Search

Background: Current evidence suggests that chlamydia screening programmes can be cost-effective, conditional on assumptions within mathematical models. We explored differences in cost estimates used in published economic evaluations of chlamydia screening from seven countries (four papers each from UK and the Netherlands, two each from Sweden and Australia, and one each from Ireland, Canada and Denmark).Methods: From these studies, we extracted management cost estimates for seven major chlamydia sequelae. In order to compare the influence of different sequelae considered in each paper and their corresponding management costs on the total cost per case of untreated chlamydia, we applied reported unit sequelae management costs considered in each paper to a set of untreated infection to sequela progression probabilities. All costs were adjusted to 2013/2014 Great British Pound (GBP) values.Results: Sequelae management costs ranged from £171 to £3635 (pelvic inflammatory disease); £953 to £3615 (ectopic pregnancy); £546 to £6752 (tubal factor infertility); £159 to £3341 (chronic pelvic pain); £22 to £1008 (epididymitis); £11 to £1459 (neonatal conjunctivitis) and £433 to £3992 (neonatal pneumonia). Total cost of sequelae per case of untreated chlamydia ranged from £37 to £412.Conclusions: There was substantial variation in cost per case of chlamydia sequelae used in published chlamydia screening economic evaluations, which likely arose from different assumptions about disease management pathways and the country perspectives taken. In light of this, when interpreting these studies, the reader should be satisfied that the cost estimates used sufficiently reflect the perspective taken and current disease management for their respective context. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to conduct the first cross-sectional survey on depression, Resilience, well-being, depression symptoms and concussion levels in equestrian athletes and to assess whether past concussion rates were associated with depression, resilience and well-being. Design/methodology/approach: In total, 511 participants from Canada, Republic of Ireland, UK, Australia and USA took part in an international cross-sectional, online survey evaluating concussion history, depression symptoms, resilience and well-being. Findings: In total, 27.1% of athletes met clinically relevant symptoms of major depressive disorder. Significant differences were shown in the well-being and resilience scores between countries. Significant relationships were observed between reported history of concussion and both high depression scores and low well-being scores. Practical implications: Findings highlight the need for mental health promotion and support in equestrian sport. Social implications: Results support previous research suggesting a need for enhanced mental health support for equestrians. There is reason to believe that mental illness could still be present in riders with normal levels of resilience and well-being. Originality/value: This study examined an understudied athlete group: equestrian athletes and presents important findings with implications for the physical and mental health of this population. [ABSTRACT FROM AUTHOR]

This paper reports on pilot studies of adolescents who have been studying Italian as a second language (L2), for at least one year, post-elementary (primary school). The study was conducted in Canada and Australia. The study focuses on the use if the Italian language abroad as a social dialect spoken by high school students, in certain social contexts in Canada and Australia. Students pursuing Italian courses as a second language (L2) in high schools in Canada and Australia were asked to complete a voluntary written survey. The data collected, once analysed, revealed a framework of patterns of adolescent communication, consisting of connotative and clique-coded language discourses. This framework was utilised to undertake a cross-cultural comparison on Italian adolescent discourse. The paper points out that it is essential for a teacher of Italian, as a second language (L2), to incorporate adolescent learning interest in considering the design of a specific learning syllabus. The paper concludes by acknowledging that Italian-Canadian and Italian-Australian adolescent speech reflects the types of observations suggested in the literature by researchers in North America, such as Danesi (2003a, 2003b) and Clivio and Danesi (2000), who are among the very few who have carried out cross-cultural comparisons. In Europe, too, researchers such as Cortelazzo (1994), De Paoli (1998) and Marcato (1994, 1997) all report similarities in a distinct and recongisable speech code developed by adolescents. [ABSTRACT FROM AUTHOR]

Canada has been discussing whether to implement an orphan drug policy for more than 25 years. Recently, the federal government announced funding for orphan drugs starting in 2022, and the Canadian Senate has recommended that the country develop an orphan drug policy. This paper uses a list of orphan drugs approved by the United States Food and Drug Administration between 2008 and 2017, inclusive. It then compares Canada, which has no orphan drug policy, and Australia, which has had such a policy since 1997. There was no difference between the countries in the proportion of orphan drugs approved, the time drugs spent in the regulatory review process, and any delay in marketing the drugs in the respective countries compared to the United States. Both Canada and Australia approved virtually all of the drugs that offered a moderate to significant therapeutic improvement. If Canada hopes to provide faster access to orphan drugs, especially those that are therapeutically innovative, it will need to develop a policy that is significantly different from that in Australia. [ABSTRACT FROM AUTHOR]

Background: Lone parents and their children experience higher than average levels of adverse health and social outcomes, much of which are explained by high rates of poverty. Many high income countries have attempted to address high poverty rates by introducing employment requirements for lone parents in receipt of welfare benefits. However, there is evidence that employment may not reduce poverty or improve the health of lone parents and their children.Methods: We conducted a systematic review of qualitative studies reporting lone parents' accounts of participation in welfare to work (WtW), to identify explanations and possible mechanisms for the impacts of WtW on health and wellbeing. Twenty one bibliographic databases were searched. Two reviewers independently screened references and assessed study quality. Studies from any high income country that met the criteria of focussing on lone parents, mandatory WtW interventions, and health or wellbeing were included. Thematic synthesis was used to investigate analytic themes between studies.Results: Screening of the 4703 identified papers and quality assessment resulted in the inclusion of 16 qualitative studies of WtW in five high income countries, USA, Canada, UK, Australia, and New Zealand, covering a variety of welfare regimes. Our synthesis found that WtW requirements often conflicted with child care responsibilities. Available employment was often poorly paid and precarious. Adverse health impacts, such as increased stress, fatigue, and depression were commonly reported, though employment and appropriate training was linked to increased self-worth for some. WtW appeared to influence health through the pathways of conflict and control, analytical themes which emerged during synthesis. WtW reduced control over the nature of employment and care of children. Access to social support allowed some lone parents to manage the conflict associated with employment, and to increase control over their circumstances, with potentially beneficial health impacts.Conclusion: WtW can result in increased conflict and reduced control, which may lead to negative impacts on mental health. Availability of social support may mediate the negative health impacts of WtW. [ABSTRACT FROM AUTHOR]

In the past decades, public health has increasingly addressed what has been called the children's obesity 'epidemic', most notably through large-scale initiatives promoting physical activity. Through a discourse analysis the current paper critically examines such efforts in Canadian and Australian public health. Public health websites in Canada and Australia were examined for information concerning children's health, physical activity and obesity and explored for how these issues were represented in the discourse. Bacchi's (2009) 'What's the problem represented to be?' approach to discourse analysis guided our interrogation of the taken-for-granted assumptions underlying Canadian and Australian public health discourse, the ideological and political influences involved in its construction, and the knowledge base upon which it rests. The article calls for critical reflection on how children's physical and leisure activities are being advanced. [ABSTRACT FROM AUTHOR]

