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This article offers a global overview of the burgeoning field of micro-credentials and their relationship to lifelong learning, employability and new models of digital education. Although there is no globally accepted definition of micro-credentials, the term indicates smaller units of study, which are usually shorter than traditional forms of accredited learning and courses leading to conventional qualifications such as degrees. The paper aims to provide educators with a helicopter view of the rapidly evolving global micro-credential landscape, with particular relevance to higher education leaders, industry stakeholders and government policy-makers. It addresses five questions: (i) What are micro-credentials? (ii) Why micro-credentials? (iii) Who are the key stakeholders? (iv) What is happening globally? and (v) What are some of the key takeaways? Drawing on a European-wide perspective and recent developments in The Republic of Ireland, the paper concludes that micro-credentials are likely to become a more established and mature feature of the 21st-century credential ecology over the next five years. While the global micro-credential landscape is currently disconnected across national boundaries, more clarity and coherence will emerge as governments around the world increasingly align new credentialing developments with existing national qualification frameworks. The micro-credentialing movement also provides opportunities for governments and higher education institutions in partnership with industry to harness new digital learning models beyond the pandemic.

This rapid systematic review aims to examine emerging evidence on the effects of COVID-19 on educational institutions and assess the prevalence of e-learning changes in the sector. This paper reviews literature on learning, teaching, and assessment approaches adopted since the COVID-19 outbreak, and assesses the impact on the sector, staff, and students, summarizing findings from peer-reviewed articles. It categorizes these into five key themes: (1) digital learning; (2) e-learning challenges; (3) digital transition to emergency virtual assessment (EVA); (4) psychological impact of COVID-19; and (5) creating collaborative cultures. This represents the first systematic review of COVID-19's impact on education, clarifying current themes being investigated. The author suggests that the term 'emergency virtual assessment' (EVA) is now added for future research discussion. Finally, the paper identifies research gaps, including researching the impact on lesser developed countries, the psychological impact of transition, and the important role of leadership and leadership styles during the transition and handling of the pandemic.

Many children with developmental language disorder (DLD) have emotion recognition and regulation difficulties, but there are currently no known interventions enhancing emotional awareness in this population. This study explores the impact of parents' perspectives regarding children with DLD emotional understanding through a parent-led online emotion recognition (ER) intervention. Ten parents of children with DLD aged 6–11 participated in the study. A nonconcurrent multiple baseline design was employed, allowing for a rigorous analysis of changes in parental beliefs over time. Weekly data were collected through the Parents' Beliefs About Children's Emotions Questionnaire. Interviews were also conducted to gain deeper insights into parents' perceptions regarding the ER skills of their children. Results indicated that parents' beliefs about the need for guiding and supporting their child's ER skills increased over the intervention. Interviews also supported this, and three main themes were generated. The intervention program increased parents' awareness of (a) the importance of ER for children with DLD, (b) emotion-focused communication and engagement with their child, and (c) the integration of emotions into daily life. This study is the first known study that explores parents' beliefs about children with DLD ER skills, highlighting the importance of supporting parents through accessible interventions. [ABSTRACT FROM AUTHOR]

This specially themed ""Getting of Wisdom," Learning in Later Life" Edition of the "Australian Journal of Adult Learning" ("AJAL") is not so much concerned with the issue of ageing itself, but more about quality of life regardless of age. It is about taking, but also giving back as best as possible at any age. This special issue is a result of the one week "The Getting of Wisdom Exchange", a collaboration between around 100 adult education practitioners and researchers from ten countries from Australia, New Zealand, Asia and Europe. In this issue, papers are presented from Sweden, Ireland, Aotearoa/New Zealand, Australia, Slovenia, Poland, Germany, Portugal and the United Kingdom. Papers cover different topics and open questions about various issues in older people's learning.

