and trust, 4) informed choice, 5) use of reliable internet resources and 6) involvement of family and support people. Preferences on content, timing, provider and format of information delivery were highly individualised indicating the need for information to be personalised to the needs of the service user. A trusted relationship with their healthcare provider was essential . Making informed decisions reduced confusion or fear about medicines. Understanding medicines information needs of patients can help improve the education health professionals provide on medicines, thus potentially improving patient engagement and outcomes.

National pharmacy associations in the commonwealth: current scenario and future needs to maximise effective contributions of the pharmacy profession towards universal health coverage.

BACKGROUND: The Commonwealth Pharmacists Association (CPA) is a charity representing pharmacists across the Commonwealth, with the vision of empowering and collaboratively develop the profession and fully utilise the potential of pharmacists to strengthen health systems through supporting better access to, quality and use of medicines and related services. Commonwealth comprises predominantly of low- and middle-income countries, where limited data often exists in pharmacy practice. There is a recognised need across the Commonwealth to focus on developing, implementing and fully utilising pharmacy professional services to progress universal health coverage and achieve the sustainable development goals, particularly in low and middle-income countries; however, currently a knowledge gap exists in understanding the national priorities in Commonwealth nations. CPA is ideally positioned to access to these nations. The aim of this study was thus to explore the priorities and focus areas of NPAs across the Commonwealth and create evidence for a needs-based approach to inform the support that the Commonwealth pharmacists association can collaboratively and strategically provide to its members to progress towards shared goals. METHODS: Data were collected virtually on Zoom by conducting interviews using a semi-structured interview guide developed for this study with CPA councillors representing NPAs or their equivalents if no official body existed. An inductive, reflexive, thematic analysis was performed for data analysis. RESULTS: In total, 30 councillors were interviewed from 30 low- and medium-income countries. The three main overarching priority areas identified across respective Commonwealth nations developing extended pharmacy services, improving pharmacy education, and developing and redefining the role of NPAs. CONCLUSIONS: This novel study highlights the collective priorities for the pharmacy profession across the low and middle-income countries of the Commonwealth and the urgent need for supporting NPAs around the three identified overarching priority areas. The mapped-out priorities will inform an evidence-based approach for the CPA to better support NPAs in their mission through advocacy and practitioner development, to fully harness pharmacists' unique skill set and maximise their contribution to progressing universal health coverage.

Needs assessment and impact of COVID-19 on pharmacy professionals in 31 commonwealth countries.

BACKGROUND: The declaration of COVID-19 a pandemic by the World Health Organization on 11 March 2020 marked the beginning of a global health crisis of an unprecedented nature and scale. The approach taken by countries across the world varied widely, however, the delivery of frontline healthcare was consistently recognised as being central to the pandemic response. This study aimed to identify and explore the issues currently facing pharmacy teams across Commonwealth countries during the COVID-19 pandemic. The study also evaluates pharmacy professionals' understanding of key knowledge areas from the COVID-19 webinar hosted by the Commonwealth Pharmacists' Association (CPA). METHOD: A quantitative survey-based approach was adopted, using a 32-item questionnaire developed from the literature on pharmacy and pandemic response. The survey was hosted on Survey Monkey and pilot tested. The final survey was disseminated by CPA member organisations. A 6-item online questionnaire was sent via email to all attendees of CPA's COVID-19 webinar. Descriptive statistics on frequency distributions and percentages were used to analyse the responses. Data were analysed using Microsoft® Excel (2010). RESULTS: There were 545 responses from pharmacy professionals across 31/54 Commonwealth countries in Africa, Asia, the Americas, Europe and the Pacific. Majority of the respondents reported being at least somewhat worried (90%) and more than 65% were very worried or extremely about the impact of COVID-19 on them personally and professionally. Nearly two-thirds of respondents stated finding it somewhat difficult or very difficult to work effectively during the pandemic. Challenges mostly faced by pharmacy professionals working remotely included; general anxiety about the impact of COVID-19 on their lives (12%), and difficulties in communicating with their co-workers (12%). Most pharmacy professionals had not previously been actively involved in a global health emergency (82%) nor obtained training on global/public health emergency preparedness (62%). Between 45 and 97% of the COVID-19 webinar attendees provided the correct answers to post-webinar questions, suggesting some improvement in knowledge. CONCLUSION: Our study confirms pharmacy professionals' concerns about practice during a pandemic and provides preliminary data on the challenges and learning needs of the profession. The CPA has since acted on these findings, providing ongoing opportunities to develop and refine resources for the profession as the pandemic evolves. Pharmacy professionals have also demonstrated improved knowledge on the management of COVID-19 and resources available for professionals.

Exploratory study of a screening measure for polycystic ovarian syndrome, quality of life assessment, and neuropsychological evaluation.