This paper reports on pilot studies of adolescents who have been studying Italian as a second language (L2) at the secondary level (high school) in Australia, Canada and Italy. These studies focus on the use of adolescent 'net lingo' (Crystal, 2006) and 'pop language' (Danesi, 2008; Savan 2005) and 'linguanet' (Danesi, 2008) used as a social dialect by these adolescents. Linguanet is the language used for online communications, across a wide variety of media, such as email, instant messaging and virtual social network sites. Data for these studies were gathered by means of a voluntary written survey. An analysis of the data reveals a framework of patterns of adolescent communication consisting of emotive, connotative and clique-coded language discourse. The use of this framework allows cross-cultural comparisons on Italian adolescents studying English as a second language (L2) at high school level in Italy with their counterparts in Canada and Australia. The analysis reveals the same speech patterns and variety as their Italian-canadian and Italian-australian counterparts. The paper acknowledges that adolescent speech varieties discovered in this pilot study reflect the types of observations suggested in the literature by other researchers in Europe and North America, such as Abatantuono, Navigli and Rocca (2006); Aulino (2008); Cortelazzo (1994); Danesi (2008); Crystal (2006); Marcato (1994, 1997) and Savan (2005). These researchers highlighted the similarities within a distinct and recognizable speech code that adolescents have developed and use among their peers. The paper concludes by highlighting the need to incorporate adolescent social network interests in the design of the curriculum to ensure it is relevant and of interest to modern day adolescents in the context of classroom teaching and learning. [ABSTRACT FROM AUTHOR]

This paper presents a comparative analysis of the extent to which party law influences the internal organisation of parties in four Commonwealth common law states: Australia, Canada, New Zealand and the United Kingdom. The research engages with recent comparative party literature that emphasises the increasingly close relationship between political parties and the state, in particular the cartel party thesis. My findings indicate that over the last few decades parties have become subject to greater legal regulation, which supports the claim that parties are now managed more closely by the state. However, it is important to distinguish between legislative and common law (judicial) regulation, as each has a different impact on the organisational autonomy of the cartel party. I argue that parties (as autonomous actors and the authors of parliamentary decrees) have been able to shape legislative regulation to their advantage by eliciting significant financial support from the state, yet minimising the corresponding degree of legislative intrusion into their internal activities. However, cartel parties have not been able to prevent judicial scrutiny of their internal workings, and have lost a significant degree of organisational independence as principles of administrative law (usually reserved for state bodies) are being increasingly applied to their structure and behaviour. [ABSTRACT FROM AUTHOR]

Background: Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning.Methods: A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines.Results: The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females).Conclusion: Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning. [ABSTRACT FROM AUTHOR]

Background Characteristics of preschool and child care centres have previously been shown to be associated with children's health behaviours such as physical activity and screen-based sedentary behaviour. This paper investigates differences in physical environments, policies and practices between child care centres in Melbourne, Australia and Kingston, Canada which may be associated with such behaviours. Methods Audits of child care centres were undertaken by trained research assistants for the Healthy Active Preschool and Primary Years ( Melbourne, Australia; n = 136) study and the Healthy Living Habits in Pre- School Children ( Kingston, Canada; n = 46) study. Twenty-one of the audit items (nine physical environment; 12 policies and practices) were assessed in both samples. Example items included outdoor play and shaded areas, availability of equipment, physical activity instruction for children and staff, opportunities to use electronic media and staff/child interaction during physical activity time. Analyses were completed using SAS version 9.2. Results Compared with Australian centres, a higher per cent of Canadian centres had a formal physical activity policy, reported children sat more frequently for 30 min or more and allowed children to watch television. A higher per cent of Australian centres provided an indoor area for physical activity, shade outdoors and physical activity education to staff. Children in Australian centres had access to more fixed play equipment and spent more time outdoors than in Canadian centres. Conclusions These findings may help inform the development of best practice and policy guidelines to enhance opportunities for healthy levels of physical activity and screen-based sedentary behaviour within child care centres in both countries. [ABSTRACT FROM AUTHOR]

The European Commission is revising the EU's data protection framework. One of the changes concerns privacy impact assessment (PIA). This paper argues that the European Commission and the EU Member States should draw on the experience of other countries that have adopted PIA policies and methodologies to construct its own framework. There are similarities and differences in the approaches of Australia, Canada, Ireland, New Zealand, the UK and US, the countries with the most experience in PIA. Each has its strong points, but also shortcomings. Audits have identified some of the latter in the instance of Canada. This paper provides a comparative analysis of the six countries to identify some of the best elements that could be used to improve Article 33 in European Commission's proposed Data Protection Regulation. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents a summary of the main international and national regulations for geologic storage of carbon dioxide. The international group includes the EU Directives, London Convention, and OSPAR. For the national regulations, three countries were covered in this study: United States, Canada, and Australia. In addition to these regulations, a group of guidelines and best practice manuals were also included in this study. As discussion, although this paper recognizes that current legislations have contributed for the regulation of this technology, it is still necessary the development of new rules in other regions. Industry will not invest in large CCS plants without such regulations because of high CCS costs and large financial risks related to CCS. [Copyright &y& Elsevier]

The paucity of literature in the field of visitor attractions, combined with the virtual vacuum of literature on international comparative research methodologies in tourism generally, and more specifically within the visitor attractions sector, together serve as the catalytic focus for this paper. Where studies have been completed on visitor attractions in the international arena, they have often been practitioner-led and lack the depth of analysis and rigour required for academic scrutiny. This paper will begin to fill this gap, by evaluating the methodological options available to academics when researching visitor attractions in different countries. Reference will be made throughout the paper to an international comparative Study undertaken by the authors at visitor attractions in Scotland, Canada, Australia and New Zealand. The paper concludes with a synthesis of those methodological issues deemed to be of benefit to future researchers wishing to advance their understanding of the management of-visitor attractions in different countries around the world. [ABSTRACT FROM AUTHOR]

Objectives Damage accrual in SSc can be tracked using the Scleroderma Clinical Trials Consortium Damage Index (DI). Our goal was to develop a prediction model for damage accrual in SSc patients with early disease. Methods Using patients with <2 years disease duration from Canada and Australia as a derivation cohort, and from the Netherlands as a validation cohort, we used group-based trajectory modelling (GBTM) to determine 'good' and 'bad' latent damage trajectories. We developed a prediction model from this analysis and applied it to patients from derivation and validation cohorts. We plotted the actual DI trajectories of the patients predicted to be in 'good' or 'bad' groups. Results We found that the actual trajectories of damage accumulation for lcSSc and dcSSc were very different, so we studied each subset separately. GBTM found two distinct trajectories in lcSSc and three in dcSSc. We collapsed the two worse trajectories in the dcSSc into one group and developed a prediction model for inclusion in either 'good' or 'bad' trajectories. The performance of models using only baseline DI and sex was excellent with ROC AUC of 0.9313 for lcSSc and 0.9027 for dcSSc. Using this model, we determined whether patients would fall into 'good' or 'bad' trajectory groups and then plotted their actual trajectories which showed clear differences between the predicted 'good' and 'bad' cases in both derivation and validation cohorts. Conclusions A simple model using only cutaneous subset, baseline DI and sex can predict damage accumulation in early SSc. [ABSTRACT FROM AUTHOR]

