Evaluation of the Gosnells Women's Health Service Healthy Lifestyles for Multicultural Women Program

In 2008 the Gosnells Women's Health Service (GWHS) was the recipient of a Healthy Active Australia grant. The aim of the grant was to increase the physicalactivity levels and healthy eating knowledge and behaviours of migrant women who access the GWHS. To achieve this aim the GWHS implemented learning activities for the target group, with the intention of increasing knowledge and changing behaviours for physical activity and nutrition. The physical activity component of the grant was implemented through swimming lessons and gentle exercise classes. Cooking and nutrition classes were held to teach the women about healthy and affordable foods.The swimming program attracted 118 participants, and 56 women participated in the gentle exercise sessions. The program increased most participants' physical activity levels by providing an opportunity to be active, as most women in the target group were not able to engage in physical activity for several reasons.The main barriers to physical activity in this group are a lack of affordable culturally appropriate (women's only) venues, and a lack of affordable child care. GWHS overcame these barriers by providing women's only activities and childcare. Twenty-seven women attended the cooking and nutrition classes. The classes increased women's knowledge of healthy and affordable foods which are available in Australia. The classes also assisted women, for whom English is a second language, with reading recipes. Nearly all participants who participated in evaluation reported cooking healthy meals at home for their families on completion of the sessions, and agreed that the sessions had increased their ability to do so. As a result of the program, the aquatic centre where the swimming lessons were held has agreed to continue running women's-only classes for those women who can attend the centre and pay for lessons

The burden of peripheral intravenous catheters in older hospital inpatients : a national cross-sectional study part of the One Million Global Peripheral Intravenous Catheters Collaboration

Objectives: To investigate the burden of peripheral intravenous catheters (PIVCs) in older hospitalised patients. Methods: A cross-sectional prospective observational study (2014/2015) to describe the characteristics, indications and outcomes of PIVCs among patients aged ≥65 from 65 Australian hospitals. Results: Amongst 2179 individual PIVCs (in 2041 patients, mean age 77.6 years, 45% female, 58% in NSW), 43% were inserted by doctors and 74% used that day, meaning 25% were ‘idle’. Overall, 18% (393/2179) exhibited signs of PIVC-related complications. Most commonly exhibited PIVC-related complications were tenderness (4.1%) and local redness (1.8%). Nearly one in three (29.1%) dressings was soiled, loosened or had come off, and only 36.8% had the time and date documented on the dressing. Both infusing IV medications (aOR 1.74, 95% CI 1.28–2.38, p 84 years) was independently associated with lower likelihood of a high score (aOR 0.71, 95% CI 0.54–0.94, p = 0.02). Conclusions: Given 1 in 5 PIVCs were identified with having complications, further research should focus on optimising PIVC use in older patients

Patient preferences for different methods of blood pressure measurement: is ethnicity relevant?

This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by the Royal College of General Practitioners.$\textit{Background:}$ Ambulatory and/or home monitoring are recommended in the UK and North America for the diagnosis of hypertension but little is known about acceptability. $\textit{Aim:}$ To determine the acceptability of different methods of measuring blood pressure to people from different ethnic minority groups. $\textit{Design and setting:}$ Cross sectional study with focus groups in primary care. $\textit{Methods:}$ People with and without hypertension of different ethnicities were assessed for acceptability of clinic, home and ambulatory blood pressure measurement using completion rate, questionnaire and focus groups. $\textit{Results:}$ 770 participants were included comprising white British (n=300), South Asian (n=241) and African Caribbean (n=229). White British participants had significantly higher successful completion rates across all monitoring modalities compared to the other ethnic groups, especially for ambulatory monitoring: white British (277 completed, 92%[89-95%]) vs South Asian (171, 71%[65-76%], p<0.001 and African Caribbean (188, 82%[77-87%], p<0.001) respectively. There were significantly lower acceptability scores for minority ethnic participants across all monitoring methods compared to white British. Focus group results highlighted self-monitoring as most acceptable and ambulatory monitoring least without consistent differences by ethnicity. Clinic monitoring was seen as inconvenient and anxiety provoking but with the advantage of immediate professional input. $\textit{Conclusions:}$ Reduced acceptability and completion rates amongst minority ethnic groups raise important questions for the implementation and interpretation of blood pressure monitoring in general and ambulatory monitoring in particular. Selection of method for blood pressure monitoring should take into account clinical need and patient preference as well as consideration of potential cultural barriers to monitoring.National Institute for Health Research (Grant ID: PB-PG-1207-15042

