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Aims To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument. Background Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. Design Psychometric systematic review. Data sources A systematic literature search of the multiple databases (1990-September 2014). Review methods Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability. Results Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category. Conclusion Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy. [ABSTRACT FROM AUTHOR]

This study aims to identify the literacy skills of individuals whose highest level of education was in the field 'teacher training and educational sciences'. The study sample comprised 10,618 individuals in the field of teacher training and educational sciences, selected from 31 countries (participating in the International Adult Skills Assessment Programme during the 2014-2015 survey) using a multi-stage sampling method. The study employed multi-level latent class analysis and three-step analysis in order to determine both the number of multi-level latent classes of educators' literacy scores as well as the selected independent variables' success in predicting those latent classes. The analysis revealed that educators in Germany constituted the group with the highest literacy skills while educators from Singapore comprised the group with the lowest literacy skills. [This study was presented at the 9th International Congress of Educational Research. Ordu University, Ordu, Turkey.]

In this study, the variables having impact on the student motivation have been analyzed based on the articles, conference papers, master's theses and doctoral dissertations published in the years 2000-2017. A total of 165 research papers were selected for the research material and the data were collected through qualitative research techniques through document review and content analysis. According to the research results, the most important factors affecting student motivation are the fields of teacher, teachers' classroom management skills and their teaching methods. In this research, factors having less influence on the student motivation are parental communication, student characteristics and study fields. In addition, relational search type was used more than others, mostly students were selected as the study group and most researches were conducted in USA and Turkey.

Purpose: Scholarly interest in interorganizational learning (IOL) has spiked in the past decade because of its potential to absorb, transfer and create valuable knowledge for enhanced innovative performance and sustained competitive advantage. However, only a handful of review studies exists on the topic. The evolution of IOL has not been studied explicitly and there is a lack of understanding of the field trends. To fill this gap, this paper aims to comprehensively review the literature on IOL and map its evolution and trends using bibliometric techniques. In particular, the authors use visualization of science mapping freeware to systematize the findings and interpret the results. Design/methodology/approach: The authors synthesize the findings using "evaluative bibliometric techniques" to identify the quality and quantity indicators of the IOL research and use "relational bibliometric techniques" to determine the structural indicators of the IOL field such as the intellectual foundations and emerging research themes of IOL research. Findings: Through an analysis of 208 journal publications obtained from the Scopus database, the authors determine the leading authors, countries, highly cited papers and their contributions to the IOL literature. By identifying the key hotspots, intellectual foundations and emerging trends of IOL, the authors provide promising avenues in IOL research. Originality/value: To the best of the knowledge, this study is the first to systematically review the IOL literature and provide future research directions.

This article maps the scientific production and the contents associated with the sustainable development goals and their integration with universities during the past 21 years. Although many of the topics related to sustainable development goals (SDGs) have been addressed in different studies for decades, it is since 2015 onwards that they gained greater prominence due to the inclusion of higher education as an important actor in the fulfillment of the 2030 agenda and the United Nations SDGs. For the purpose of this paper, a bibliometric analysis of 871 papers, 535 documents in Scopus, and 336 in Web of Science (WoS) from 1998 to 2019 was performed, and the Bibliometrix analysis tool was used. The objective of this mapping is to answer the following research question: Is the integration of the Sustainable Development Goals and Universities a field of study? An analysis of the network of collaborators and trend topics in Scopus and WoS allows us to identify the concurrence and relationships of some keywords, such as sustainable development, sustainability and planning, and some background words, such as humans and global health. In another analysis, the word "higher education" is related to change. This article suggests that the integration of the Sustainable Development Goals in Universities is becoming a field of study under exploration, with a peak of production in 2016 and that has remained stable in the last three years, but thanks to the leading role assigned to Universities, intellectual production should increase in the following years.

In this work, a bibliometric analysis of the investigations of the last 54 years focused on the teaching of topology and its applications in the learning of other areas of knowledge was carried out. The articles that appear in the SCOPUS database were taken into account under the search criteria of the words topology and teaching, connected with the Boolean expression AND in the search field ABS. As a result, 329 articles were obtained which, based on the PRISMA methodology, were reduced to 74 papers. In them publication trends, impact of publications, citation frequencies, among others, were compared. In addition, its use was identified for learning topology at different levels of training, areas of knowledge where this discipline is most applied and strategies used to teach these applications.