Objective. The aim of the present study was to describe how policy makers (bureaucrats and politicians) in Australia and Ontario (Canada) perceive evidence provided by doctors to substantiate applications for disability income support (DIS) by their patients with mental illnesses. Because many mental illnesses (e.g. depression) lack diagnostic tests, their existence and effects are more difficult to demonstrate than most somatic illnesses. Methods. Semi-structured interviews were conducted with 45 informants, all influential in the design of the assessment of DIS programs. The informants were subcategorised into advocates, legal representatives, doctors (general practitioners (GPs) and specialists (e.g. psychiatrists)), policy insiders and researchers. Informants were found through snowball sampling. Following the principles of grounded theory, data collection and analysis occurred in tandem. Results. Informants expressed some scepticism about doctors' evidence. Informants perceived that doctors could, due to lack of diagnostic certainty, 'write these things [evidence] however [they] want to'. Psychiatrists, perceived as having more time and skills, were considered as providing more trustworthy evidence than GPs. Conclusion. Doctors, providing evidence to support applications, play an important role in determining disability. However, policy makers perceive doctors' evidence about mental illnesses as less trustworthy than evidence about somatic illnesses. This affects decisions by government adjudicators. [ABSTRACT FROM AUTHOR]

Background: There is significant interest in comparing countries on many different indicators of social problems and policies. Cross-national comparisons of drug prevalence and policies are often hampered by differences in the approach used to reach respondents and the methods used to obtain information in national surveys. The paper explores how much these differences could affect cross-country comparisons.Methods: This study reports prevalence of drug use according to the most recent national household survey and then adjusts estimates as if all national surveys used the same methodology. The analysis focuses on European countries for which the European Monitoring Centre for Drugs and Drug Addiction reports data, the United States, Canada, and Australia. Adjustment factors are based on US data.Findings: Adjusting for modality differences appears likely to modestly affect the rankings of countries by prevalence, but to an extent that could be important for comparisons. For example, general population surveys suggest that the US had some of the highest cannabis and cocaine prevalence rates circa 2012, but this is partially driven by the use of a modality known to produce higher prevalence estimates. This analysis shows that country rankings are partly an artifact of the mode of interview used in national general population surveys.Conclusions: Our preliminary efforts suggest that cross-national prevalence comparisons, policy analyses and, other projects such as estimating the global burden of disease could be improved by adjusting estimates from drug use surveys for differences in modality. Research is needed to create more authoritative adjustment factors. [ABSTRACT FROM AUTHOR]

This study analyzes the previous literature on the online safety of children and youth under "the 4Cs risk framework" concerning contact, content, conduct, and contract risks. It then conducts a comparative study of Australia, Canada, and the UK, comparing their institutions, governance, and government-led programs. Relevant research in Childhood Education Studies is insufficient both in quantity and quality. To minimize the four major online risks for children and youth in cyberspace, it is necessary to maintain a regulatory approach to the online exposure of children under the age of 13. Moreover, the global society should respond together to these online risks with "multi-level" policymaking under a "multi-stakeholder approach". At the international level, multilateral discussion within the OECD and under UN subsidiaries should continue to lead international cooperation. At the domestic level, a special agency in charge of online safety for children and youth should be established in each country, encompassing all relevant stakeholders, including educators and digital firms. At the school and family levels, both parents and teachers need to work together in facilitating digital literacy education, providing proper guidelines for the online activities of children and youth, and helping them to become more satisfied and productive users in the digital era. [ABSTRACT FROM AUTHOR]

This article reports findings from a large mixed-method study exploring the migration to the United Kingdom (UK) of social workers trained in Australia, Canada, India, Romania, South Africa, the US, and Zimbabwe, and the migration of British trained social workers to Australia. The project aimed at exploring the motivations for migration, the experiences of integration, and the impact of culture on these. This article focuses on the quantitative findings and will use some of the qualitative data to further explain and interrogate the differences between these groups based on their country of origin. The findings show the greater challenges migrants from developing countries have experienced, including lack of recognition of their qualifications and experience, and discrimination. The findings also show that contrary to common assumptions, the migration experiences of social workers coming from Australia, Canada and the US are not as easy as expected. American social workers who migrated to the UK turned out to be the group least professionally satisfied. The British in Australia on the other hand, were the most satisfied. Implications for practice and future research are explored. [ABSTRACT FROM AUTHOR]

Summary: Background. Previous research focused on the clinical evidence supporting new cancer drugs' initial US Food and Drug Administration (FDA) approval. However, targeted drugs are increasingly approved for supplementary indications of unknown evidence and benefit. Objectives. To examine the clinical trial evidence supporting new targeted cancer drugs' initial and supplementary indication approval in the US, EU, Canada, and Australia. Data and Methods. 25 cancer drugs across 100 indications were identified with FDA approval between 2009–2019. Data on regulatory approval and clinical trials were extracted from the FDA, European Medicines Agency (EMA), Health Canada (HC), Australian Therapeutic Goods Administration (TGA), and clinicaltrials.gov. Regional variations were compared with χ2-tests. Multivariate logistic regressions compared characteristics of initial and supplementary indication approvals, reporting adjusted odds ratios (AOR) with 95% confidence intervals (CI). Results. Out of 100 considered cancer indications, the FDA approved 96, the EMA 92, HC 86, and the TGA 83 (83%, p < 0.05). The FDA more frequently granted priority review, conditional approval, and orphan designations than other agencies. Initial approvals were more likely to receive conditional / accelerated approval (AOR: 2.69, 95%CI [1.07–6.77], p < 0.05), an orphan designation (AOR: 3.32, 95%CI [1.38–8.00], p < 0.01), be under priority review (AOR: 2.60, 95%CI [1.17–5.78], p < 0.05), and be monotherapies (AOR: 5.91, 95%CI [1.14–30.65], p < 0.05) than supplementary indications. Initial indications' pivotal trials tended to be shorter (AOR per month: 0.96, 95%CI [0.93–0.99], p < 0.05), of lower phase design (AOR per clinical phase: 0.28, 95%CI [0.09–0.85], p < 0.05), and enroll more patients (AOR per 100 patients: 1.19, 95%CI [1.01–1.39], p < 0.05). Conclusions. Targeted cancer drugs are increasingly approved for multiple indications of varying clinical benefit. Drugs are first approved as monotherapies in rare diseases with a high unmet need. Whilst expedited regulatory review incentivizes this prioritization, indication-specific safety, efficacy, and pricing policies are necessary to reflect each indication's differential clinical and economic value. [ABSTRACT FROM AUTHOR]