BACKGROUND: The universally adopted 2018 PCOS medical diagnostic and treatment guidelines for Polycystic Ovarian Syndrome (PCOS) cites the need for a brief screening measure that can be easily administered in the clinical care setting. We evaluate a 12-item questionnaire emphasizing the medical symptoms of PCOS with a group of women with PCOS as well as comparison samples of college women not diagnosed with PCOS. METHOD: Of 120 undergraduate psychology women 18 to 41 years of age, 86 screened negative on a 12-item PCOS symptoms inventory. They were compared to a group of PCOS patients diagnosed medically in a manner consistent with the Teede et al. (2018) evidence-based diagnostic guidelines. The screen-positive, screen-negative, and PCOS-confirmed groups were compared on the PCOS Quality-of-Life (QoL) questionnaire, Zung Self-Rating Depression Scale (ZDS), Spielberg State-Trait Anxiety Inventory (STAI), Fatigue Symptom Inventory (FSI), Spiritual well-being and Spiritual Beliefs Inventories, the computerized Automated Neuropsychological Assessment Metric (ANAM) battery, and an experimental tachistoscopic Bilateral Perceptual Asymmetries Letter and Dots Matching Bilateral Field Advantage (BFA) test (to evaluate the effects of early brain androgenization possible from PCOS). For each questionnaire and neuropsychological performance principal outcome, the Linear Mixed Effects (LME) model was employed to evaluate the predictive significance of demographic characteristics and group membership (confirmed cases, screen negative and screen positive cases) for these outcomes. RESULTS: The PCOS-confirmed women scored more poorly than the screen-negative (reference) and screen-positive groups on all the measures of physical, emotional, social, and spiritual well-being measures. On the ANAM neuropsychological battery, PCOS-confirmed women did more poorly on Sternberg Memory and Stimulus Response throughput measures. They also had slower correct response speed for both the unilateral and bilateral dot- and letter-matching tachistoscopic stimulus presentations. However, the bilateral field advantage throughput performance ratio did not differ among groups, which is a global measure of bilateral versus unilateral brain/behavior asymmetries. CONCLUSION: PCOS screening can be a feasible and important part of women's healthcare. PCOS-confirmed women should receive not only the medical standard of care from the 2018 guidelines, but also comprehensive psychosocial and neurocognitive support to enhance their quality of life.

Editorial: Medicines pricing, access and safety in Morocco.

Unregulated supply of medicines compromises quality assurance and risks patient safety. The emergence of illegal medicines trafficking in Morocco presents a major health threat, which highlights the need for region-wide alignment in policies to drive stringent regulatory enforcement and robust health systems that ensure population- wide access to safe medicines. Herein, we draw on insights from a situational analysis in Morocco, as a lower- middle income setting, to present access to medicines through regulated supply procedures as a vital prerequisite for quality assurance and patient safety.

L'approvisionnement non réglementé en médicaments compromet l'assurance qualité et la sécurité des patients. L'émergence du trafic illégal de médicaments au Maroc constitue une menace majeure pour la santé, ce qui souligne la nécessité d'un alignement régional des politiques pour une application stricte de la réglementation et des systèmes de santé robustes garantissant l'accès de la population à des médicaments sûrs. Nous nous inspirons d'une analyse situationnelle menée au Maroc, en tant que pays à revenu moyen-inférieur, pour présenter l'accès aux médicaments par le biais de procédures d'approvisionnement réglementées, prérequis indispensable à l'assurance qualité et à la sécurité des patients.

Enhancing Web-based mindfulness training for mental health promotion with the health action process approach: randomized controlled trial.

BACKGROUND: With increasing evidence demonstrating the effectiveness of Web-based interventions and mindfulness-based training in improving health, delivering mindfulness training online is an attractive proposition. OBJECTIVE: The aim of this study was to evaluate the efficacy of two Internet-based interventions (basic mindfulness and Health Action Process Approach enhanced mindfulness) with waitlist control. Health Action Process Approach (HAPA) principles were used to enhance participants' efficacy and planning. METHODS: Participants were recruited online and offline among local universities; 321 university students and staff were randomly assigned to three conditions. The basic and HAPA-enhanced groups completed the 8-week fully automated mindfulness training online. All participants (including control) were asked to complete an online questionnaire pre-program, post-program, and at 3-month follow-up. RESULTS: Significant group by time interaction effect was found. The HAPA-enhanced group showed significantly higher levels of mindfulness from pre-intervention to post-intervention, and such improvement was sustained at follow-up. Both the basic and HAPA-enhanced mindfulness groups showed better mental well-being from pre-intervention to post-intervention, and improvement was sustained at 3-month follow-up. CONCLUSIONS: Online mindfulness training can improve mental health. An online platform is a viable medium to implement and disseminate evidence-based interventions and is a highly scalable approach to reach the general public. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR): ChiCTR-TRC-12002954; http://www.chictr.org/en/proj/show.aspx?proj=3904 (Archived by WebCite at http://www.webcitation.org/6VCdG09pA).