For over two decades now, the application of Citizen Science to Education has been evolving, and fundamental topics, such as the drivers of motivation to participate in Citizen Science projects, are still under discussion. Some recent developments, though, like the use of Artificial Intelligence to support data collection and validation, seem to point to a clear-cut divergence from the mainstream research path. The objective of this paper is to summarise the development trajectory of research on Citizen Science in Education so far, and then shed light on its future development, to help researchers direct their efforts towards the most promising open questions in this field. We achieved these objectives by using the lens of the Affordance-Actualisation theory and the Main Path Analysis method.

Although concepts such as research without borders have become more commonplace in recent decades, few studies have investigated the capabilities that global researchers require to cross both cultural and disciplinary borders. This paper explores global capabilities along with strategies and spaces that may facilitate academic researchers' acquisition and development of global research competence. The study's dataset comprises responses of 26 participants across 15 countries -- all of whom are members of a specific comparative education society -- who contributed their views via e-questionnaire. Findings indicate that research capacity building is a dynamic process and global competence calls for complex skills and conscious attitudes. Commitment to expand scientific curiosity beyond one's own culture and academic discipline appears to be a main criterion in achieving global competence. Results of this study are not meant to be prescriptive but rather exploratory and informative for a broad group of academic stakeholders.

Background: Patient safety in primary care is an emerging field of research with a growing evidence base in western countries but little has been explored in the Gulf Cooperation Council Countries (GCC) including the Sultanate of Oman. This study aimed to review the literature on the safety culture and patient safety measures used globally to inform the development of safety culture among health care workers in primary care with a particular focus on the Middle East. Methods: A systematic review of the literature. Searches were undertaken using Medline, EMBASE, CINAHL and Scopus from the year 2000 to 2014. Terms defining safety culture were combined with terms identifying patient safety and primary care. Results: The database searches identified 3072 papers that were screened for inclusion in the review. After the screening and verification, data were extracted from 28 papers that described safety culture in primary care. The global distribution of the articles is as follows: the Netherlands (7), the United States (5), Germany (4), the United Kingdom (1), Australia, Canada and Brazil (two for each country), and with one each from Turkey, Iran, Saudi Arabia and Kuwait. The characteristics of the included studies were grouped under the following themes: safety culture in primary care, incident reporting, safety climate and adverse events. The most common theme from 2011 onwards was the assessment of safety culture in primary care (13 studies, 46%). The most commonly used safety culture assessment tool is the Hospital survey on patient safety culture (HSOPSC) which has been used in developing countries in the Middle East. Conclusions: This systematic review reveals that the most important first step is the assessment of safety culture in primary care which will provide a basic understanding to safety-related perceptions of health care providers. The HSOPSC has been commonly used in Kuwait, Turkey, and Iran. [ABSTRACT FROM AUTHOR]

Epidemiological evidence suggests that regular physical activity (PA) positively impacts individuals' mental health (MH). The PA-MH relationship may be critical among immigrants owing to psycho-social-cultural influences. This scoping review of 61 studies employed a holistic bio-psycho-socio-cultural framework to thoroughly investigate the complex relationship between PA (across life domains) and immigrants' MH in Western countries. A systematic search of five electronic databases (Medline, PubMed, Embase, PsycINFO and Anthropology Plus) was conducted to locate relevant articles. No limitations were applied to study design, age, gender, home country, MH condition or PA type. A bio-psycho-socio-cultural-informed conceptual model guided the analysis of the multi-domain PA-MH relationship. Immigrant PA-MH studies were conducted and reported most commonly in the USA (38%), Australia (18%), and Canada (11%). Overall, PA was positively related to MH. Each domain-specific PA appeared to be associated with unique MH-promoting pathways/mechanisms. Leisure-related PA may support MH by enhancing self-agency and minimizing risky behaviors, whilst travel- and domestic-related PA may promote self-accomplishment and physical engagement. Ethnic sports appeared to enhance resilience. Occupational-related PA was associated with either positive or negative MH, depending on the type of occupation. A bio-psycho-socio-cultural-informed model is required to gain an encompassing and integrated understanding of immigrants' health. The first iteration of such a model is presented here, along with an illustration of how the model may be used to deepen analysis and understanding of the multi-domain PA-MH relationship among immigrants and inform public health planners and practitioners. [ABSTRACT FROM AUTHOR]

Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]