Background: There is some evidence that corticosteroids may have a beneficial effect in hand osteoarthritis. We examined the efficacy of corticosteroids on symptoms and structural outcomes in hand osteoarthritis.Methods: Ovid MEDLINE, Embase and Cochrane Central Register of Controlled Trials were searched from inception to October 2021 for randomized controlled trials investigating the efficacy of corticosteroids in hand osteoarthritis. Two authors independently screened records, extracted data, and assessed risk of bias using the RoB 2 tool. Standardized mean difference (SMD) or mean difference (MD) was calculated, and random-effects meta-analyses were performed.Results: Of 13 included trials, 3 examined oral corticosteroids and clinical outcomes in any hand joints, 9 examined intra-articular injection of corticosteroids and clinical outcomes at the first carpometacarpal joint and one in the interphalangeal joints. In meta-analysis, oral corticosteroids reduced pain (SMD -0.53, 95% CI -0.79 to -0.28) and improved stiffness (MD -5.03, 95% CI -9.91 to -0.15; Australian Canadian Osteoarthritis Hand Index stiffness subscale) and function (SMD -0.37, 95% CI -0.63 to -0.12) at 4-6 weeks. However, there was no significant persistent effect on pain and function at 3 months which was 6-8 weeks after study medication was stopped. There was no significant effect of intra-articular corticosteroids on pain or function at 4-6 weeks or over 3-12 months in first carpometacarpal osteoarthritis. Two trials evaluated joint structure at 4-6 weeks: one study showed oral corticosteroids reduced synovial thickening, neither showed an effect on synovitis.Conclusions: There was low-certainty evidence for a medium effect of oral corticosteroids on pain relief and stiffness improvement and small-to-medium effect on functional improvement at 4-6 weeks, with no significant effect for intra-articular corticosteroids. Corticosteroids had no significant effect on any outcomes over longer term (3-12 months) off treatment. No trials examined the effect of corticosteroids on disease progression. The role of corticosteroids in hand osteoarthritis is limited. [ABSTRACT FROM AUTHOR]

The article presents a study on non-clinical interventions that help increase the success rate of vaginal birth after caesarean section. Vaginal birth after caesarean section in a subsequent pregnancy reportedly poses the risk of uterine rupture. Non-clinical interventions may reportedly have a significant impact on the success of vaginal birth after caesarean section. These interventions include national and local guidelines, individualized information, and feedback on mode of birth rates.

Clinical trials for the treatment of schizophrenia now often include cognitive assessments in addition to clinical ratings of symptoms. Recently, these trials have included cross-national assessments. It is not clear if translated psychological tests produce consistent results across different languages. This paper presents the results of a study of the comparability of the results of cognitive assessments in different English-speaking countries and a number of countries where tests were translated into other languages. Performance on tests of executive functioning, verbal and visuo-spatial learning and memory, language skills, psychomotor speed, and vigilance was compared across the first episode patients with schizophrenia (n=301) assessed in six different languages (English, French, Finnish, German, Hebrew, and Afrikaans), including two different countries where patients were assessed in English and other languages: Canada (French) and South Africa (Afrikaans). The variance in performance across the sites tested in English was as large as the variance between English and non-English speakers when all tests were considered. Performance differences across English and other languages were found only for executive functions, vigilance, and psychomotor speed, with executive functioning differences nonsignificant when education was considered. No differences were found between English and non-English speakers in Canada. These results suggest that the translation of tests of memory and verbal skills can lead to consistent results across translated versions of the tests. Differences between countries were greater than differences between languages, suggesting the need to consider representativeness of patient samples in terms of local educational attainment. In general, these data support the validity of cross-national neuropsychological assessments. [Copyright &y& Elsevier]

Background and Aims: Past research has found that young smokers are more likely to make quit attempts; however, there are conflicting findings regarding age and quit success. This study examined the degree to which smoker age is related to making quit attempts and quit success. Design Ten waves of the International Tobacco Control Policy Cohort survey (ITC‐4C) collected between 2002 and 2014, with nine wave‐to‐wave transitions with predictors at the first wave predicting quit attempts and success by the next wave. Setting: Canada, the United States, the United Kingdom and Australia. Participants: Data from 15 874 smokers categorized into four age groups at baseline (18–24, 25–39, 40–54 and 55+ years). Measurements Age, quit attempts and success (defined as ≥ 30 days abstinence confirmed, if possible, on a third wave for recent attempts). Findings Older smokers were more likely to smoke daily (χ2 = 1557.86, r = 0.136, P < 0.001) than younger smokers. Daily smokers were less likely to report quit attempts (38.1 versus 58.2%) and to achieve 30 days of abstinence (22.9 versus 34.3%) than non‐daily smokers. Older daily smokers were less likely to make quit attempts [0.61, confidence interval (CI) = 0.54–0.70, P < 0.001], even after controlling for indicators of nicotine dependence, country, sex, education, income, relationship status and household composition, than younger smokers. Younger smokers (< 25) were more likely to succeed for at least 30 days of abstinence, but only when compared with those aged 40–54 (OR = 0.83, 95% CI = 0.68–0.99). However, when controlling for heaviness of smoking the age effect disappeared. Significant interactions with age were found between age and intention when predicting quit attempts, and age and heaviness of smoking when predicting quit success. Conclusions: An international cohort study indicates that young smokers are more likely to attempt to quit and appear to have similar levels of success in abstaining from smoking compared with older smokers when controlling for dependence. Quit success in all ages is most predicted by lower levels of nicotine dependence. [ABSTRACT FROM AUTHOR]

A conference organized by the Royal Society of Medicine Foundation was attended by 37 participants from Canada, the United Kingdom, the United States, and Australia. The discussants reviewed eight precirculated papers and concluded that society's concerns about the provision, availability, and costs of health care warranted re-examination of the assumptions and priorities of medical education. To reorient medical education to the actual and perceived health care needs of the population, specific recommendations were developed in five areas that integrate the patient, physician, and population perspectives on medical education: the medical school's goals and objectives, faculty development, undergraduate and postgraduate education, educational resources, and health intelligence. The participants also devised implementation strategies. [ABSTRACT FROM AUTHOR]

Objective: To explore differences in position emission tomography-computed tomography (PET-CT) service provision internationally to further understand the impact variation may have upon cancer services. To identify areas of further exploration for researchers and policymakers to optimize PET-CT services and improve the quality of cancer services.Design: Comparative analysis using data based on pre-defined PET-CT service metrics from PET-CT stakeholders across seven countries. This was further informed via document analysis of clinical indication guidance and expert consensus through round-table discussions of relevant PET-CT stakeholders. Descriptive comparative analyses were produced on use, capacity and indication guidance for PET-CT services between jurisdictions.Setting: PET-CT services across 21 jurisdictions in seven countries (Australia, Denmark, Canada, Ireland, New Zealand, Norway and the UK).Participants: None.Intervention(s): None.Main Outcome Measure(s): None.Results: PET-CT service provision has grown over the period 2006-2017, but scale of increase in capacity and demand is variable. Clinical indication guidance varied across countries, particularly for small-cell lung cancer staging and the specific acknowledgement of gastric cancer within oesophagogastric cancers. There is limited and inconsistent data capture, coding, accessibility and availability of PET-CT activity across countries studied.Conclusions: Variation in PET-CT scanner quantity, acquisition over time and guidance upon use exists internationally. There is a lack of routinely captured and accessible PET-CT data across the International Cancer Benchmarking Partnership countries due to inconsistent data definitions, data linkage issues, uncertain coverage of data and lack of specific coding. This is a barrier in improving the quality of PET-CT services globally. There needs to be greater, richer data capture of diagnostic and staging tools to facilitate learning of best practice and optimize cancer services. [ABSTRACT FROM AUTHOR]