Abstract As institutions established to administer the penal exile of British imperial subjects, the historic gaols of Australia and Ireland are linked by a painful legacy of involuntary transportation. Today, outstanding examples of these prisons are conserved and publicly presented as monuments of national significance. This paper considers material meanings associated with these unusual heritage places. Given their explicit historic association with British imperial power, what role do heritage prisons play in the formation of a postcolonial affiliation or consciousness? This paper will consider how heritage prisons have come to embody the emotive links of longing and belonging forged between the modern nations of Ireland and Australia. [ABSTRACT FROM AUTHOR]

Much has been written about why students engage in academic studies at university, with less attention given to the concept of disengagement. Understanding the risks and factors associated with student disengagement from learning provides opportunities for targeted remediation. The aims of this review were to (i) explore how student disengagement has been conceptualised, (ii) identify factors associated with disengagement, and (iii) identify measureable indicators of disengagement in previous literature. A systematic search was conducted across relevant databases and key websites. Reference lists of included papers were screened for additional publications. Studies and national published survey data were included if they addressed issues pertaining to student disengagement with learning or the academic environment, were in full text and in English. In the 32 papers that met the inclusion criteria, student disengagement was conceptualised as a multi-faceted, complex yet fluid state that has a combination of behavioural, emotional and cognitive domains influenced by intrinsic (psychological factors, low motivation, inadequate preparation for higher education, and unmet or unrealistic expectations) or extrinsic (competing demands, institutional structure and processes, teaching quality and online teaching and learning). A number of measurable indicators of disengagement were synthesised from the literature including those that were self-reported by students and those collected by a number of tertiary institutions. An examination of the conceptualisation, influences and indicators of disengagement could inform intervention programs to ameliorate the consequences of disengagement for students and academic institutions.

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.

While ChatGPT has recently become very popular, AI has a long history and philosophy. This paper intends to explore the promises and pitfalls of the Generative Pre-trained Transformer (GPT) AI and potentially future technologies by adopting a speculative methodology. Speculative future narratives with a specific focus on educational contexts are provided in an attempt to identify emerging themes and discuss their implications for education in the 21st century. Affordances of (using) AI in Education (AIEd) and possible adverse effects are identified and discussed which emerge from the narratives. It is argued that now is the best of times to define human vs AI contribution to education because AI can accomplish more and more educational activities that used to be the prerogative of human educators. Therefore, it is imperative to rethink the respective roles of technology and human educators in education with a future-oriented mindset.

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.

Across the globe, students with disabilities have been increasing in prevalence in higher education settings. In the twenty-first century the struggle to include individuals with disabilities into nursing schools and workplaces continues in different parts of the world. Historically, entry criteria in nursing schools have been based on essential functions, which were primarily designed to be used in the workforce, rather than technical standards for education. In other health professions, such as medicine, this is not necessarily the case. For example, the American Association of Medical Colleges has worked over the past two decades to develop appreciation among medical schools for the need to admit and accommodate students with disabilities. We argue that nursing has not followed suit. This paper presents an integrative literature review, consisting of material from the United States, Ireland, United Kingdom, and Australia, investigating compelling stories, legal mandates, websites, and extant literature looking at essential functions or technical standards as entry criteria for nursing schools. The results show that, when essential functions for employment are used in nursing education, they may be a barrier to entry into that program. The paper concludes with recommendations for well-defined technical standards for nursing schools to be used primarily as entry criteria.

This report shares the findings and lessons learned from an investigation into the economics of disaggregated models for assessing and accrediting informal learners undertaking post secondary education. It presents some key economic and governance challenges for universities to consider in implementing OER assessment and accreditation policies. It also includes discussion of findings from a small-scale survey conducted by two of the authors on perceptions, practices and policies relating to openness in assessment and accreditation in post secondary institutions, with a particular focus on the "OER universitas" (OERu) concept. [This paper was presented at the OpenCourseWare Consortium Global Conference (Ljubljana, Slovenia, April 23-25, 2014).]

In response to the diverse number of child sexual abuse (CSA) prevention programs currently implemented in school contexts, this paper examines key considerations for selecting such initiatives and the multiplicity of understandings required to inform facilitation of contextually relevant prevention curriculum. First, the paper examines concerns about the lack of explicit professional development for educators concerning child protection, and the need to develop understandings about prevention program best practices within pre-service and in-service training. Second, drawing on a systematic review of literature, the paper identifies five key considerations to inform teachers' selection and facilitation of CSA prevention curriculum in school contexts. Third, the paper advances calls by Wurtele (2009) and presents CSA prevention "best practices" overview and "model programs" list for professionals such as teachers. (Contains 1 table.)

