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Background Unlike some other safety critical professions, there is no mandatory age of retirement for doctors, including surgeons. Medical regulators in Australia are implementing additional checks on doctors from the age of 70. We describe expert opinions on assuring performance and supporting career transitions among older surgeons. Methods In this qualitative study, experts in four countries were purposively selected for their expertise in surgical governance. Experts responded to interviews (Australia, New Zealand and UK) or a survey (Canada). A tiered framework of interventions was developed by integrating findings with previous literature and responsive regulation theory. Results 52 experts participated. Participants valued the contribution of senior surgeons, while acknowledging that age- related changes can affect performance. Participants perceived that identity, relationships and finances influence retirement decisions. Experts were divided on the need for age- specific testing, with some favouring whole- of- career approaches to assuring safe care. A lack of validated tools for assessing performance of older surgeons was highlighted. Participants identified three options for addressing performance concerns-- remediate, restrict or retire--and emphasised the need for co- ordinated and timely responses. Conclusion Experts perceive the need for a staged approach to assessing the performance of older surgeons and tailoring interventions. Most older surgeons are seen to make decisions around career transitions with self- awareness and concern for patient safety. Some older surgeons may benefit from additional guidance and support from employers and professional colleges. A few poorly performing older surgeons, who are recalcitrant or lack insight, require regulatory action to protect patient safety. Developing robust processes to assess performance, remediate deficits and adjust scopes of practice could help to support safe career transitions at any age. [ABSTRACT FROM AUTHOR]

Objectives Waterpipe tobacco smoking (WTS), a traditional tobacco consumption practice in the Middle East, is gaining popularity worldwide. Estimates of population-level interest in WTS over time are not documented. We assessed the popularity of WTS using World Wide Web search query results across four English-speaking countries. Methods We analysed trends in Google search queries related to WTS, comparing these trends with those for electronic cigarettes between 2004 and 2013 in Australia, Canada, the UK and the USA. Weekly search volumes were reported as percentages relative to the week with the highest volume of searches. Results Web-based searches for WTS have increased steadily since 2004 in all four countries. Search volume for WTS was higher than for e-cigarettes in three of the four nations, with the highest volume in the USA. Online searches were primarily targeted at WTS products for home use, followed by searches for WTS cafés/lounges. Conclusions Online demand for information on WTSrelated products and venues is large and increasing. Given the rise in WTS popularity, increasing evidence of exposure-related harms, and relatively lax government regulation, WTS is a serious public health concern and could reach epidemic levels in Western societies. [ABSTRACT FROM AUTHOR]

Background Weight concerns are widely documented as one of the major barriers for girls and young adult women to quit smoking. Therefore, it is important to investigate whether smokers who have weight concerns respond to tobacco control policies differently than smokers who do not in terms of quit attempts, and how this difference varies by gender and country. Objective This study aims to investigate, by gender and country, whether smokers who believe that smoking helps control weight are less responsive to tobacco control policies with regards to quit attempts than those who do not. Methods We use longitudinal data from the International Tobacco Control Policy Evaluation Project in the USA, Canada, the UK and Australia to conduct the analysis. We first constructed a dichotomous indicator for smokers who have the weight control belief and then examined the disparity in policy responsiveness in terms of quit attempts by directly estimating the interaction terms of policies and the weight control belief indicator using generalised estimating equations. Findings We find that weight control belief significantly attenuates the policy impact of tobacco control measures on quit attempts among US female smokers and among UK smokers. This pattern was not found among smokers in Canada and Australia. Conclusions Although our results vary by gender and country, the findings suggest that weight concerns do alter policy responsiveness in quit attempts in certain populations. Policy makers should take this into account and alleviate weight concerns to enhance the effectiveness of existing tobacco control policies on promoting quitting smoking. [ABSTRACT FROM AUTHOR]