Ethnicity and differences between clinic and ambulatory blood pressure measurements.

BACKGROUND: This study investigated the relationship of ethnicity to the differences between blood pressure (BP) measured in a clinic setting and by ambulatory blood pressure monitoring (ABPM) in individuals with a previous diagnosis of hypertension (HT) and without a previous diagnosis of hypertension (NHT). METHODS: A cross-sectional comparison of BP measurement was performed in 770 participants (white British (WB, 39%), South Asian (SA, 31%), and African Caribbean (AC, 30%)) in 28 primary care clinics in West Midlands, United Kingdom. Mean differences between daytime ABPM, standardized clinic (mean of 3 occasions), casual clinic (first reading on first occasion), and last routine BP taken at the general practitioner practice were compared in HT and NHT individuals. RESULTS: Daytime systolic and diastolic ABPM readings were similar to standardized clinic BP (systolic: 128 (SE 0.9) vs. 125 (SE 0.9) mm Hg (NHT) and 132 (SE 0.7) vs. 131 (SE 0.7) mm Hg (HT)) and were not associated with ethnicity to a clinically important extent. When BP was taken less carefully, differences emerged: casual clinic readings were higher than ABPM, particularly in the HT group where the systolic differences approached clinical relevance (131 (SE 1.2) vs. 129 (SE 1.0) mm Hg (NHT) and 139 (SE 0.9) vs. 133 (SE 0.7) mm Hg (HT)) and were larger in SA and AC hypertensive individuals (136 (SE 1.5) vs. 133 (SE 1.2) mm Hg (WB), 141 (SE 1.7) vs. 133 (SE 1.4) mm Hg (SA), and 142 (SE 1.6) vs. 134 (SE 1.3) mm Hg (AC); mean differences: 3 (0-7), P = 0.03 and 4 (1-7), P = 0.01, respectively). Differences were also observed for the last practice reading in SA and ACs. CONCLUSIONS: BP differences between ethnic groups where BP is carefully measured on multiple occasions are small and unlikely to alter clinical management. When BP is measured casually on a single occasion or in routine care, differences appear that could approach clinical relevance.This report presents independent research funded by the National Institute for Health Research (NIHR).The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of HealthThis is a pre-copyedited, author-produced PDF of an article accepted for publication in American Journal of Hypertension following peer review. The version of record, Am J Hypertens (2014) doi: 10.1093/ajh/hpu211, is available online at: http://ajh.oxfordjournals.org/content/early/2014/11/18/ajh.hpu211.long

Measurement of blood pressure for the diagnosis and management of hypertension in different ethnic groups: one size fits all.