Our paper focuses on delineating and scoping international Women's Sheds, a movement that has emerged within the past decade, mainly in Australia, Ireland and the UK. It addresses two main research questions. Firstly, what is the origin, distribution, nature and intent of Women's Sheds internationally to March 2021? Secondly, how might Women's Sheds be located within a typology inclusive of Men's Sheds and a range of community development models? We employed a systematic search via the internet in 2020-21, followed up by attempted email or phone contact to publicly reported Women's Sheds and like organisations internationally. In the process, we created a publicly shareable blog including a database of 122 existing, previously active, developing or planned Women's Sheds and like organisations to 13 March 2021. We identify four nations where self-identified Women's Sheds have operated or commenced within the past decade: Australia (61), the UK (30), Ireland (28) and New Zealand (3), particularly during the five years between 2014 and 2019. The COVID-19 pandemic seriously curtailed this previous momentum and development after March 2020. We identify some similarities but also important differences between Women's and Men's Sheds. We propose a typology that accounts not only for the different ways in which Women's Sheds operate and women participate within their communities but also the different ways in which they locally collaborate (or not) with Men's Sheds in different countries. We conclude that Women's Sheds have largely been created by women in order to claim the shed as a positive female gendered space, in order to create an alternative community of women's hands-on practice. Sheds have operated or commenced within the past decade: Australia (61), the UK (30), Ireland (28) and New Zealand (3), particularly during the five years between 2014 and 2019. The COVID-19 pandemic seriously curtailed this previous momentum and development after March 2020. We identify some similarities but also important differences between Women's and Men's Sheds. We propose a typology that accounts not only for the different ways in which Women's Sheds operate and women participate within their communities but also the different ways in which they locally collaborate (or not) with Men's Sheds in different countries. We conclude that Women's Sheds have largely been created by women in order to claim the shed as a positive female gendered space, in order to create an alternative community of women's hands-on practice.

Education is the core of the factors that improved people for a better lifestyle and increases the level of society' development. Quality education is one of the most vital goals of Sustainable Development Goals (SDGs) due to actualizing these factors. Using relational network data envelopment analysis (DEA), which have three interrelated substages, this current paper computes the educational economy efficiency of the Organisation for Economic Co-operation and Development (OECD) countries bearing in mind the characteristics related to SDGs. The contribution of our study is the use of a novel approach to computing the educational economy efficiency using relational network DEA with GAMS. Even though some interesting differences reveal in the efficiency of the countries, the findings show that countries with high-efficiency scores are clustered around countries like Latvia, Slovenia, and Korea.

Background: A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation. Method: We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents. Findings: One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities. Conclusion: This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care. Plain Language Summary: High-quality health care for women and girls should be provided by health workers who are respectful and caring. Health workers should also work with others as a team and help women and girls make their own decisions about their health care. This approach is called patient-centred care. Female genital mutilation (FGM) is a cultural practice associated with poor health outcomes. Women who have experienced FGM have not always received quality health care. We studied the guidance and tools to help health workers provide care to women and girls with or at risk of FGM. This study aimed to understand how health workers are supported to provide woman and girl-centred health care in these documents. We searched for these documents on the websites of health professional associations, government health departments and organisations working in FGM in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The documents were analysed using a tool that described all the important areas needed to provide patient-centred health care. Of the 124 documents, we found that only 12% contained information about all aspects of patient-centred care. Only one document had details about all the areas that are part of patient-centred care. This study shows that we need to improve the FGM-related guidance provided to health workers to care for and protect women and girls. There is a need for health workers to involve women and girls with or at risk of FGM in designing guidelines and tools and evaluating them to these documents best fit their needs. [ABSTRACT FROM AUTHOR]