Efforts to combat continuing gender inequalities in academia need to be informed by evidence about where differences occur. Citations are relevant as potential evidence in appointment and promotion decisions, but it is unclear whether there have been historical gender differences in average citation impact that might explain the current shortfall of senior female academics. This study investigates the evolution of gender differences in citation impact 1996–2018 for six million articles from seven large English‐speaking nations: Australia, Canada, Ireland, Jamaica, New Zealand, UK, and the USA. The results show that a small female citation advantage has been the norm over time for all these countries except the USA, where there has been no practical difference. The female citation advantage is largest, and statistically significant in most years, for Australia and the UK. This suggests that any academic bias against citing female‐authored research cannot explain current employment inequalities. Nevertheless, comparisons using recent citation data, or avoiding it altogether, during appointments or promotion may disadvantage females in some countries by underestimating the likely greater impact of their work, especially in the long term. [ABSTRACT FROM AUTHOR]

Background: Implementation theories, models and frameworks offer guidance when implementing and sustaining healthcare evidence-based interventions. However, selection can be challenging given the myriad of potential options. We propose to inform a decision support tool to facilitate the appropriate selection of an implementation theory, model or framework in practice. To inform tool development, this study aimed to explore barriers and facilitators to identifying and selecting implementation theories, models and frameworks in research and practice, as well as end-user preferences for features and functions of the proposed tool.Methods: We used an interpretive descriptive approach to conduct semi-structured interviews with implementation researchers and practitioners in Canada, the United States and Australia. Audio recordings were transcribed verbatim. Data were inductively coded by a single investigator with a subset of 20% coded independently by a second investigator and analyzed using thematic analysis.Results: Twenty-four individuals participated in the study. Categories of barriers/facilitators, to inform tool development, included characteristics of the individual or team conducting implementation and characteristics of the implementation theory, model or framework. Major barriers to selection included inconsistent terminology, poor fit with the implementation context and limited knowledge about and training in existing theories, models and frameworks. Major facilitators to selection included the importance of clear and concise language and evidence that the theory, model or framework was applied in a relevant health setting or context. Participants were enthusiastic about the development of a decision support tool that is user-friendly, accessible and practical. Preferences for tool features included key questions about the implementation intervention or project (e.g., purpose, stage of implementation, intended target for change) and a comprehensive list of relevant theories, models and frameworks to choose from along with a glossary of terms and the contexts in which they were applied.Conclusions: An easy to use decision support tool that addresses key barriers to selecting an implementation theory, model or framework in practice may be beneficial to individuals who facilitate implementation practice activities. Findings on end-user preferences for tool features and functions will inform tool development and design through a user-centered approach. [ABSTRACT FROM AUTHOR]

Context: The use of registries to Coronary Artery Disease (CAD) data management plays an important role in the improvement of healthcare processes and reduction of outcomes for patients and healthcare providers. The present study aimed to compare the data management processes of CAD registries in the selected countries. Evidence Acquisition: This review study was conducted comparatively in 2019. After selecting countries based on some criteria, the required data were collected by searching valid databases, more useful search engines, and related websites to CAD registries for the selected countries as well as by sending E-mails containing a data extraction form to the related organizations. Results: Totally, five registries were chosen in the selected countries as follows: CADOSA (Australia), APPROACH (Canada), START (Italy), CLARIFY (Spain), and GWTG-CAD (US). The results showed that 60% of the selected registries made use of the electronic case report form for data gathering. The main data elements included demographic and general information, risk factors, vital sings, medication, laboratory tests results, examination results, ECG results, invasive measures and interventions, patient's status on discharge, results of follow-ups, and post-discharge outcomes. Conclusion: Developing CAD registries based on the data management principles provides the context to conduct cohort studies with very low costs. With regard to the study results, attention should be paid to data management processes, include data gathering, data processing, and information distribution, in development of CAD registries. [ABSTRACT FROM AUTHOR]

A scoping review of published literature and dialogue with international nurse practitioner educators and researchers revealed the education of nurse practitioner students varied within and between countries. This lack of cohesiveness hinders nurse practitioner role development and practice nationally and internationally. A rapid review of grey literature was conducted on nurse practitioner education standards in six countries (Australia, Canada, Finland, Norway, the Netherlands, and USA). Data were extracted from graduate level nurse practitioner education programs' websites from each country (n = 24). Extracted data were verified for accuracy and completeness with a nurse practitioner educator from each program. Data were analyzed using content analysis. Variations in nurse practitioner education within and between countries were explored by comparing admission criteria, curricular content, clinical requirements, teaching methods, and assignment and evaluative methods. The findings will help inform education programs and further research about nurse practitioner education internationally. [ABSTRACT FROM AUTHOR]

Background: Family caregivers of people at the end of life can face significant financial burden. While appropriate financial support can reduce the burden for family caregivers, little is known about the range and adequacy of financial support, welfare and benefits for family caregivers across countries with similarly developed health care systems. Aim: The aim is o identify and compare sources of financial support for family caregivers of people approaching the end of life, across six countries with similarly performing health care systems (Australia, Canada, Ireland, New Zealand, the United Kingdom and the United States). Design: A survey of financial support, welfare and benefits for end of life family caregivers was completed by 99 palliative care experts from the six countries. Grey literature searches and academic database searches were also conducted. Comparative analyses of all data sources documented financial support within and between each country. Results: Some form of financial support for family caregivers is available in all six countries; however the type, extent and reach of support vary. Financial support is administered by multiple agencies, eligibility criteria for receiving support are numerous and complex, and there is considerable inequity in the provision of support. Conclusion: Numerous barriers exist to the receipt of financial support, welfare and benefits. We identified several areas of concern, including a lack of clarity around eligibility, inconsistent implementation, complexity in process and limited support for working carers. Nonetheless, there is significant potential for policymakers to learn from other countries' experiences, particularly with regard to the scope and operationalisation of financial support. [ABSTRACT FROM AUTHOR]

We examine data from Australia, Canada, and the United States to assess the potential for immigrant screening policies to influence the labor market performance of skilled immigrants. Our estimates point to improvements in employment rates and weekly earnings of male university-educated immigrants in all three countries concomitant with policy reforms. Nonetheless, the gains are modest in comparison to a substantial and persistent performance advantage of US skilled immigrants. Given that there is increasingly little to distinguish the screening policies of these countries, we interpret the US advantage as primarily reflecting the relative positive self-selectivity of US immigrants. [ABSTRACT FROM AUTHOR]

Objective: To compare the nutritional content, serving size and taxation potential of supermarket beverages from four different Western countries.Design: Cross-sectional analysis. Multivariate regression analysis and χ 2 comparisons were used to detect differences between countries.Setting: Supermarkets in New Zealand (NZ), Australia, Canada and the UK.Subjects: Supermarket beverages in the following categories: fruit juices, fruit-based drinks, carbonated soda, waters and sports/energy drinks.Results: A total of 4157 products were analysed, including 749 from NZ, 1738 from Australia, 740 from Canada and 930 from the UK. NZ had the highest percentage of beverages with sugar added to them (52 %), while the UK had the lowest (39 %, P<0.001).Conclusions: There is substantial difference between countries in the mean energy, serving size and proportion of products eligible for fiscal sugar taxation. Current self-regulatory approaches used in these countries may not be effective to reduce the availability, marketing and consumption of sugar-sweetened beverages and subsequent intake of free sugars. [ABSTRACT FROM AUTHOR]