This paper focuses "interest in science" as one of the attitudinal aspects of scientific literacy. Large-scale data from the Programme for International Student Assessment (PISA) 2006 are analysed in order to describe student interest more precisely. So far the analyses have provided a general indicator of interest, aggregated over all contexts and contents in the science test. With its innovative approach PISA embeds interest items within the cognitive test unit and its contents and contexts. The main difference from conventional interest measures is that in most questionnaires, a relatively small number of interest items cover broad fields of contents and contexts. The science units represent a number of systematically differentiated scientific contexts and contents. The units' stimulus texts allow for concrete descriptions of relevant content aspects, applications, and contexts. In the analyses, multidimensional item response models are applied in order to disentangle student interest. The results indicate that multidimensional models fit the data. A two-dimensional model separating interest into two different "knowledge of science dimensions" described in the PISA science framework is further analysed with respect to gender, performance differences, and country. The findings give a comprehensive description of students' interest in science. The paper deals with methodological problems and describes requirements of the test construction for further assessments. The results are discussed with regard to their significance for science education. (Contains 5 tables and 6 figures.)

The paper looks at part-time higher educational services for students in the educational systems of Australia, Canada, Germany, France, Italy, Japan, The Netherlands, New Zealand, Spain, Sweden, the United Kingdom, and the United States. A comparative examination of the nature and importance of part-time higher education is then presented. (DB)

Cross-border higher education institutions are considered a main way to fulfill the educational internalization in Mainland China; to some extent they represent the attitude of entering the international market. In this paper, the history, status quo, and future of Chinese-foreign cooperatively-run schools are analyzed and discussed. Cross-border higher education institutions in Mainland China have experienced the process from accidental and disorder to a systematic and quality orientation.

This paper presents a bibliometric analysis of highly cited articles published in the Web of Science category "Education and Educational Research" in the Social Science Citation Index (SSCI). A total of 2091 journal articles published in this category and cited more than 100 times up to the end of the year 2016 were retrieved as highly cited articles. Distributions of highly cited articles per publication year, journals, institutions and countries were analysed, as well as the citation life cycle of the top-cited articles. The USA, its institutions and researchers are the absolute leaders in the category of Education and Educational Research according to the results of the conducted analysis.

The Changing Academic Profession (CAP) international survey was designed in part to consider the effects of globalization on the work context and activities of academics in 19 countries or regions around the world. This paper draws from a subset of these data to explore the extent to which academics are globally connected in their research and teaching, and the ways this connectedness relates to global migration. Across multiple measures, immigrant academics (i.e., academics working in countries where they were not born and did not receive their first degree) were more globally connected than national academics (i.e., those working in the countries of their birth and first degree). Global migration by academic staff is clearly a major contributor to the internationalization of higher education institutions, yet there was no evidence these contributions led to enhanced career progress or job satisfaction for immigrant academics relative to national academics. The international expertise and experience of immigrant academics may not be sufficiently recognized and valued by their institutions.

In this paper, we develop an information distortion model (IDM) of social class differences in self-beliefs and values. The IDM combines psychological biases on frame-of-reference effects with sociological foci on ability stratification. This combination is hypothesized to lead to working-class children having more positive math self-beliefs and values than equally able salariat children. We further suggest that the same conditions that give rise to the working-class benefit in self-beliefs and values are associated with signaling effects that suppress educational aspirations and attainment. These hypotheses are tested in 1 cross-sectional multinational and 1 longitudinal study. The results in favor of the IDM challenge cultural models of social class differences and have implications for rational action theory.

Background: Data from the Programme for the International Assessment of Adult Competencies (PIAAC) revealed that countries systematically differ in their respondents' literacy, numeracy, and problem solving in technology-rich environments skills; skill levels also vary by gender, age, level of education or migration background. Similarly, systematic differences have been documented with respect to adults' participation in education, which can be considered as a means to develop and maintain skills. From a psychological perspective, motivation to learn is considered a key factor associated with both skill development and participation in (further) education. In order to account for motivation when analyzing PIAAC data, four items from the PIAAC background questionnaire were recently compiled into a motivation-to-learn scale. This scale has been found to be invariant (i.e., showing full weak and partial strong measurement invariance) across 21 countries. Methods: This paper presents further analyses using multiple-group graded response models to scrutinize the validity of the motivation-to-learn scale for group comparisons. Results: Results indicate at least partial strong measurement invariance across gender, age groups, level of education, and migration background in most countries under study (all CFI > 0.95, all RMSEA < 0.08). Thus, the scale is suitable for comparing both means and associations across these groups. Conclusions:Results are discussed in light of country characteristics, challenges of measurement invariance testing, and potential future research using PIAAC data.