This paper examines the policy context of the rise in the international mobility and migration of nurses. It describes the profile of the migration of nurses and the policy context governing the international recruitment of nurses to five countries: Australia, Ireland, Norway, the United Kingdom, and the United States. We also examine the policy challenges for workforce planning and the design of health systems infrastructure. Data are derived from registries of professional nurses, censuses, interviews with key informants, case studies in source and destination countries, focus groups, and empirical modelling to examine the patterns and implications of the movement of nurses across borders. The flow of nurses to these destination countries has risen, in some cases quite substantially. Recruitment from lower-middle income countries and low-income countries, as defined by The World Bank, dominate trends in nurse migration to the United Kingdom, Ireland, and the United States, while Norway and Australia, primarily register nurses from other high-income countries. Inadequate data systems in many countries prevent effective monitoring of these workforce flows. Policy options to manage nurse migration include: improving working conditions in both source and destination countries, instituting multilateral agreements to manage the flow more effectively, and developing compensation arrangements between source and destination countries. Recommendations for enhancements to workforce data systems are provided. [ABSTRACT FROM AUTHOR]

It is a decade since the last review of the geographical understandings of pre-service primary teachers. Examining the range of research about novice primary teachers' geographical and environmental knowledge and understanding, it is clear there have been limited follow up studies, and there remain important gaps in the research. Research relevant to this topic was identified through journal, research book and conference proceedings searches, where these were accessible. It is evident that more research now exists into pre-service primary teachers' senses of geography, geographical and environmental knowledge and environmental attitudes. For instance, it appears that they have an information oriented view of geography but are not clear about the meaning of the term "environment", that there are misunderstandings in such aspects of their geographical knowledge as climate change, that they may not adapt their behaviors though they appreciate a need for care for the environment, and that they have limited experience in planning for and teaching geography in primary schools. Furthermore, studies are lacking into their understanding of such aspects of geographical learning as fieldwork, map work, geographical enquiry and a wide range of topics in physical and human geography. While there is some information, little is known really about their teaching of geography to younger children. In view of the increased focus globally on geographical knowledge in the school curriculum, this raises serious questions about geography teacher educators' understanding of their trainee primary teachers, in part because tutors seem rarely to undertake such research. This appears to be an embedded situation, resulting in negligible evidence to challenge the status quo and improve pre-service primary teachers' geographical knowledge. Is it really a concern? Four responses are presented, but the paper concludes that more needs to be known.

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.

The UK has long experienced a shortage of social workers and has recruited internationally to meet demand. There have been few specific data quantifying the scale of social work mobility to the UK through which such experiences can be set in context. The analysis reported in this article uses data from October 2008, relating to registered social workers working in England. As part of a wider study of migrant social care workers in England, the article reports analysis of data records of over 7,000 non-UK social workers registered to work in England and compares their characteristics to UK-qualified social workers. These analyses are supplemented by analysis of more recent application and registration data from the General Social Care Council pertaining to social workers qualified within and outside the European Union during 2008 and 2009. The findings highlight several important observations in terms of non-UK-qualified social workers' profile as well as some possible trends in migration and variations in rates of qualification verification. Over half of all international social workers in England were trained in four countries: Australia, South Africa, India and the USA. Findings are contextualised with qualitative data obtained from the wider study and policy debates. [ABSTRACT FROM PUBLISHER]

The job description for legislators in western democracies includes constituency-focused activities such as casework and district visits. Unfortunately we have a limited theoretical and empirical understanding of the factors affecting legislators' constituency-oriented activities, in large part because most studies focus on single nations; even studies that are comparative do not span a variety of electoral systems. In this article we examine the constituency focus of MPs in six chambers that do provide such variance: the Australian House and Senate, Canadian House, Irish Dáil, New Zealand House, and the British House of Commons. We find that electoral considerations and incentives provided by different electoral systems, as well as other factors, affect the priority that MPs place on constituency service. [ABSTRACT FROM AUTHOR]

The "Journal of the Experimental Analysis of Behavior" was founded in 1958 by a group of male psychologists, mainly from the northeastern USA and connected with either Harvard or Columbia. Fifty years later about 20% of both editors and authors reside outside this country and almost the same proportion is women. Other changes in the journal include having its own website for more than a decade and now publishing online as well as on paper. A recent connection with PubMed Central of the National Library of Medicine has made possible the completely free electronic presentation of the entire archive of about 3,800 articles. (Contains 5 tables and 3 figures.)