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease and prevalence varies by ethnic group. The diagnosis and management of blood pressure are informed by guidelines largely based on data from white populations. This study addressed whether accuracy of blood pressure measurement in terms of diagnosis of hypertension varies by ethnicity by comparing two measurement modalities (clinic blood pressure and home monitoring) with a reference standard of ambulatory BP monitoring in three ethnic groups. METHODS: Cross-sectional population study (June 2010 - December 2012) with patients (40-75 years) of white British, South Asian and African Caribbean background with and without a previous diagnosis of hypertension recruited from 28 primary care practices. The study compared the test performance of clinic BP (using various protocols) and home-monitoring (1 week) with a reference standard of mean daytime ambulatory measurements using a threshold of 140/90 mmHg for clinic and 135/85 mmHg for out of office measurement. RESULTS: A total of 551 participants had complete data of whom 246 were white British, 147 South Asian and 158 African Caribbean. No consistent difference in accuracy of methods of blood pressure measurement was observed between ethnic groups with or without a prior diagnosis of hypertension: for people without hypertension, clinic measurement using three different methodologies had high specificity (75-97%) but variable sensitivity (33-65%) whereas home monitoring had sensitivity of 68-88% and specificity of 64-80%. For people with hypertension, detection of a raised blood pressure using clinic measurements had sensitivities of 34-69% with specificity of 73-92% and home monitoring had sensitivity (81-88%) and specificity (55-65%). CONCLUSIONS: For people without hypertension, ABPM remains the choice for diagnosing hypertension compared to the other modes of BP measurement regardless of ethnicity. Differences in accuracy of home monitoring and clinic monitoring (higher sensitivity of the former; higher specificity of the latter) were also not affected by ethnicity

Coastal Mooring Observing Networks and Their Data Products: Recommendations for the Next Decade

Instrumented moorings (hereafter referred to as moorings), which are anchored buoys or an anchored configuration of instruments suspended in the water column, are highly valued for their ability to host a variety of interchangeable oceanographic and meteorological sensors. This flexibility makes them a useful technology for meeting end user and science-driven requirements. Overall, societal needs related to human health, safety, national security, and economic prosperity in coastal areas are met through the availability of continuous data from coastal moorings and other complementary observing platforms within the Earth-observing system. These data streams strengthen the quality and accuracy of data products that inform the marine transportation industry, the tourism industry, fisheries, the military, public health officials, coastal and emergency managers, educators, and research scientists, among many others. Therefore, it is critical to sustain existing observing system networks, especially during this time of extreme environmental variability and change. Existing fiscal and operational challenges affecting the sustainability of observing networks will likely continue into the next decade, threatening the quality of downstream data and information products – especially those used for long-term monitoring, planning, and decision-making. This paper describes the utility of coastal moorings as part of an integrated coastal observing system, with an emphasis on stakeholder engagement to inform observing requirements and to ensure data products are tailored to user needs. We provide 10 recommendations for optimizing moorings networks, and thus downstream data products, to guide regional planners, and network operators: 1.Develop strategies to increase investment in coastal mooring networks2.Collect stakeholder priorities through targeted and continuous stakeholder engagements3.Include complementary systems and emerging technologies in implementation planning activities4.Expand and sustain water column ecosystem moorings in coastal locations5.Coordinate with operators and data managers across geographic scales6.Standardize and integrate data management best practices7.Provide open access to data8.Promote environmental health and operational safety stewardship and regulatory compliance9.Develop coastal mooring observing network performance metrics10.Routinely monitor and assess the design of coastal mooring network

Cohort Profile: The United Kingdom Research study into Ethnicity and COVID-19 outcomes in Healthcare workers (UK-REACH)

The UK-REACH cohort was established to understand why ethnic minority healthcare workers (HCWs) are at risk of poorer outcomes from COVID-19 when compared with their White ethnic counterparts in the UK. Through study design, it contains a uniquely high percentage of participants from ethnic minority backgrounds about whom a wide range of qualitative and quantitative data have been collected. A total of 17 891 HCWs aged 16–89 years (mean age: 44) have been recruited from across the UK via all major healthcare regulators, individual National Health Service hospital trusts and UK HCW membership bodies who advertised the study to their registrants/staff to encourage participation in the study. Data available include linked healthcare records for 25 years from the date of consent and consent to obtain genomic sequencing data collected via saliva. Online questionnaires include information on demographics, COVID-19 exposures at work and home, redeployment in the workforce due to COVID-19, mental health measures, workforce attrition and opinions on COVID-19 vaccines, with baseline (n = 15 119), 6 (n = 5632) and 12-month follow-up (n = 6535) data captured. Request data access and collaborations by following documentation found at https://www.uk-reach.org/main/data_sharing

Influence of ethnicity on acceptability of method of blood pressure monitoring: a cross-sectional study in primary care.