Maternal depression can be accounted for one of the most common complications during pregnancy and the postpartum period affecting women all over the world. So far, no detailed map of the worldwide maternal depression research architecture has been constructed, which encompasses aspects of research activity, quality, and also socioeconomic features. Using the NewQIS platform, density-equalizing mapping projections, scientometric techniques, and economic benchmarking procedures were applied to evaluate global maternal depression research for the period between 1900 and 2012. In total, 7330 related publications and 3335 international collaborations were identified. The USA was the most active country concerning collaborations and total research activity. In the socioeconomic analysis of research activity in high-income countries, Australia was ranked first with an average of 412.05 maternal depression-related publications per 1000 billion US$ GDP (Q), followed by the UK (Q = 373.51) and Canada (Q = 306.32). The group of upper-middle-income countries was led by South Africa (Q = 145.67), followed by Turkey (Q = 91.8). China authored 11.95 maternal depression-related publications per 1000 billion US$ GDP. The USA had the highest activity of maternal depression research per GDP in billion US$ per capita (Q = 60.86). When research activity was related to population size (Q = publications per Mio. inhabitants), Australia (Q = 26.44) was leading the field, followed by Norway (Q = 18.48). Gender analysis revealed a relatively high degree of female scientists involved in this field of research with pronounced differences between single subject areas. In summary, we here present the first picture of the global scientific development in maternal depression research over a period of more than 100 years. The research landscape is clearly dominated by North American and Western European countries, with only minor contribution of Asian or South American countries. [ABSTRACT FROM AUTHOR]

Background: The availability of costly safety measures against transfusion-transmissible infections forces Western countries to confront difficult ethical questions. How to decide about implementing such measures? When are such decisions justified? As a preliminary to addressing these questions, we assessed which concerns shape actual donor blood safety policymaking in five Western countries.Study Design and Methods: Our qualitative study involved determining which issues had been discussed in advisory committee meetings and capturing these issues in general categories. Appropriate documents were identified in collaboration with local decision-making experts in Canada, Germany, the Netherlands, the United States, and the United Kingdom. The introduction of hepatitis B virus nucleic acid testing and selected measures against variant Creutzfeldt-Jakob disease, West Nile virus, and Q-fever were chosen as cases representing decision-making on safety measures with high costs and low or uncertain added safety.Results: A broad inventory of concerns was established, including: 1) nine categories of advantages and disadvantages of candidate safety policies; 2) six kinds of difficulties in assessing risks and forecasting the effects of safety policies; 3) 13 decision-making principles; and 4) six kinds of practical barriers hampering the translation of candidate policies into decisions.Conclusion: Blood safety policymaking involves a wide variety of competing concerns, and approaches to reconcile these considerations are themselves contested. Developing a systematic decision-making approach requires ethical reflection on, among others, reasonable costs of safety and the value of transparency in public policy. [ABSTRACT FROM AUTHOR]

This paper empirically examines the impact of academic research on high-tech manufacturing growth of 28 Organisation for Economic Co-operation and Development (OECD) and emerging countries over the 1991-2005 period. A standard research and development (R&D) expenditure based measure is found to be too general to capture the input in high-tech research. To overcome this problem, a novel proxy for high-tech research investment--the supercomputer capacity--is proposed. Empirical evidence strongly supports this choice of variable. It is also found that academic R&D exerts a larger growth effect on high-tech output than its industry and government counterparts, but only the impact differential between academic and government R&D is statistically significant.