The evaluation of government-financed research has become increasingly important in the last few decades in terms of increasing the quality of, and payoff from, the research that is done, reducing the cost of doing it, and lending public credibility to the manner in which research is funded. But there are very large differences throughout the world in the extent to which systems used promote these results. This paper briefly presents the dimensional results of a study designed to comparatively evaluate the national-level research evaluation models in sixteen countries on five merit-defining dimensions. (Contains 6 figures.)

Background: Breastfeeding is a complex behaviour relying on a combination of individual mother and infant characteristics, health systems, and family, community and professional support. Optimal breastfeeding in high-income countries is particularly low. Despite having similar sociocultural backgrounds, breastfeeding rates between Ireland, the United Kingdom (UK) and Australia vary, thus there is a need to understand whether this is due to individual, sociocultural or policy differences. This research identifies the between-country differences in infant feeding mode and examines if country differences in feeding mode persist once known individual, behavioural and structural factors are considered using socioecological and person-context models. Methods: Participants were adult women with at least one infant less than 6 months of age, who completed an online survey (n = 2047) that was distributed by social media in June 2016. Within-country differences in infant feeding mode ('any breastfeeding' vs. 'no breastfeeding') were examined first before hierarchical multivariable logistic regression was used to determine if country differences in feeding mode persisted after adjusting for known factors associated with breastfeeding. Results: In this sample, 'any breastfeeding' rates were 89, 71 and 72% in Australia, Ireland and the United Kingdom respectively. Within-country differences were evident in Australia, Ireland and the UK. Four factors showed no association with infant feeding mode in Australia while they did in the other countries (maternal age, income, skin-to-skin contact, support from friends and family). Two factors were unique to Australia: the odds of being in the 'no breastfeeding' group increased when the baby was delivered via caesarean and when not enough breastfeeding information was available after birth. One determinant was unique to Ireland: the odds of being in the 'no breastfeeding' group increased when respondents indicated they were not religious; in the UK this occurred when respondents were living in a town/village. After adjusting for sets of known factors of infant feeding mode based on socioecological and person-context models, country differences remained in hierarchical regressions: the odds of not breastfeeding were higher in both Ireland (AOR 3.3, 95%CI 1.8,6.1) and the United Kingdom (AOR 2.7, 95%CI 1.5, 4.7) compared to Australia. Conclusions: This study indicates that different levels in the socioecological system are related to infant feeding behaviours. An adequate inter-systems level response would consider the interactions within and between behavioural and structural mechanisms which support breastfeeding behaviour. Optimising infant feeding practices will require an integrated web of interventions that go beyond the individual and focus on addressing factors that will influence families within their communities as they move between systems. [ABSTRACT FROM AUTHOR]

Introduction: Gestational diabetes mellitus and overweight are associated with an increased likelihood of complications during birth and for the newborn baby. These complications lead to increased immediate and long-term healthcare costs as well as reduced health and well-being in women and infants. This protocol presents the health economic evaluation to investigate the cost-effectiveness of Bump2Baby and Me (B2B&Me), which is a health coaching intervention delivered via smartphone to women at risk of gestational diabetes., Methods and Analysis: Using data from the B2B&Me randomised controlled trial, this economic evaluation compares costs and health effects between the intervention and control group as an incremental cost-effectiveness ratio. Direct healthcare costs, costs of pharmaceuticals and intervention costs will be included in the analysis, body weight and quality-adjusted life-years for the mother will serve as the effect outcomes. To investigate the long-term cost-effectiveness of the trial, a Markov model will be employed. Deterministic and probabilistic sensitivity analysis will be employed., Ethics and Dissemination: The National Maternity Hospital Human Research and Ethics Committee was the primary approval site (EC18.2020) with approvals from University College Dublin HREC-Sciences (LS-E-20-150-OReilly), Junta de Andalucia CEIM/CEI Provincial de Granada (2087-M1-22), Monash Health HREC (RES-20-0000-892A) and National Health Service Health Research Authority and Health and Care Research Wales (HCRW) (21/WA/0022). The results from the analysis will be disseminated in scientific papers, through conference presentations and through different channels for communication within the project., Trial Registration Number: ACTRN12620001240932., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The development and enhancement of occupational health services (OHS) at the national level is central to ensuring the sustainable health, well-being and work engagement of the working population. However, due to differences in national health, social security and occupational safety and health systems, the content, capacity, coverage and provisions of OHS vary considerably across national contexts. Obtaining a better understanding in terms of such similarities and variations internationally is essential as such comparative information can help inform evidenced-based decision-making on OHS at both policy and practice levels. This paper therefore reviews and analyses the key policies, standards and approaches in OH systems and services, using both academic and grey literature, across 12 industrialised countries (Australia, Canada, Finland, France, Germany, Ireland, Italy, Japan, The Netherlands, Poland, United Kingdom and the United States of America). It provides a detailed overview and categorization of OHS in these selected countries in terms of the legal and policy context, organisation and financing and coverage and staffing while specifically discussing variations aimed at psychosocial risk management and the promotion of mental health and well-being at work. It draws conclusions on key development needs of OHS internationally to ensure psychosocial risk management and mental health promotion are prioritised effectively in a preventive manner.

