A qualitative exploration of challenges recruiting older adults for Being Your Best, a co-designed holistic intervention to manage and reduce frailty: lessons learnt amidst the COVID-19 pandemic in Melbourne, Australia.

OBJECTIVES: Researchers face numerous challenges when recruiting participants for health and social care research. This study reports on the challenges faced recruiting older adults for Being Your Best, a co-designed holistic intervention to manage and reduce frailty, and highlights lessons learnt amidst the COVID-19 pandemic. DESIGN: A qualitative study design was used. Referrer interviews were conducted to explore the recruitment challenges faced by the frontline workers. An audit of the research participant (aged ≥65) database was also undertaken to evaluate the reasons for refusal to participate and withdrawal from the study. SETTING: Hospital emergency departments (EDs) and a home care provider in Melbourne, Australia. PARTICIPANTS: Frontline workers and older adults. RESULTS: From May 2022 to June 2023, 71 referrals were received. Of those referrals, only 13 (18.3%) agreed to participate. Three participants withdrew immediately after baseline data collection, and the remaining 10 continued to participate in the programme. Reasons for older adult non-participation were (1) health issues (25.3%), (2) ineligibility (18.3%), (3) lack of interest (15.5%), (4) perceptions of being 'too old' (11.2%) and (5) perceptions of being too busy (5.6%). Of those participating, five were female and five were male. Eleven referrer interviews were conducted to explore challenges with recruitment, and three themes were generated after thematic analysis: (1) challenges arising from the COVID-19 pandemic, (2) characteristics of the programme and (3) health of older adults. CONCLUSION: Despite using multiple strategies, recruitment was much lower than anticipated. The ED staff were at capacity associated with pandemic-related activities. While EDs are important sources of participants for research, they were not suitable recruitment sites at the time of this study, due to COVID-19-related challenges. Programme screening characteristics and researchers' inability to develop rapport with potential participants also contributed to low recruitment numbers. TRIAL REGISTRATION NUMBER: ACTRN12620000533998; Pre-results.

Health literacy in Pakistani migrants in Australia-An emerging and neglected culturally and linguistically diverse community.

ISSUE ADDRESSED: Pakistani migrants are one of the fastest-growing culturally and linguistically diverse (CALD) communities in Australia, but there is currently a lack of information regarding their health literacy. This study aimed to investigate the health literacy of Pakistani migrants residing in Australia. METHODS: Using a cross-sectional study design, health literacy was measured using the Urdu version of Health Literacy Questionnaire (HLQ). Descriptive statistics and linear regression were used to describe the health literacy profile of respondents and to examine its association with their demographic characteristics. RESULTS: The responses of 202 Pakistani migrants were included. The median age of the respondents was 36 years, 61.8% were males and 87.6% had a university education. The majority spoke Urdu at home and almost 80% were Australian permanent residents or citizens. Pakistani respondents scored high on HLQ domains; feeling understood by health providers (Scale 1), social support for health care (Scales 4), engaging with health care providers (Scale 6) and understanding health information (Scale 9). The respondents scored low on HLQ domains; having sufficient information (Scale 2), actively managing health (Scale 3), appraisal of health information (Scale 5), navigating the health care system (Scale 7) and ability to find information (Scale 8). In the regression model, university education and age were significantly associated with health literacy in almost all the domains, but the effect size was small for age. Speaking English at home and being a permanent resident were also associated with better health literacy in two to three HLQ domains. CONCLUSIONS: Health literacy strengths and weaknesses of Pakistani migrants residing in Australia were identified. Health care providers and organisations may use these findings to tailor health information and services to better support health literacy in this community. SO WHAT?: This study will inform future interventions to better support health literacy and reduce health disparities in Pakistani migrants residing in Australia.

Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis.