Objectives To analyse the tobacco industry’s use of international trade agreements to oppose policies to strengthen health warning labels (HWLs). Design A review of tobacco industry documents, tobacco control legislation and international treaties. Results During the early 1990s, the tobacco industry became increasingly alarmed about the advancement of HWLs on cigarettes packages. In response, it requested legal opinions from British American Tobacco’s law firms in Australia and England, Britain’s Department of Trade and Industry and the World Intellectual Property Organisation on the legality of restricting and prohibiting the use of their trademarks, as embodied in cigarette packages. The consistent legal advice, privately submitted to the companies, was that international treaties do not shield trademark owners from government limitations (including prohibition) on the use of their trademarks. Despite receiving this legal advice, the companies publicly argued that requiring large HWLs compromised their trademark rights under international treaties. The companies successfully used these arguments as part of their successful effort to deter Canadian and Australian governments from enacting laws requiring the plan packaging of cigarettes, which helped delay large graphic HWLs, including ‘plain’ packaging, for over a decade. Conclusions Governments should not be intimidated by tobacco company threats and unsubstantiated claims, and carefully craft HWL laws to withstand the inevitable tobacco industry lawsuits with the knowledge that the companies’ own lawyers as well as authoritative bodies have told the companies that the rights they claim do not exist. [ABSTRACT FROM AUTHOR]

Background The official prescribing information document distributed with a prescription drug is a key source of safety information, but it may include excessive or insufficient details. Objectives To compare prescribing information approved by the US Food and Drug Administration with the UK, Canada and Australia to identify content differences in safety warnings. Methods For 20 top-selling prescription drugs, we used an automated natural language processing tool to calculate the number and severity of reported adverse drug reactions (ADRs). We fit hierarchical Poisson models and included fixed effects for other prescribing information characteristics. Separately, we analysed the appearance and content of 'black box' warnings. Results There was substantial variation in safety content of approved prescribing information. Canada had the highest median ADRs per drug (138 (IQR 86-234)) and the UK had the lowest (84 (IQR 51-111)). The number of ADRs reported was on average 50% higher in Canada compared with the USA (ratio of ADRs/ document: 1.5, 95% CI 1.4 to 1.6, p<0.001). By contrast, there were on average 15% fewer ADRs listed in the UK compared with the USA (ratio of ADRs/document 0.85 (95% CI 0.78 to 0.93, p<0.001), and 21% fewer ADRs listed in Australia compared with the USS (ratio of ADRs/ document 0.79, 95% CI 0.74 to 0.85, p<0.001). There were no variations in ADR severity. The presence and qualitative content of boxed warnings also showed substantial diversity. Conclusions International variations exist in the presentation of safety data in drug prescribing information, which may have important implications for patient safety. Better international coordination is necessary to enhance use of this information for patient decision-making. [ABSTRACT FROM AUTHOR]

Objectives To investigate the links between health warning labels (WLs) on cigarette packets and relapse among recently quit smokers. Design Prospective longitudinal cohort survey. Setting Australia, Canada, the UK and the USA. Participants 1936 recent ex-smokers (44.4% male) from one of the first six waves (2002-2007) of the International Tobacco Control 4-Country policy evaluation survey, who were followed up in the next wave. Main outcome measures Whether participants had relapsed at follow-up (approximately 1 year later). Results In multivariate analysis, very frequent noticing of WLs among ex-smokers was associated with greater relapse 1 year later (OR: 1.52, 95% CI 1.11 to 2.09, p<0.01), but this effect disappeared after controlling for urges to smoke and self-efficacy (OR: 1.29, 95% CI 0.92 to 1.80, p¼0.135). In contrast, reporting that WLs make staying quit ‘a lot’ more likely (compared with ‘not at all’ likely) was associated with a lower likelihood of relapse 1 year later (OR: 0.65, 95% CI 0.49 to 0.86, p<0.01) and this effect remained robust across all models tested, increasing in some. Conclusions This study provides the first longitudinal evidence that health warnings can help ex-smokers stay quit. Once the authors control for greater exposure to cigarettes, which is understandably predictive of relapse, WL effects are positive. However, it may be that ex-smokers need to actively use the health consequences that WLs highlight to remind them of their reasons for quitting, rather than it being something that happens automatically. Ex-smokers should be encouraged to use pack warnings to counter urges to resume smoking. Novel warnings may be more likely to facilitate this. [ABSTRACT FROM AUTHOR]

The article discusses a survey on smokers that assessed if the relationship between beliefs and smoking behaviors was in consistent with Cognitive Dissonance Theory. It included adult smokers from Canada, U.S., Great Britain and Australia. The findings revealed that smokers with no intetion of quitting across the three waves, were inclined towards the highest levels of rationalizations for smoking. It suggests studies to determine if the change in beliefs has any effect on intentions to quit.