Introduction: The International Cancer Benchmarking Partnership (ICBP) identified significant international differences in lung cancer survival. Differing levels of comorbid disease across ICBP countries has been suggested as a potential explanation of this variation but, to date, no studies have quantified its impact. This study investigated whether comparable, robust comorbidity scores can be derived from the different routine population-based cancer data sets available in the ICBP jurisdictions and, if so, use them to quantify international variation in comorbidity and determine its influence on outcome.Methods: Linked population-based lung cancer registry and hospital discharge data sets were acquired from nine ICBP jurisdictions in Australia, Canada, Norway and the UK providing a study population of 233 981 individuals. For each person in this cohort Charlson, Elixhauser and inpatient bed day Comorbidity Scores were derived relating to the 4-36 months prior to their lung cancer diagnosis. The scores were then compared to assess their validity and feasibility of use in international survival comparisons.Results: It was feasible to generate the three comorbidity scores for each jurisdiction, which were found to have good content, face and concurrent validity. Predictive validity was limited and there was evidence that the reliability was questionable.Conclusion: The results presented here indicate that interjurisdictional comparability of recorded comorbidity was limited due to probable differences in coding and hospital admission practices in each area. Before the contribution of comorbidity on international differences in cancer survival can be investigated an internationally harmonised comorbidity index is required. [ABSTRACT FROM AUTHOR]

Objective: Fear of cancer recurrence (FCR) is a common concern among cancer survivors. Identifying survivors with clinically significant FCR requires validated screening measures and clinical cut-offs. We evaluated the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) clinical cut-off in 2 samples.Methods: Level of FCR in study 1 participants (from an Australian randomized controlled trial: ConquerFear) was compared with FCRI-SF scores. Based on a biopsychosocial interview, clinicians rated participants as having nonclinical, subclinical, or clinical FCR. Study 2 participants (from a Canadian FCRI-English validation study) were classified as having clinical or nonclinical FCR by using the semistructured clinical interview for FCR (SIFCR). Receiver operating characteristic analyses evaluated the screening ability of the FCRI-SF against clinician ratings (study 1) and the SIFCR (study 2).Results: In study 1, 167 cancer survivors (mean age: 53 years, SD = 10.1) participated. Clinicians rated 43% as having clinical FCR. In study 2, 40 cancer survivors (mean age: 68 years, SD = 7.0) participated; 25% met criteria for clinical FCR according to the SIFCR. For both studies 1 and 2, receiver operating characteristic analyses suggested a cut-off ≥22 on the FCRI-SF identified cancer survivors with clinical levels of FCR with adequate sensitivity and specificity.Conclusions: Establishing clinical cut-offs on FCR screening measures is crucial to tailoring individual care and conducting rigorous research. Our results suggest using a higher cut-off on the FCRI-SF than previously reported to identify clinically significant FCR. Continued evaluation and validation of the FCRI-SF cut-off is required across diverse cancer populations. [ABSTRACT FROM AUTHOR]

Little is known about the types of work accommodations and natural supports that are useful for people experiencing severe mental illness working in social businesses. We conducted an exploratory, descriptive and cross-sectional investigation in Australia, Canada and Italy to study the nature of work accommodations and natural supports available in social businesses. Study findings are drawn from survey responses of a convenience sample of 90 employees with self-reported psychiatric disabilities. Results showed that, regardless of the country, social businesses provide many work accommodations and natural supports, especially those linked to schedule flexibility and support, while work accommodations related to training and schedule flexibility were linked to longer job tenure. Overall, this study advances our knowledge about the spectrum of work accommodations and natural supports that are available in social businesses for people with severe mental illness. Also, it highlights the type of work accommodations that are likely to support this population to sustain employment. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the face validity of a measure of therapeutic alliance for paediatric speech–language pathology and to determine whether a difference exists in therapeutic alliance reported by speech–language pathologists (SLPs) conducting face-to-face sessions, compared with telepractice SLPs or in their ratings of confidence with technology. Method: SLPs conducting telepractice (n = 14) or face-to-face therapy (n = 18) completed an online survey which included the Therapeutic Alliance Scales for Children – Revised (TASC-r) (Therapist Form) to rate clinicians’ perceptions of rapport with up to three clients. Participants also reported their overall perception of rapport with each client and their comfort with technology. Result: There was a strong correlation between TASC-r total scores and overall ratings of rapport, providing preliminary evidence of TASC-r face validity. There was no significant difference between TASC-r scores for telepractice and face-to-face therapy (p = 0.961), nor face-to-face and telepractice SLPs’ confidence with familiar (p = 0.414) or unfamiliar technology (p = 0.780). Conclusion: The TASC-r may be a promising tool for measuring therapeutic alliance in speech–language pathology. Telepractice does not appear to have a negative effect on rapport between SLPs and paediatric clients. Future research is required to identify how SLPs develop rapport in telepractice. [ABSTRACT FROM PUBLISHER]

Introduction: Brenzys was developed as an etanercept biosimilar of Enbrel. The aim of this study was to assess preference and perceived ease of use for the new Brenzys autoinjector compared to the currently available marketed Enbrel MYCLIC autoinjector (Australia) and Enbrel SureClick autoinjector (Canada) for the treatment of rheumatoid arthritis (RA). Because RA affects manual dexterity, ease of use of an autoinjector is a particularly important consideration in developing effective self-delivery of long-term courses of therapy.Methods: Patients (N = 191) reporting a diagnosis of RA and nurses and rheumatologists (N = 90) with experience managing RA were shown how to use Brenzys and Enbrel autoinjectors (in counterbalanced order between participants), then they used each autoinjector by injecting into a pad simulating skin, and completed a questionnaire. Study sessions took place in Australia and Canada.Results: A binomial test showed that significantly more patients indicated that the Brenzys autoinjector was easier to use than the Enbrel autoinjector (79% reporting Brenzys easier to use; p < 0.001, two-sided, 95% CI [73%, 85%]). In addition, significantly more nurses and rheumatologists with experience managing RA also indicated that the Brenzys autoinjector was easier to use (86%; p < 0.001, two-sided, 95% CI [77%, 92%) and that they would recommend the buttonless Brenzys autoinjector over the Enbrel autoinjector to patients (83%; p < 0.001, two-sided, 95% CI [74%, 90%]). Almost all patients who reported past experience using an Enbrel autoinjector (N = 17) reported on the basis of using the two devices in the study that they would prefer to switch their device to the Brenzys autoinjector rather than continue their course of therapy using the Enbrel autoinjector (16/17, 94%, 95% CI [71%, 100%]).Conclusion: On the basis of the study results, the Brenzys autoinjector was rated statistically significantly easier to use, and was overall preferred by patients and healthcare professionals with experience managing RA patients.Funding: Merck & Co., Inc. [ABSTRACT FROM AUTHOR]