OBJECTIVES: Pain, a complex subjective experience, is common in care home residents. Despite advances in pain management, optimal pain control remains a challenge. In this updated systematic review, we examined effectiveness of interventions for treating chronic pain in care home residents. DESIGN: A Cochrane-style systematic review and meta-analysis using PRISMA guidelines. SETTING AND PARTICIPANTS: Randomized and nonrandomized controlled trials and intervention studies included care home residents aged ≥60 years receiving interventions to reduce chronic pain. METHODS: Six databases were searched to identify relevant studies. After duplicate removal, articles were screened by title and abstract. Full-text articles were reviewed and included if they implemented a pain management intervention and measured pain with a standardized quantitative pain scale. Meta-analyses calculated standardized mean differences (SMDs) using random-effect models. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool 2.0. RESULTS: We included 42 trials in the meta-analysis and described 13 more studies narratively. Studies included 26 nondrug alternative treatments, 8 education interventions, 7 system modifications, 3 nonanalgesic drug treatments, 2 analgesic treatments, and 9 combined interventions. Pooled results at trial completion revealed that, except for nonanalgesic drugs and health system modification interventions, all interventions were at least moderately effective in reducing pain. Analgesic treatments (SMD -0.80; 95% CI -1.47 to -0.12; P = .02) showed the greatest treatment effect, followed by nondrug alternative treatments (SMD -0.70; 95% CI -0.95 to -0.45; P < .001), combined interventions (SMD -0.37; 95% CI -0.60 to -0.13; P = .002), and education interventions (SMD -0.31; 95% CI -0.48 to -0.15; P < .001). CONCLUSIONS AND IMPLICATIONS: Our findings suggest that analgesic drugs and nondrug alternative pain management strategies are the most effective in reducing pain among care home residents. Clinicians should also consider implementing nondrug alternative therapies in care homes, rather than relying solely on analgesic drug options.

Investigating the impact of patient-centred labels on comprehension of medication dosing: a randomised controlled trial.

OBJECTIVE: This study aims to implement a version of patient-centred labels (PCL) consistent with current labelling practice in Australia; assess the effectiveness of PCL in relation to the proportion of participants that correctly comprehend dosing instructions, and explore the proportion of correct comprehension of PCL in participants with both low and high health literacy. DESIGN: Randomised controlled trial. SETTING: A large tertiary care hospital in Brisbane, Queensland, Australia. PARTICIPANTS: 121 participants with a majority born in Australia (65.3%), New Zealand (14.0%), the UK (6.6%) and Ireland (2.5%). INTERVENTION: Participants were randomly assigned to either a panel of three PCL (n=61) or three standard labels (n=60) and asked to comprehend their assigned panel of labels. OUTCOME MEASURES: Difference in the proportion of participants that correctly comprehend dosing instructions provided on PCL compared with standard labels. The two-proportion test was used to measure the impact of PCL on the proportion of participants correctly comprehending dosing instructions. RESULTS: A greater proportion of participants were able to accurately comprehend PCL compared with standard labels. The proportion of participants who were able to correctly comprehend dose instructions provided on all three labels was significantly higher in the group that received PCL; 23.3% standard vs 83.6% PCL, p<0.001. The effect was observed in both low and high health literacy participants. The proportion of participants with accurate label comprehension was higher in participants with low Newest Vital Signs scores (8.3% standard vs 85.7% PCL, p<0.001) and low Rapid Estimate of Adult Literacy in Medicine scores (10.5% standard vs 96.0% PCL, p<0.001) who received PCL. CONCLUSION: This study supports the use of PCL in Australian pharmacy practice. PCL provide simple, clear and explicit dosing instructions to patients. Implementing PCL may reduce the risk of misinterpreting dosing instructions by patients and improve quality use of medicines. TRIAL REGISTRATION NUMBER: ACTRN12621000083897; Results.

Attitudes of ambulatory care older Nepalese patients towards deprescribing and predictors of their willingness to deprescribe.