Background: People living in rural and remote communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. The aim of this paper was to describe the characteristics and outcomes of studies investigating innovative models of care for people living with chronic disease in rural areas of developed countries where a metropolitan comparator was included., Methods: An integrative systematic review was undertaken. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to understand the empirical and theoretical data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom., Results: Literature searching revealed 620 articles published in English between 1st January 2000 and 31st March 2019. One hundred sixty were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease; 27% (43) diabetes mellitus; 8% (12) chronic obstructive pulmonary disease; and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations., Conclusions: This integrated review reveals that the published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease.

Objective: To map key policy documents worldwide and establish how they address the treatment and care needs of children and young people (CYP) who are suicidal., Design: We conducted a scoping review to systematically identify relevant key policy documents following a pre-established published protocol., Data Sources: Four databases (CINAHL; Medline; PsycINFO; The Cochrane Database of Systematic reviews) and the websites of key government, statutory and non-statutory agencies were searched. Google and Google Scholar were used to identify other policy documents and relevant grey literature. Leading experts were consulted by email., Eligibility Criteria for Selected Studies: Policies, policy guidance, strategies, codes of conduct, national service frameworks, national practice guidance, white and green papers, and reviews of policy-concerned with indicated suicide prevention approaches for children up to 18 years old. Limited by English language and published after 2000., Data Extraction and Synthesis: Data were extracted using a predetermined template. Second reviewers independently extracted 25%. Documents were categorised as international guidance, national policy and national guidance, and presented in a table providing a brief description of the policy, alongside how it specifically addresses suicidal CYP. Findings were further expressed using narrative synthesis., Results: 35 policy documents were included in the review. Although many recognise CYP as being a high-risk or priority population, most do not explicitly address suicidal CYP. In general, national guidance documents were found to convey that suicidal children should be assessed by a child and adolescent mental health practitioner but offer no clear recommendations beyond this., Conclusion: The lack of specific reference within policy documents to the treatment and care of needs of children who are suicidal highlights a potential gap in policy that could lead to the needs of suicidal children being overlooked, and varying interpretations of appropriate responses and service provision., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Treatment with new and/or innovative drugs with uncertain safety and efficacy profile is associated with substantial ethical concerns. The main objective of this paper is to present guidance on the use of such drugs contained in: (i) major international codes and guidelines pertaining to medical ethics and biomedical research; (ii) national codes of medical ethics and professional conduct of the USA, Canada, Australia, New Zealand, the UK, Ireland, France and Germany. Out of the four international codes and guidelines analysed, only the Declaration of Helsinki addresses the question of the use of unproven drugs. Among national codes, only two (USA and New Zealand) explicitly allow for use of new or innovative drugs. Moreover, treatment with unproven drugs seems to be permissible under the French code, though this is not stated explicitly. The remaining codes do not contain any articles on the use of new and innovative drugs. An update of existing articles, as well as the addition of new guidelines to the codes, should be considered in view of the rapid pace of development and introduction to clinical practice of new drugs. This work is relevant to innovative off-label applications of approved drugs and expanded access to investigational drugs., (© 2018 The British Pharmacological Society.)