Objective: To systematically review and critically appraise the economic evaluations of one to one interventions to reduce sexually transmitted infections (STIs) and teenage conceptions. Design: Systematic review. Data Sources: Search of four electronic bibliographic databases from 1990 to January 2006. Search keywords included teenage, pregnancy, adolescent, unplanned, unwanted, cost benefit, cost utility, economic evaluation, cost effectiveness and all terms for STIs, including specific diseases. Review Methods: We included studies that evaluated a broad range of one to one interventions to reduce STIs. Outcomes included major outcomes averted, life years and quality adjusted life years (QALY). All studies were assessed against quality criteria. Results: Of 3,190 identified papers, 55 were included. The majority of studies found one to one interventions to be either cost saving or cost effective, although one highlighted the need to target the population to receive post-exposure prophylaxis to reduce transmission of HIV. Most studies used a static approach that ignores the potential re-infection of treated patients. Conclusion: One to one interventions have been shown to be cost saving or cost effective but there are some limitations in applying this evidence to the UK policy context. More UK research using dynamic modelling approaches and QALYs would provide improved evidence, enabling more robust policy recommendations to be made about which one to one interventions are cost effective in reducing STIs in the UK setting. The results of this review can be used by policy makers, health economists and researchers considering further research in this area. [ABSTRACT FROM AUTHOR]

The article discusses a bibliometric study which examined the quality of published primary care research in Australia, Canada, Germany, the Netherlands, Great Britain and the U.S. The study reviewed published research on primary care. It discovered that primary care research conducted by British researchers are among the best internationally.

This article reports that a U.S. Commonwealth Fund survey of health systems in six industrialised nations has the U.S. coming in last overall. Great Britain was ranked first overall but got poor scores on indicators of healthy lives. The U.S. performed best in preventive care. Australia ranked the best in terms of healthy lives. Mortality rates were the lowest in Australia and Canada. The U.S. came in the bottom of five dimensions measured. Additionally, the report also found the U.S. behind in the adoption of information technology spending.

Aims: To determine the prevalence and characteristics of smokers who experience smoking-induced deprivation (SID), and to examine its effect on quit attempts, relapse and cessation. Methods: Waves 2 and 3 (2003-5) of the International Tobacco Control Policy Evaluation Survey were used, which is a prospective study of a cohort of smokers in the US, Canada, UK and Australia. SID was measured with the question "In the last six months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?" A total of 7802 smokers participated in the survey in wave 2, of whom 5408 were also interviewed in wave 3. Findings: The proportion of smokers who reported SID was highest in Australia (33%) and lowest in the UK (20%). Younger age, minority status and low income were associated with a higher probability of SID. Some of the other factors related to a higher probability of SID were higher level of nicotine dependence, having an intention to quit and smoking to help one socialise or control weight. The relationship between SID and quit attempt was mediated by having an intention to quit and worrying that smoking would damage health and reduce the quality of life. The relationship between SID and relapse was mediated by perceived stress. SID was not associated with successful cessation. Conclusions: Many smokers experience deprivation that is the result of their smoking. Strategies to reduce the prevalence of smoking probably effect a general improvement in standards of living and reduction in deprivation. [ABSTRACT FROM AUTHOR]

Presents news briefs relating to medicine. Trial of cannabis for medical use in New South Wales, Australia, which will involve people with cancer, AIDS, severe and chronic pain, spinal cord injuries, and multiple sclerosis; Development of Gulf war syndrome symptoms by British soldiers who received vaccinations before the invasion of Iraq; Win by David Skidmore of his case in the House of Lords in Great Britain, after he was accused of lying to a patient; Efforts of Australia's federal government to address the country's medical indemnity crisis; Case of bovine spongiform encephalopathy which was discovered in Canada.