INTRODUCTION: Older adults continue to receive potentially inappropriate medications necessitating the need for medication optimization, by deprescribing. To ensure a holistic approach to deprescribing, it is essential to understand the perception of older adults towards deprescribing. This study aimed to assess the attitude of older ambulatory patients towards deprescribing and to identify factors predicting their willingness to deprescribe. METHODS: A cross-sectional survey was conducted in central Nepal between March and September 2019 among 385 older ambulatory care patients (aged ⩾65 years) who were taking at least one regular medicine. The perception of patients towards deprescribing was assessed using the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire via a face-to-face interview method. Descriptive statistics were performed to describe patients' characteristics and their attitudes towards deprescribing. A multivariate logistic regression analysis was used to determine predictors of the willingness of older ambulatory patients towards deprescribing. RESULTS: The median [interquartile range (IQR)] age of patients was 72 (8) years. Nearly three in five patients (64.9%) had hypertension, with 11.2% having polypharmacy. More than half of the patients (57.4%) would be willing to stop one or more of their regular medicines if their doctor said it was possible to do so. Regression analysis showed that age [odds ratio (OR) 0.946; 95% CI 0.913, 0.981; p = 0.003] and concerns about stopping medicine score (OR 0.541; 95% CI 0.334, 0.876; p = 0.013) were predictors of the willingness of the older patients towards deprescribing. CONCLUSION: One in two older ambulatory care patients in Nepal would be willing to have one or more of their medicines deprescribed. The factors predicting their willingness to deprescribe are their age and concerns about stopping medicines. Clinicians should consider discussing the possibility of deprescribing with older patients for the prevention of potential medication-related harms. PLAIN LANGUAGE SUMMARY: What do older Nepalese patients think about withdrawal or dose reduction of an inappropriate medication?Introduction: Research suggests that older adults (aged ⩾65 years) continue to receive medications that have the potential for harm rather than a benefit. This necessitates the need for withdrawal or dose reduction of such inappropriate medications, the process known as deprescribing. Understanding what older patients think about this process could be a stepping-stone to the general approach for its implementation. Data on deprescribing is lacking from Nepal. Therefore, we designed a survey to explore the attitude of older patients towards deprescribing and factors that could predict their willingness to deprescribe.Methods: This study was conducted between March to September 2019 among 385 older patients who were taking at least one regular medicine and were visiting selected hospitals of Nepal for outpatient services. We performed a face-to-face interview to assess the attitude of patients towards deprescribing using a validated tool called revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire that quantified the response through scoring. The data were subjected to statistical analysis to determine the attitudes of Nepalese older patients towards deprescribing and to develop a model to predict their willingness to deprescribe.Results: The average age of the participant was 72 years with 65% having hypertension and 11% using more than five medications. Our data suggested that one in two older Nepalese patients would be willing to stop one or more of their regular medications if their doctors said it was possible to do so. Their willingness to deprescribe could be predicted from their age and concerns about stopping medications.Conclusion: Clinicians should consider discussing the possibility of deprescribing with older patients for the prevention of potential medication-related harms.

Sacrificial Dissolution of Zinc Electroplated and Cold Galvanized Coated Steel in Saline and Soil Environments: A Comparison.

To protect steel structures, zinc coatings are mostly used as a sacrificial barrier. This research aims to estimate the dissolution tendency of the electroplated and zinc-rich cold galvanized (ZRCG) coatings of a controlled thickness (35 ± 1 µm) applied via brush and dip coating methods on the mild steel. To assess the corrosion behavior of these coated samples in 3.5% NaCl and 10% NaCl containing soil solutions, open circuit potential (OCP), cyclic polarization (CP), and electrochemical impedance spectroscopy (EIS) tests were performed. The more negative OCP and appreciably large corrosion rate of the electroplated and ZRCG coated samples in 3.5% NaCl solution highlighted the preferential dissolution of Zn coatings. However, in saline soil solution, the relatively positive OCP (>-850 mV vs. Cu/CuSO4) and lower corrosion rate of the electroplated and ZRCG coatings compared to the uncoated steel sample indicated their incapacity to protect the steel substrate. The CP scans of the zinc electroplated samples showed a positive hysteresis loop after 24 h of exposure in 3.5% NaCl and saline soil solutions attributing to the localized dissolution of the coating. Similarly, the appreciable decrease in the charge transfer resistance of the electroplated samples after 24 h of exposure corresponded to their accelerated dissolution. Compared to the localized dissolution of the electroplated and brush-coated samples, the dip-coated ZRCG samples exhibited uniform dissolution during the extended exposure (500 h) salt spray test.

Translating and validating the Health Literacy Questionnaire into Urdu: a robust nine-dimension confirmatory factor model.

Pakistani migrants are one of the fastest-growing communities in Australia, and the majority speak Urdu at home. There is a lack of information regarding the health literacy of this population. This study aimed to translate the Health Literacy Questionnaire (HLQ) into Urdu and to explore its psychometric properties. A structured standardized procedure was followed to translate and validate HLQ into Urdu. Data were collected from 202 Pakistani migrants residing in Australia. The HLQ-Urdu was well understood by the respondents. The structural properties of HLQ-Urdu were close to the original HLQ. Data for all HLQ scales met pre-specified criteria for fit in the one-factor CFA model. The composite reliability was high, ranging from 0.84 to 0.91. A strict nine-factor CFA model was also fitted to the data with no cross-loadings or correlated residuals allowed, which showed excellent model fit statistics [χ2WLSMV = 1266.022 (df = 866, p = 0.000), comparative fit index = 0.995, Tucker-Lewis index = 0.994, root mean square error of approximation = 0.050 and standardized root mean square residual = 0.069]. The Urdu version of HLQ showed robust psychometric properties. This HLQ-Urdu tool is now ready to be used to assess health literacy in Pakistani migrants in Australia. Availability of health literacy tools in migrant languages may help healthcare providers better understand the health literacy needs of migrant communities.