There is extensive health and public health literature on the 'evidence-policy gap', exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems.We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy.We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda - should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise 'evidence-based' policymaking above other factors? The latter includes governance principles such the 'co-production' of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence.We conclude that successful engagement in 'evidence-based policymaking' requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions and familiarity with information; learn 'where the action is', and be prepared to engage in long-term strategies to be able to influence policy; and, in both cases, decide how far you are willing to go to persuade policymakers to act and secure a hierarchy of evidence underpinning policy. These are value-driven and political, not just 'evidence-based', choices. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare services in Australia, Canada, New Zealand and the United States have embraced the concept of family-centred care as a promising approach to supporting and caring for the health of young Indigenous children and their families. This scoping review assesses the quality of the evidence base and identifies the published literature on family- centred interventions for Indigenous early childhood wellbeing.Methods: Fourteen electronic databases, grey literature sources and the reference lists of Indigenous maternal and child health reviews were searched to identify relevant publications from 2000 to 2015. Studies were included if the intervention was: 1) focussed on Indigenous children aged from conception to 5 years from the abovementioned countries; 2) led by a primary healthcare service; 3) described or evaluated; and 4) scored greater than 50% against a validated scale for family-centredness. The study characteristics were extracted and quality rated. Reported aims, strategies, enablers and outcomes of family-centredcare were identified using grounded theory methods.Results: Eighteen studies (reported in 25 publications) were included. Three were randomised controlled studies; most were qualitative and exploratory in design. More than half of the publications were published from 2012 to 2015. The overarching aim of interventions was to promote healthy families. Six key strategies were to: support family behaviours and self- care, increase maternal knowledge, strengthen links with the clinic, build the Indigenous workforce, promote cultural/ community connectedness and advocate for social determinants of health. Four enablers were: competent and compassionate program deliverers, flexibility of access, continuity and integration of healthcare, and culturally supportive care. Health outcomes were reported for Indigenous children (nutritional status; emotional/behavioural; and prevention of injury and illness); parents/caregivers (depression and substance abuse; and parenting knowledge, confidence and skills); health services (satisfaction; access, utilization and cost) and community/cultural revitalisation.Discussion and Conclusion: The evidence for family-centred interventions is in the early stages of development, but suggests promise for generating diverse healthcare outcomes for Indigenous children and their parents/caregivers, as well as satisfaction with and utilisation of healthcare, and community/cultural revitalisation. Further research pertaining to the role of fathers in family-centred care, and the effects and costs of interventions is needed. [ABSTRACT FROM AUTHOR]

Although we do know that out-of-pocket healthcare expenditure is relatively high in Australia, little is known about what health conditions are associated with the highest out-of-pocket expenditure, and whether the cost of healthcare acts as a barrier to care for people with different chronic conditions. Cross-sectional analysis using linear and logistic regression models applied to the Commonwealth Fund international health policy survey of adults aged 18 years and over was conducted in 2013. Adults with asthma, emphysema and chronic obstructive pulmonary disease (COPD) had 109% higher household out-of-pocket healthcare expenditure than did those with no health condition (95% CI: 50-193%); and adults with depression, anxiety and other mental health conditions had 95% higher household out-of-pocket expenditure (95% CI: 33-187%). People with a chronic condition were also more likely to forego care because of cost. People with depression, anxiety and other mental health conditions had 7.65 times higher odds of skipping healthcare (95% CI: 4.13-14.20), and people with asthma, emphysema and chronic obstructive pulmonary disease had 6.16 times higher odds of skipping healthcare (95% CI: 3.30-11.50) than did people with no health condition. People with chronic health conditions in Canada, the United Kingdom, Germany, France, Norway, Sweden and Switzerland were all significantly less likely to skip healthcare because of cost than were people with a condition in Australia. The out-of-pocket cost of healthcare in Australia acts as a barrier to accessing treatment for people with chronic health conditions, with people with mental health conditions being likely to skip care. Attention should be given to the accessibility and affordability of mental health services in Australia. [ABSTRACT FROM AUTHOR]

When investigating the association between brain tumors and use of mobile telephones, accurate data on tumor position are essential, due to the highly localized absorption of energy in the human brain from the radio-frequency fields emitted. We used a point process model to investigate this association using information that included tumor localization data from the INTERPHONE Study (Australia, Canada, Denmark, Finland, France, Germany, Israel, Italy, Japan, New Zealand, Norway, Sweden, and the United Kingdom). Our main analysis included 792 regular mobile phone users diagnosed with a glioma between 2000 and 2004. Similar to earlier results, we found a statistically significant association between the intracranial distribution of gliomas and the self-reported location of the phone. When we accounted for the preferred side of the head not being exclusively used for all mobile phone calls, the results were similar. The association was independent of the cumulative call time and cumulative number of calls. However, our model used reported side of mobile phone use, which is potentially influenced by recall bias. The point process method provides an alternative to previously used epidemiologic research designs when one is including localization in the investigation of brain tumors and mobile phone use. [ABSTRACT FROM AUTHOR]

Aim Much research on attitudes towards older adults has used younger adults as participants and identified a range of negative attitudes towards older persons. Comparatively little literature has explored the attitudes of older adults themselves towards their own age cohort. Methods The present study explicitly compared attitudes towards other older adults from samples of 195 older adults in Australia and 172 older Canadians. Attitudinal measures included the Aging Attitudes Questionnaire (assesses older adults' attitudes toward other older adults), Fraboni Scale of Ageism (assesses younger adults' attitudes toward older adults) and the Reactions to Aging Questionnaire (assesses attitudes toward one's own aging), as well as a scale measuring knowledge of aging, the Facts on Aging Quiz, adapted for Australia and Canada. Responses on the three attitudinal measures were subjected to principal components analysis. Results Two components emerged in both samples, one defined by the Reactions to Aging Questionnaire and Aging Attitudes Questionnaire scales and the second by the Fraboni Scale of Ageism scales. Regression analyses to ascertain prediction of scores on the Facts on Aging Quiz, adapted for Australia and Facts on Aging Quiz, adapted for Canada showed that only the Aging Attitudes Questionnaire scale for Physical Changes predicted scores on the Facts on Aging Quiz, adapted for Australia and no attitudes predicted Facts on Aging Quiz, adapted for Canada scores. Conclusions It appears that older adults distinguish between their own aging and aging in others. Knowledge of aging appears to be predicted only by attitudes toward physical changes. Given increasing proportions of older adults in the population, as well as increasing access to aging information available to older cohorts, continued research on how older adults view themselves and the aging process is important, and will almost certainly continue to evolve over time. Geriatr Gerontol Int 2016; 16: 1226-1230. [ABSTRACT FROM AUTHOR]

