Both living and working environments have a substantial influence on promoting healthy living habits. A holistic and accurate assessment of the community health-promoting practices is important to identify gaps and to make continuous, tangible improvements. The aim of the study is to assess the prevalence of the Singapore community health-promoting practices. The community health-promoting practices in all residential zones of an electoral constituency were assessed based on a composite health promotion scoring system comprising of 44 measurable elements under the 5 domains of community support and resources; healthy behaviours; chronic conditions; mental health; and common medical emergencies. An alphabetical grading system was used based on the score ranges: grade 'A' (75% and above), grade 'B' (60% to below 75%), grade 'C' (50% to below 60%) and grade 'D' (below 50%). The community health-promoting practices were graded 'D' with an overall average score of 41%. The constituency achieved grade 'C' (59%) for mental health domain and grade 'B' (72%) for common medical emergencies. The health-promoting practices for the other domains were graded 'D' (<50%) except for healthy behaviour (physical activity) sub-domain which achieved grade 'B' (65%). Significant gaps were identified in the community health-promoting practices. The residential zones may benefit from the scoring system to identify gaps and prioritize high-impact strategies to improve their health practices.

INTRODUCTION In view of the important role of the environment in improving population health, implementation of health promotion programmes is recommended in living and working environments. Assessing the prevalence of such community health-promoting practices is important to identify gaps and make continuous and tangible improvements to health-promoting environments. We aimed to evaluate the inter-rater reliability of a composite scorecard used to assess the prevalence of community health-promoting practices in Singapore. METHODS Inter-rater reliability for the use of the composite health promotion scorecards was evaluated in eight residential zones in the western region of Singapore. The assessment involved three raters, and each zone was evaluated by two raters. Health-promoting practices in residential zones were assessed based on 44 measurable elements under five domains – community support and resources, healthy behaviours, chronic conditions, mental health and common medical emergencies – in the composite scorecard using weighted kappa. The strength of agreement was determined based on Landis and Koch’s classification method. RESULTS A high degree of agreement (almost perfect-to-perfect) was observed between both raters for the measurable elements from most domains and subdomains. An exception was observed for the community support and resources domain, where there was a lower degree of agreement between the raters for a few elements. CONCLUSION The composite scorecard demonstrated a high degree of reliability and yielded similar scores for the same residential zone, even when used by different raters.

has recently been utilised in this group with favourable outcomes. A more challenging group are those with intractable vertigo and they have traditionally posed a significant management dilemma. Methods: Retrospective case note review was performed in a tertiary referral centre. Three female patients with recurrent incapacitating attacks of vertigo despite conservative management underwent simultaneous labyrinthectomy and cochlear implantation. Two patients had unaidable hearing preoperatively. One patient had moderate-severe sensorineural loss and was suffering from frequent debilitating drop attacks that had resulted in injury.