Improving dimensional stability of dental amalgam by using Nano Zinc Oxide.

OBJECTIVE: To investigate the dimensional stability of dental amalgam after the incorporation of zinc oxide nano powder. METHODS: The experimental study was conducted at the Hamdard University Dental Hospital and the Pakistan Council of Scientific and Industrial Research laboratories, Karachi, from January to June, 2018. Direct precipitation method was used in which analytical grade sodium hydroxide and zinc nitrate hex hydrate were used without any further purification. The sample was randomly divided into two groups. The control group A had 0 wt.% of nano zinc oxide, while the experimental group was further divided into 2 subgroups, with group B containing samples having 3 wt.% and group C 5 wt.% of nano zinc oxide. Delayed expansion was checked using electron micrometer. Data was analysed using SPSS 22. RESULTS: Of the 180 samples, there were 90(50%) in control group A, and 45(25%) each in experimental groups B and C. Subgroup B showed significantly more linear expansion than subgroup C. Subgroups B and C achieved their entire linear expansion after 24 hours. CONCLUSIONS: There was improvement in the dimensional stability of dental amalgam after the incorporation of nano particles of zinc oxide.

Consumers' expectations and experiences with chain community pharmacies in Lahore, Pakistan: a qualitative exploratory study.

Background The model of community pharmacy practice is changing remarkably not only in the West but also in developing countries, which has led retail pharmacies to transform into chain community pharmacies. However, very little is known about consumers' expectations and experiences with chain community pharmacies in developing countries. Objective This study aims to assess the expectations and experiences of consumers with services provided by chain community pharmacies in Lahore, Pakistan. Setting Four random chain community pharmacies. Methods A qualitative study design was employed and face-to-face, audio-recorded, interviews were conducted with 12 consumers attending 4 randomly selected chain community pharmacies. All interviews were transcribed verbatim and the interview data were analysed thematically using NVivo® software. Main outcome measure Consumers' expectations and experiences with chain community pharmacies. Results The results contributed to a deeper understanding of the consumers' expectations and experiences with the services provided by chain community pharmacies. Six themes emerged from interview data including; access to pharmacists, quality use of medicines, range of distinct services, staff's behaviour, inventory management, and scope of services. The consumers reported that pharmacists working in chain community pharmacies were building trusting relationships and encouraging them to take an active role in healthcare. Pharmacists working there were providing them medication information and counselling services, which they normally do not expect from traditional pharmacies. Consumers mentioned that they had access to pharmacists and quality services, but the inventory of pharmacies was limited. Conclusions This exploratory study provides preliminary evidence that some of the consumers' expectations and experiences were aligned. However, some deficiencies were highlighted by the consumers that need to be addressed by relevant stakeholders. Further research is needed to assess the expectations and experiences of pharmacists working in the chain community pharmacy sector.

Utilisation of Healthcare Services and Medicines by Pakistani Migrants Residing in High Income Countries: A Systematic Review and Thematic Synthesis.

Migration, as a global phenomenon, gives rise to many challenges for healthcare professionals providing care to migrant populations. Migrants originating from diverse cultural backgrounds have unique beliefs and healthcare needs, and their utilisation of healthcare services and medicines is influenced by a number of factors. This review aims to assess the factors influencing the utilisation of healthcare services and medicines among Pakistani migrants residing in high income countries. The databases searched included PubMed/Medline, Scopus, EMBASE, Web of Science, CINAHL, and IPA. Of the 2566 publications initially obtained, 37 met the inclusion criteria. They included eight countries-the United Kingdom, United States of America, Canada, Denmark, Norway, Australia, United Arab Emirates and Cyprus. Eight descriptive themes emerged and two analytical constructs were established, as a result of thematic synthesis of included publications. The profile of utilisation of healthcare services and medicines among Pakistani migrants was multifaceted and influenced by their individual circumstances (socioeconomic characteristics; personal beliefs, preferences, and experiences; individual culture and religion; family and friends; and language and communication), and host country characteristics (work environment; healthcare organisation, access and affordability; and health professionals' education, practices, and preferences). Awareness of population-specific characteristics of migrant communities is important to promote and implement culturally appropriate healthcare practices and service provision.