Accessible summary For some heron addicts, heroin-assisted treatment is more efficacious than methadone treatment., Seven European countries have implemented outpatient centres where patients self-administer pharmaceutical heroin under close supervision., Nurses deliver pharmaceutical heroin and supervise administration. The two main concerns are overdosing and smuggling., Nurses are convinced of the utility of this treatment for severe heroin addicts., Abstract Heroin-assisted treatment (HAT) is a solution for improving the condition of treatment-resistant heroin addicts. Since 1994, six randomized controlled trials have concluded that HAT is more efficacious than oral methadone for severe heroin addicts. We visited seven HAT treatment centres in four countries in order to observe diacetylmorphine (DAM) administration and to study the main concerns of the staff. Nurses were concerned by the risk taken if a previously intoxicated patient received his dose of DAM. Another concern was the smuggling of DAM doses. The HAT centres face a dilemma: treating patients while at the same time allowing their risky street habits in the centre. [ABSTRACT FROM AUTHOR]

This paper is a macro study on higher education R&D and its impact on productivity growth. I measure the social rate of return on higher education R&D in 17 high-income OECD countries using country level data on the percentage of gross expenditure on R&D performed by higher education, business, and government sectors over the period 1981-2006. Empirical results suggest that lagged R&D performed by higher education is positively affecting productivity growth in all specifications. The long-run propensity of productivity growth to R&D performed by the higher education sector is also found to be positive and significant while it is found be insignificant to business R&D. (Contains 13 notes, 3 figures and 8 tables.)

At least one-third of the 72 million children currently missing out on primary education are estimated to be disabled. With just five years remaining to achieve the Millennium Development and Education for All (EFA) goals, global efforts to ensure all children complete a full cycle of primary education by 2015 will fail if bilateral and multilateral donor support for education does not prioritise the inclusion of disabled children. This paper reviews the commitments and practices of key EFA Fast Track Initiative (FTI) donors in relation to early childhood and primary education for disabled children between 2005 and 2008/9. The review highlights that, while a number of FTI donor partners are beginning to pay greater attention to the inclusion of disabled children in education through their international development cooperation and policy commitments, this has not been accompanied by sustained and systematic action. Weak political will and continued marginalisation of the issue of education for disabled children from the mainstream EFA agenda threatens to impede current efforts towards "education for all". (Contains 9 notes and 1 table.)

While higher education is regarded a high priority for economic development in many countries, public budgets often fall short to support desired levels of expansion in higher education. This leads to cost-sharing: students and their families are required to contribute more to the costs of higher education. This paper explores worldwide trends to cope with this issue based on the following questions: Is it fair to ask for larger contributions from students? What are the global patterns and forms of higher private shares in the costs of higher education? And what is the impact of cost-sharing on higher education access and equity? (Contains 4 tables and 2 footnotes.)

Based on data from 700 companies in 20 countries, this paper records the research that investigates the contribution of organisational and technological practices to speed up New Product Development (NPD). The organisational practice is found positively correlated with the speed of NPD. However, no significant direct relationship was found between technology practice and the speed of NPD. The organisational and technological practices are found to be in balance, which may be a new input to explain how technology helps NPD. The implication is that organisational practices such as team, continuous improvement and Total Quality Management (TQM) philosophy are needed in order to implement technologies successfully. This result supports the simultaneous theory on innovation, which is especially important in developing countries. (Contains 1 figure and 4 tables.)

This paper presents a model of the approaches open to government to ensure that early childhood services are affordable to families. We derived the model from a comparative literature review of affordability approaches taken by government, both in Australia and internationally. The model adds significantly to the literature by proposing a means to understand and assess the numerous options for affordability funding. The model suggests that the options fall into only three basic approaches: operational funding, fee subsidies and tax relief. Application of this simple model helps clarify the costs and benefits of particular choices within these approaches. We predict that the choices affect cost to government, affordability to families, and participation by children in early childhood services. (Contains 2 tables.)

This paper examines the extent that material, social, and cultural resources and schools account for the relationship between socioeconomic background and student achievement among 15-year-olds in 30 countries. Generally, cultural factors play a more important role in most countries although in a small minority of countries, material resources have a substantial impact. Most often, social resources have little impact. In many countries, educational differentiation--that is, school tracks and school types, and curriculum tracking within schools--mediates the relationship between socioeconomic background and student achievement. Countries with highly tracked systems tend to show stronger relationships. On average, over 60% of the effect of socioeconomic background on achievement is accounted for by these factors. These findings are independent of whether achievement in reading, mathematics, or science is examined. The implications of this study for reducing socioeconomic inequalities in education are discussed.