Aims To determine whether abstinence or relapse on a quit attempt in the previous year is associated with current depressive symptoms. Design Prospective cohort with approximately annual waves. Mixed-effect logistic regressions tested whether time 2 (T2) quitting status was associated with reporting symptoms at T2, and whether time 1 (T1) symptoms moderated this relationship. Setting Waves 5-8 of the Four-Country International Tobacco Control Study: a quasi-experimental cohort study of smokers from Canada, the United States, the United Kingdom and Australia. Participants A total of 6978 smokers who participated in telephone surveys. Measurements T1 and T2 depressive symptoms in the last 4 weeks were assessed with two screening items from the PRIME-MD questionnaire. Quitting status at T2: (1) no attempt since T1; (2) attempted and relapsed; and (3) attempted and abstinent at T2. Findings Compared with no attempt, relapse was associated with reporting T2 symptoms [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.33, 1.59]). Associations between T2 quitting status and T2 symptoms were moderated by T1 symptoms. Relapse was associated positively with T2 symptoms for those without T1 symptoms (OR = 1.71, 95% CI = 1.45, 2.03) and those with T1 symptoms (OR = 1.45, 95% CI = 1.23, 1.70). Abstinence was associated positively for those without T1 symptoms (OR = 1.37, 95% CI = 1.10, 1.71) and negatively for those with T1 symptoms (OR = 0.74, 95% CI = 0.59, 0.94). Age moderated these associations significantly. Relapse did not predict T2 symptoms for those aged 18-39 irrespective of T1 symptoms. The negative effect of abstinence on T2 symptoms for those with T1 symptoms was significant only for those aged 18-39 (OR = 0.61, 95% CI = 0.40, 0.94) and 40-55 (OR = 0.58, 95% CI = 0.40, 0.84). The positive effect of abstinence on T2 symptoms for those without T1 symptoms was significant only for those aged more than 55 (OR =1.97, 95% CI = 1.35, 2.87). Conclusions Most people who stop smoking appear to be at no greater risk of developing symptoms of depression than if they had continued smoking. However, people aged more than 55 who stop smoking may be at greater risk of developing symptoms of depression than if they had continued smoking. [ABSTRACT FROM AUTHOR]

Objective: To assess the mean package size and manufacturer-recommended serving size of sweet beverages available in four high-income countries: Australia, Canada, the Netherlands and New Zealand.Design: Cross-sectional surveys.Setting: The two largest supermarket chains of each country in 2012/2013.Subjects: Individual pack size (IPS) drinks (n 891) and bulk pack size (BPS) drinks (n 1904).Results: For all IPS drinks, the mean package size was larger than the mean serving size (mean (sd)=412 (157) ml and 359 (159) ml, respectively). The mean (sd) package size of IPS drinks was significantly different for all countries (range: Australia=370 (149) ml to New Zealand=484 (191) ml; P<0·01). The mean (sd) package size of Dutch BPS drinks (1313 (323) ml) was significantly smaller compared with the other countries (New Zealand=1481 (595) ml, Australia=1542 (595) ml, Canada=1550 (434) ml; P<0·01). The mean (sd) serving size of BPS drinks was significantly different across all countries (range: Netherlands=216 (30) ml to Canada=248 (31) ml; P<0·00). New Zealand had the largest package and serving sizes of the countries assessed. In all countries, a large number of different serving sizes were used to provide information on the amount appropriate to consume in one sitting.Conclusions: At this point there is substantial inconsistency in package sizes and manufacturer-recommended serving sizes of sweet beverages within and between four high-income countries, especially for IPS drinks. As consumers do factor serving size into their judgements of healthiness of a product, serving size regulations, preferably set by governments and global health organisations, would provide consistency and assist individuals in making healthier food choices. [ABSTRACT FROM AUTHOR]

Background: The issue of home care for older people is concerned with availability of information. Aim: To compare delivery of electronic health record (EHR) in home care for older people. Methods: An applied-comparative library study was conducted in 2015. The study population included Canada, Australia, England, Denmark and Taiwan. Data were extracted from literature related to EHR on home care and older people. Results: The main functions included collection, documentation of lab and imaging results. Common data elements were demographic information, prescriptions and nursing observations. Security needs were identified according to the Personal Information Protection and Electronic Document Act, enacted in Canada and the Privacy Act 1988 in Australia. Conclusions: The basic functions of EHR are determined as collection, documentation and retrieval of information. It is recommended that legislation protects access to information on personal health and implementation of a national unique identifier applicable to shared data. [ABSTRACT FROM AUTHOR]

Background: Admission to the neonatal intensive care unit (NICU) may disrupt parent-infant interaction with adverse consequences for infants and their families. Several family-centered care programs promote parent-infant interaction in the NICU; however, all of these retain the premise that health-care professionals should provide most of the infant's care. Parents play a mainly supportive role in the NICU and continue to feel anxious and unprepared to care for their infant after discharge. In the Family Integrated Care (FICare) model, parents provide all except the most advanced medical care for their infants with support from the medical team. Our hypothesis is that infants whose families complete the FICare program will have greater weight gain and better clinical and parental outcomes compared with infants provided with standard NICU care.Methods/design: FICare is being evaluated in a cluster randomized controlled trial among infants born at ≤ 33 weeks' gestation admitted to 19 Canadian, 6 Australian, and 1 New Zealand tertiary-level NICU. Trial enrollment began in April, 2013, with a target sample size of 675 infants in each arm, to be completed by August, 2015. Participating sites were stratified by country, and by NICU size within Canada, for randomization to either the FICare intervention or control arm. In intervention sites, parents are taught how to provide most of their infant's care and supported by nursing staff, veteran parents, a program coordinator, and education sessions. In control sites standard NICU care is provided. The primary outcome is infants' weight gain at 21 days after enrollment, which will be compared between the FICare and control groups using Student's t-test adjusted for site-level clustering, and multi-level hierarchical models accounting for both clustering and potential confounders. Similar analyses will examine secondary outcomes including breastfeeding, clinical outcomes, safety, parental stress and anxiety, and resource use. The trial was designed, is being conducted, and will be reported according to the CONSORT 2010 guidelines for cluster randomized controlled trials.Discussion: By evaluating the impact of integrating parents into the care of their infant in the NICU, this trial may transform the delivery of neonatal care.Trial Registration: NCT01852695 , registered December 19, 2012. [ABSTRACT FROM AUTHOR]

Aim: Isolated oesophageal perforation in neonates is a rare but potentially life-threatening condition. Although management has historically been operative, conservative management (antibiotics, bowel rest, parenteral nutrition) is now more routinely used. The aim of this study was to evaluate the management of this condition in two large neonatal surgical centres.Methods: A retrospective cohort study was conducted for neonates admitted to The Hospital for Sick Children (Toronto, Canada) or The Royal Children's Hospital (Melbourne, Australia) with a diagnosis of oesophageal perforation, from 2006 to 2016. Patients with oesophageal atresia or tracheo-oesophageal fistula were excluded. Data were collected from chart review regarding demographics, clinical course, management and outcomes.Results: Eleven neonates with oesophageal perforation were identified over a 10-year period at the two centres. Median gestational age at birth was 25.3 weeks (interquartile range 24.2-28.8) and the majority (7/11, 64%) of neonates were extremely low birthweight. Diagnosis was made on day 1 of life for 9 of 11 (81%) neonates and was secondary to nasogastric tube insertion in 10 of 11 (91%) neonates. Only four (36%) neonates had symptomatic complications. All neonates were managed with bowel rest and intravenous antibiotics for a median of 7 days (interquartile range 7-10); two patients required operative intervention. Three neonates (27%) developed chronic lung disease and two (19%) died prior to discharge.Conclusions: Oesophageal perforation is severe complication secondary to instrumentation of the upper gastrointestinal tract in neonates. Prompt and accurate diagnosis is crucial. Non-operative management is effective for the majority, though morbidity is common. [ABSTRACT FROM AUTHOR]

Background: The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries.Methods: We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys.Results: Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50-69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries.Conclusions: Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese. [ABSTRACT FROM AUTHOR]