Clinical relevancy and determinants of potential drug-drug interactions in chronic kidney disease patients: results from a retrospective analysis.

BACKGROUND: Chronic kidney disease (CKD) alters the pharmacokinetic and pharmacodynamic responses of various renally excreted drugs and increases the risk of drug-related problems, such as drug-drug interactions. OBJECTIVES: To assess the pattern, determinants, and clinical relevancy of potential drug-drug interactions (pDDIs) in CKD patients. MATERIALS AND METHODS: This study retrospectively reviewed medical charts of all CKD patients admitted in the nephrology unit of a tertiary care hospital in Pakistan from January 2013 to December 2014. The Micromedex Drug-Reax® system was used to screen patient profiles for pDDIs, and IBM SPSS version 20 was used to carry out statistical analysis. RESULTS: We evaluated 209 medical charts and found pDDIs in nearly 78.5% CKD patients. Overall, 541 pDDIs were observed, of which, nearly 60.8% patients had moderate, 41.1% had minor, 27.8% had major, and 13.4% had contraindicated interactions. Among those interactions, 49.4% had good evidence, 44.0% had fair, 6.3% had excellent evidence, and 35.5% interactions had delayed onset of action. The potential adverse outcomes of pDDIs included postural hypotension, QT prolongation, ceftriaxone-calcium precipitation, cardiac arrhythmias, and reduction in therapeutic effectiveness. The occurrence of pDDIs was found strongly associated with the age of <60 years, number of prescribed medicines ≥5, hypertension, and the lengthy hospitalization of patients. CONCLUSION: The occurrence of pDDIs was high in CKD patients. It was observed that CKD patients with an older age, higher number of prescribed medicines, lengthy hospitalization, and hypertension were at a higher risk of pDDIs.

Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis.

BACKGROUND: Chronic kidney disease (CKD) alters the pharmacokinetic and pharmacodynamic response of various drugs and increases the risk of toxicity. The data regarding the pattern and predictors of medication dosing errors is scare from the developing countries. Therefore, the present study was conducted to assess the pattern and predictors of medication dosing errors in CKD patients in a tertiary care setting in Pakistan. METHODS: A retrospective study design was employed and medical charts of all those CKD patients who had an eGFR ≤60ml/min/1.73m2, hospitalization ≥24 hours, and admitted in the nephrology unit during January 2013 to December 2014 were assessed. Descriptive statistics and the logistic regression analysis were done using IBM SPSS version 20. RESULTS: In total, 205 medical charts were assessed. The mean age of patients was 38.64 (±16.82) years. Overall, 1534 drugs were prescribed to CKD patients, of which, nearly 34.0% drugs required dose adjustment. Among those drugs, only 41.8% were properly adjusted, and the remaining 58.2% were unadjusted. The logistic regression analysis revealed that the medication dosing errors were significantly associated with the CKD stages, i.e. stage 4 (OR 0.054; 95% CI [0.017-0.177]; p <0.001) and stage 5 (OR 0.098; 95% CI [0.040-0.241]; p <0.001), the number of prescribed medicines ≥ 5 (OR 0.306; 95% CI [0.133-0.704]; p 0.005), and the presence of a comorbidity (OR 0.455; 95% CI [0.226-0.916]; p 0.027) such as the hypertension (OR 0.453; 95% CI [0.231-0.887]; p 0.021). CONCLUSIONS: It is concluded that more than half drugs prescribed to CKD patients requiring dose adjustment were unadjusted. The predictors of medication dosing errors were the severe-to-end stages of chronic kidney disease, the presence of a comorbidity such as hypertension, and a higher number of prescribed medicines. Therefore, attention should be paid to these risk factors.

Evaluation of diabetes awareness among general population of Bahawalpur, Pakistan.