Background: Half of nursing home residents (NHR) suffer from dementia. End-of-life hospitalizations are often burdensome in residents with dementia. A systematic review was conducted to study the occurrence of hospitalizations at the end of life in NHR with dementia and to compare these figures to NHR without dementia. Methods: A systematic literature search in MEDLINE, CINAHL and Scopus was conducted in May 2018. Studies were included if they reported proportions of in-hospital deaths or hospitalizations of NHR with dementia in the last month of life. Two authors independently selected studies, extracted data, and assessed quality of studies. Results: Nine hundred forty-five citations were retrieved; 13 studies were included. Overall, 7 studies reported data on in-hospital death with proportions ranging between 0% in Canada and 53.3% in the UK. Studies reporting on the last 30 days of life (n = 8) varied between 8.0% in the Netherlands and 51.3% in Germany. Two studies each assessed the influence of age and sex. There seem to be fewer end-of-life hospitalizations in older age groups. The influence of sex is inconclusive. All but one study found that at the end of life residents with dementia were hospitalized less often than those without (n = 6). Conclusions: We found large variations in end-of-life hospitalizations of NHR with dementia, probably being explained by differences between countries. The influence of sex and age might differ when compared to residents without dementia. More studies should compare NHR with dementia to those without and assess the influence of sex and age. Trial registration: PROSPERO registration number CRD42018104263. [ABSTRACT FROM AUTHOR]

Background: Despite significant investments to support primary care internationally, income-based inequities in access to quality health care are present in many high-income countries. This study aims to determine whether low- and middle-income groups are more likely to report poor quality of primary care (PC) than high-income groups cross-nationally. Methods: The 2011 Commonwealth Fund Telephone Survey of Sicker Adults is a cross-sectional study across eleven countries. Respondents were recruited from randomly selected households. We used data from surveys conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. We identified all questions relating to primary care performance, and categorized these into five dimensions: 1) access to care, 2) coordination 3) patient-centered care, and 4) technical quality of care. We used logistic regression with low and middle-income as the comparison groups and high-income as the referent. Results: Fourteen thousand two hundred sixty-two respondents provided income data. Countries varied considerably in their extent of income disparity. Overall, 24.7% were categorized as low- and 13.9% as high-income. The odds of reporting poor access to care were higher for low- and middle-income than high-income respondents in Canada, New Zealand and the US. Similar results were found for Sweden and Norway on coordination; the opposite trend favoring the low- and middle-income groups was found in New Zealand, United Kingdom, and the United States. The odds of reporting poor patient-centered care were higher for low-income than high-income respondents in the Netherlands, Norway, and the US; in Australia, this was true for low- and middle-income respondents. On technical quality of care, the odds of reporting poor care were higher for the low- and middle-income comparisons in Canada and Norway; in Germany, the odds were higher for low-income respondents only. The odds of reporting poor technical quality of care were higher for high-income than low-income respondents in the Netherlands. Conclusion: Inequities in quality PC for low and middle income groups exist on at least one dimension in all countries, including some that in theory provide universal access. More research is needed to fully understand equity in the PC sector. [ABSTRACT FROM AUTHOR]

Background: Disparities in access to primary care (PC) have been demonstrated within and between health systems. However, few studies have assessed the factors associated with multiple barriers to access occurring along the care-seeking process in different healthcare systems. Methods: In this secondary analysis of the 2016 Commonwealth Fund International Health Policy Survey of Adults, access was represented through participant responses to questions relating to access barriers either before or after reaching the PC practice in 11 countries (Australia, Canada, France, Germany, Norway, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and United States). The number of respondents in each country ranged from 1000 to 7000 and the response rates ranged from 11% to 47%. We used multivariable logistic regression models within each of eleven countries to identify disparities in response to the access barriers by age, sex, immigrant status, income and the presence of chronic conditions. Results: Overall, one in five adults (21%) experienced multiple barriers before reaching PC practices. After reaching care, an average of 16% of adults had two or more barriers. There was a sixfold difference between nations in the experience of these barriers to access. Vulnerable groups experiencing multiple barriers were relatively consistent across countries. People with lower income were more likely to experience multiple barriers, particularly before reaching primary care practices. Respondents with mental health problems and those born outside the country displayed substantial vulnerability in terms of barriers after reaching care. Conclusion: A greater understanding of the multiple barriers to access to PC across the stages of the care-seeking process may help to inform planning and performance monitoring of disparities in access. Variation across countries may reveal organisational and system drivers of access, and inform efforts to improve access to PC for vulnerable groups. The cumulative nature of these barriers remains to be assessed. [ABSTRACT FROM AUTHOR]