Adherence monitoring and e-health: how clinicians and researchers can use technology to promote inhaler adherence for asthma.

In the past decade, rapid technological developments have advanced electronic monitoring devices (EMD) for asthma inhalers beyond simple recording of actuations to providing adherence promotion features and detailed information about patterns of medication use. This article describes currently available EMDs, discusses their utility and limitations in assessing adherence, and describes the potential for EMD-based adherence promotion interventions in clinical settings. To date, the main use of EMDs has been in clinical research. In selected populations, simple EMD-based adherence interventions, delivered either through clinician-to-patient feedback about medication use or by direct-to-patient reminders for missed doses, can significantly improve adherence. Further work is now needed to determine the impact of EMDs on clinical outcomes and their cost-effectiveness and feasibility for different clinical settings, including in disadvantaged populations. If this evidence can be provided, then the use of EMDs could expand into the management of asthma in populations with high health care costs, eg, severe asthma. In the future, medication monitoring could help distinguish poor treatment response from poor adherence, guide prescribing decisions, and prompt providers to discuss barriers to adherence; electronic health records may provide the gateway for integrating medication-use monitoring into digital chronic care management.

A low-cost interface for multi-electrode array data acquisition systems.

Multi-electrode array systems have enabled the in vitro electrophysiological study of neuronal networks. The data processing component of these systems consists of an advanced computer system and data acquisition electronics that collectively cost more than the multi-electrode arrays and amplifiers. Considering that these elaborate systems may be cost-prohibitive for many laboratories, we have developed a simple but novel method for recording groups of related multi-electrode array channels with a low-cost data acquisition system.

Associations between dietary habits and risk factors for cardiovascular diseases in a Hong Kong Chinese working population--the "Better Health for Better Hong Kong" (BHBHK) health promotion campaign.

Diet and nutritional status have been shown to play pivotal roles in the occurrence of many chronic diseases. In this study, we examined the patterns of dietary habits and their relationships with risk factors for cardiovascular and chronic diseases in Hong Kong working populations. In April 2000, a 5-year territory-wide health promotion campaign supported by the Li Ka Shing Foundation was launched in Hong Kong by the Health InfoWorld of Hospital Authority. Between July 2000 and March 2002, 4841 Chinese subjects [2375 (49.1%) men and 2466 (50.9%) women, mean age: 42.4 +/- 8.9 years (median: 43.0 years, range: 17-83 years)] from the general working class were recruited. Subjects were randomly selected using computer generated codes according to the distribution of occupational groups. A dietary questionnaire was used to assess 6 core dietary habits: daily fruit intake, vegetable intake, fluid intake, sugary drinks, regularity of daily meals and number of dining out each day. Overall, men had a worse cardiovascular risk profile and less desirable dietary habits than women. Those who had more unhealthy dietary habits were more likely to be obese and current smokers. Using logistic regression analysis with the dietary habits as independent variables, we found that obesity, smoking and constipation were independently associated with various unhealthy dietary patterns. In conclusion, there were close associations between dietary habits and risk factors for cardiovascular diseases in Hong Kong. More effective community education about healthy lifestyle is required in Hong Kong.

Low levels of awareness of suboptimal health conditions in a high-risk working population: the "better health for better Hong Kong" health promotion campaign.

The incidences of cardiovascular risk factors such as obesity and diabetes are rising in many Asian populations. In April 2000, a 5-year territory-wide health promotion campaign supported by Li Ka Shing Foundation was launched in Hong Kong by the Health InfoWorld of Hospital Authority. From the general working class, 4,832 Chinese people were randomly recruited into this campaign. There were 2,370 men (49.0%) and 2,462 women (51.0%; median age = 43.0 years, range = 17-83 years). Of these, 37.5% were obese (BMI > or = 25 kg/m2 or waist circumference > or = 80 cm in women and > or = 90 cm in men), 22.3% had hypertension, 11.6% were smokers, 31.0% had hypercholesterolaemia (total cholesterol > or = 5.2 mmol/l), 2.2% had diabetes, and 0.7% had a past history of cardiovascular disease. There were 1,338 participants (27.7%) who had 2 or more risk factors (more men than women: 36.9% vs. 18.9%, p < .001). Despite this high prevalence of multiple risk factors, most (83.1%) perceived their health status as satisfactory (more men than women: 85.6% vs. 80.7%, p < .001). In conclusion, the combination of high prevalence of multiple risk factors and low levels of awareness of their suboptimal health status herald a looming epidemic of life-threatening diseases in a group of middle-aged Hong Kong people. Massive public education is an important and essential, although it may not be self-sufficient, factor to reduce the socioeconomic impacts of this epidemic.