BACKGROUND: Ambulatory and/or home monitoring are recommended in the UK and the US for the diagnosis of hypertension but little is known about their acceptability. AIM: To determine the acceptability of different methods of measuring blood pressure to people from different minority ethnic groups. DESIGN AND SETTING: Cross-sectional study with focus groups in primary care in the West Midlands. METHOD: People of different ethnicities with and without hypertension were assessed for acceptability of clinic, home, and ambulatory blood pressure measurement using completion rate, questionnaire, and focus groups. RESULTS: A total of 770 participants were included, who were white British (n = 300), South Asian (n = 241), and African Caribbean (n = 229). White British participants had significantly higher successful completion rates across all monitoring modalities compared with the other ethnic groups, especially for ambulatory monitoring: white British (n = 277, 92% [95% confidence interval [CI] = 89% to 95%]) versus South Asian (n = 171, 71% [95% CI = 65% to 76%], P<0.001) and African Caribbean (n = 188, 82% [95% CI = 77% to 87%], P<0.001), respectively. There were significantly lower acceptability scores for minority ethnic participants across all monitoring methods compared with white British participants. Focus group results highlighted self-monitoring as most acceptable and ambulatory monitoring least acceptable without consistent differences by ethnicity. Clinic monitoring was seen as inconvenient and anxiety provoking but with the advantage of immediate professional input. CONCLUSION: Reduced acceptability and completion rates among minority ethnic groups raise important questions for the implementation and interpretation of blood pressure monitoring. Selection of method of blood pressure monitoring should take into account clinical need, patient preference, and potential cultural barriers to monitoring

A Treatment Trial of Acupuncture in IBS Patients

To compare the effects of true and sham acupuncture in relieving symptoms of IBS

Interarm Difference in Systolic Blood Pressure in Different Ethnic Groups and Relationship to the "White Coat Effect": A Cross-Sectional Study.

BACKGROUND: Interarm differences (IADs) ≥10 mm Hg in systolic blood pressure (BP) are associated with greater incidence of cardiovascular disease. The effect of ethnicity and the white coat effect (WCE) on significant systolic IADs (ssIADs) are not well understood. METHODS: Differences in BP by ethnicity for different methods of BP measurement were examined in 770 people (300 White British, 241 South Asian, 229 African-Caribbean). Repeated clinic measurements were obtained simultaneously in the right and left arm using 2 BPTru monitors and comparisons made between the first reading, mean of second and third and mean of second to sixth readings for patients with, and without known hypertension. All patients had ambulatory BP monitoring (ABPM). WCE was defined as systolic clinic BP ≥10 mm Hg higher than daytime ABPM. RESULTS: No significant differences were seen in the prevalence of ssIAD between ethnicities whichever combinations of BP measurement were used and regardless of hypertensive status. ssIADs fell between the 1st measurement (161, 22%), 2nd/3rd (113, 16%), and 2nd-6th (78, 11%) (1st vs. 2nd/3rd and 2nd-6th, P < 0.001). Hypertensives with a WCE were more likely to have ssIADs on 1st, (odds ratio [OR] 1.73 (95% confidence interval 1.04-2.86); 2nd/3rd, (OR 3.05 (1.68-5.53); and 2nd-6th measurements, (OR 2.58 (1.22-5.44). Nonhypertensive participants with a WCE were more likely to have a ssIAD on their first measurement (OR 3.82 (1.77 to -8.25) only. CONCLUSIONS: ssIAD prevalence does not vary with ethnicity regardless of hypertensive status but is affected by the number of readings, suggesting the influence of WCE. Multiple readings should be used to confirm ssIADs