AIMS: To evaluate diabetes awareness among general population of Bahawalpur, Pakistan. METHODS: A questionnaire based descriptive cross sectional study was performed during 2014. Descriptive and inferential statistics were applied using the IBM Statistical Package for Social Sciences version 20. RESULTS: Total 383 respondents participated in this study giving a response rate of about 88%. Mean age of the participants was 33±13.3 years and the majority of the participants were females (50.4%). Mean scores of the participants were 20.77±6.65 out of 34 and only one participant scored 34/34 marks. Kruskal-Wallis and Mann-Whitney U test revealed that females scored significantly higher diabetes awareness score than males (p<0.05). Moreover, urban residential status, better education and higher socioeconomic status were significantly associated with higher diabetes awareness. CONCLUSIONS: Majority of our study population had adequate awareness regarding diabetes. However, lack of awareness was observed among illiterate, poor and rural participants that indicated the immediate need of diabetes awareness programs for these participants.

Knowledge, attitudes, and perception towards human papillomavirus among university students in Pakistan.

This cross-sectional study comprises a questionnaire-based survey regarding knowledge about human papillomavirus and its vaccine among students in different educational fields at public and private universities in the city of Lahore in Pakistan. A 26-item questionnaire was used to attain the objective of this study. The reliability of this tool was assessed using Cronbach's alpha (0.79) and the Kaiser-Meyer-Olkin value was 0.827. The response rate to the survey was 78.0%, of whom the majority (74.9%) were females and 308 (79%) were single (median age=23 years). While assessing the respondents' knowledge about HPV, 223(57%) students reported that they had already heard of HPV (human papillomavirus) and nearly 215 (55%) reported that HPV causes cervical cancer and can infect both men and women. Gender and field of study were two main factors found influencing the respondents' knowledge about HPV. Moreover, students' understanding about the mode of transmission of HPV was cursory: 40.51% said they did not know how HPV is transmitted, 133 (34.10%) stated that HPV spreads through the exchange of bodily fluids, and 22 (5.64%) selected cough/sneezing. In terms of prevention, 175 (44.87%) students stated that HPV can be prevented by vaccination, 30.0% reported sexual abstinence, 21.54% using condoms, and nearly 5.38% disclosed use of antibiotics. Addressing the knowledge of students regarding HPV vaccine, nearly 53% stated there is no vaccine against HPV and almost 64% rejected the statement that HPV vaccine prevents cervical cancer. In addition, students reported that they will be more than willing to get vaccinated for HPV if their physician recommend them (RII=0.74) followed by parents (RII=0.69). The results of this study revealed a poor understanding among respondents about the health problems associated with HPV, its prevention, modes of transmission and arability of HPV vaccine in Pakistan.

How important is inadvertent ingestion of hazardous substances at work?

Much is known about human exposure to workplace hazardous substances by inhalation and from skin contact, but there has been little systematic research into ingestion of hazardous substances used at work. This review attempts to identify whether inadvertent ingestion of hazardous substances is an important route of exposure in the workplace and examines possible methods that could be used to quantify ingestion exposure. A number of papers highlight jobs and substances where inadvertent ingestion may be important, typically through case reports or from a theoretical analysis. These scenarios involve exposure to some metals or metal compounds, pharmaceuticals, pesticides, some infectious agents, unsealed radioactive sources and some high molecular weight allergens. In total we estimate that about 4.5 million workers in the UK could have some regular non-trivial intake of hazardous substances by inadvertent ingestion. A conceptual analysis of inadvertent ingestion exposure highlights the role of hand-to-mouth and object-to-mouth events as the primary exposure processes. Two exposure 'compartments' are defined: the peri-oral area (i.e. the area of skin around the outside of the mouth) and the oral cavity. Several options are highlighted for exposure-related measurements, including peri-oral wipes, saliva samples, mouth-rinse samples, hand-wipes and under-nail scrapings. Further research is necessary to define which measurements may be most informative. Human behaviour has a key role in determining inadvertent ingestion exposure. For example, some people are habitual nail biters or repeatedly touch their mouth, both of which will increase the chance of ingesting contaminants on their hands. The frequency that people touch their face is dependant on the circumstances of their work and probably the degree of psychological stress they are under. A proper understanding of the importance of these factors will help in designing interventions to reduce the risks from ingesting hazardous substances at work. When making inhalation or dermal exposure measurements we recommend that details of personal behaviours should be recorded so that some estimate of ingestion risks can be inferred. It is possible that inadvertent ingestion of hazardous substances at work may become more important as employers put more emphasis on controlling inhalation and dermal exposures. Further research is necessary to ensure that risk reduction strategies for inadvertent ingestion of hazardous substances are appropriate and effective.