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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]

Objectives Based mainly on findings from clinical settings, it has been claimed that women are less likely than men to quit smoking successfully. If true, this would have important implications for tobacco control interventions. The authors aimed to test this possibility using data from general population surveys. Methods The authors used data from major national surveys conducted in 2006e2007 in the USA (Tobacco Use Supplement to the Current Population Survey), Canada (Canadian Tobacco Use Monitoring Survey) and the UK (General Household Survey) to estimate rates of smoking cessation by age in men and women. Results The authors found a pattern of gender differences in smoking cessation which was consistent across countries. Below age 50, women were more likely to have given up smoking completely than men, while among older age groups, men were more likely to have quit than women. Across all age groups, there was relatively little difference in cessation between the sexes.Conclusions:Conclusions about gender differences in smoking cessation should be based on evidence from the general population rather than from atypical clinical samples. This study has found convincing evidence that men in general are not more likely to quit smoking successfully than women. [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.

Background: Television advertisements for less healthy foods are thought to contribute to overweight and obesity in children. In the UK, new regulations on television food advertising to children came into effect in April 2007. These prohibit advertisements for "less healthy" foods during or around programmes "of particular appeal to" (OPAT) children. In Canada, self-regulated codes of practice on television food advertising to children were recently strengthened. Objective: To document the nutritional content of food advertised and number of advertisements OPAT children broadcast in the UK and central Canada before the introduction of the new UK regulations. Design: All food advertisements broadcast on four popular channels in Canada and the three terrestrial commercial channels in the UK during 1 week in 2006 were identified and linked to relevant nutritional data. Food advertisements OPAT children and for "less healthy" products were identified using the criteria in the UK regulations. Results: 2315 food related advertisements broadcast in Canada and 1365 broadcast in the UK were included. 52-61% were for "less healthy" products; 5-11% were OPAT children. Around 5% of food advertisements would have been prohibited under the new UK regulations. There were few differences in the nutritional content of food described in advertisements that were and were not OPAT children. Conclusion: There was little evidence that food described in advertisements OPAT children were any less healthy than those that were not. Few food advertisements are likely to be prohibited by the new UK regulations. [ABSTRACT FROM AUTHOR]

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]

Objectives To determine if risk of multiple sclerosis (MS) is associated with month of birth in countries in the northern hemisphere and if factors related to month of birth interact with genetic risk. Design Population based study with population and family based controls and a retrospective cohort identified from death certificates. A post hoc pooled analysis was carried out for large northern datasets including Sweden and Denmark. Setting 19 MS clinics in major cities across Canada (Canadian collaborative project on the genetic susceptibility to multiple sclerosis); incident cases of MS from a population based study in the Lothian and Border regions of Scotland; and death records from the UK Registrar General. Populations 17 874 Canadian patients and 11 502 British patients with multiple sclerosis. Main outcome measure Diagnosis of multiple sclerosis. Results In Canada (n = 17 874) significantly fewer patients with MS were born in November compared with controls from the population census and unaffected siblings. These observations were confirmed in a dataset of British patients (n = 11 502), in which there was also an increase in the number of births in May. A pooled analysis of datasets from Canada, Great Britain, Denmark, and Sweden (n = 42 045) showed that significantly fewer (8.5%) people with MS were born in November and significantly more (9.1%) were born in May. For recent incident data, the effect of month of birth was most evident in Scotland, where MS prevalence is the highest. Conclusions Month of birth and risk of MS are associated, more so in familial cases, implying interactions between genes and environment that are related to climate. Such interactions may act during gestation or shortly after birth in individuals born in the northern countries studied. [ABSTRACT FROM AUTHOR]

Discusses self regulation in the medical profession and healthcare industry. Systems being used in the United States, Canada, and Great Britain; The issue of revalidation and periodic recertification for physicians; The core competencies required by the American Board of Medical Specialties; The Canadian model for monitoring and assessing the performance of physicians.

The article presents news briefs related to injury prevention. According to a study by researchers in Toronto, Ontario, incidence of concussions is higher among female players than male players in soccer. An online paper, published in the periodical "Lancet," says that top three causes of death of young Americans in 2010 included unintentional injury, suicide and homicide. A study by the Violence Prevention Center says that gun violence prevention laws are related to gun death rates in the U.S.

The article features the health care teams and initiatives that were nominated for the "British Medical Journal" Group Awards' Corporate Social Responsibility category, including Our Healthcare, Our Environment project, the Greening Initiative at St. Michael's Hospital in Canada, and the Healthcare Careers and Skills Academy from the University Hospital of North Staffordshire NHS Trust.

The article considers various issues related to the British medical practice as of March 12, 2016 which include the link between aspiring use and the incidence of cancer, the monitoring of concentration of circulating tumor DNA, and drug development for target diseases with no existing treatment.

This section offers news briefs on medical ethics. British chief medical officer Liam Donaldson has called for an opt-out system of organ donation in Great Britain. Canadian mother Melanie Boivin has frozen her own eggs to give her 7-year old daughter with Turner syndrome a genetically related child in the future. Meanwhile, Libya's High Judicial Court overthrew the death penalty of the six foreign medical workers who were charged with conspiring to deliberately inject 426 children with HIV.

Discusses the use of radiography in the diagnosing of ankle injuries. How I.G. Stiell and colleagues developed the concept of a clinical decision rule to guide the assessment of ankle injuries; How the validation of their rule involved thousands of patients in a structured program to generate rules with exceptional performance as a diagnostic test; How this became known as the Ottawa ankle rules; Ottawa ankle rules are a safe, cost-effective and reliable approach to assessing injured ankles with consistency; Applicability of the Ottawa ankle rule in children has been confirmed; Common use of the rule by clinicians in Canada and the United Kingdom.

The article focuses on a study related to the increase onset of diabetes with use of higher potency statins that was published in the June 2014 issue of the periodical. The study was conducted on 136,966 patients with age above 40 years. The study was conducted on 37,936 patients suffering with ADHD from 2006-2009 from healthcare databases of various provinces in Canada including Alberta, Manitoba and Nova Scotia. The study was funded by the Canadian Institutes of Health Research.

This section offers news briefs pertaining to medicine as of June 14, 2014 including child poverty in Great Britain, the increase in living organ donations, and the legalization of physician assisted suicide in Quebec.

This section offers medical-related news briefs as of October 19, 2013 including court's upholding of Canada's ban on physician assisted suicide, a high court's ruling for two sisters to have the measles, mumps, rubella (MMR) vaccine despite their mother's refusal and the Quebec College of Physicians' advise to its members not to issue certificates of virginity or conduct gynaecological examinations.

The article offers medical news briefs as of April 2013 on topics including new funding being sought to transform major diseases, clinical commissioning groups (CCGs) asked to improve health of people with learning disabilities, and major increase in deaths from liver disease in Canada.

The article discusses that surgically stimulating the brains of a group of six patients with chronic anorexia nervosa may help them recover from their compulsive behaviors and the study was conducted to test the safety of the procedure and not its effectiveness.

The article offers news briefs related to medical care which includes the National Institute for Health and Clinical Excellence (NICE) has been asked to assess unlicensed uses of drugs, according to the survey Dutch children eat very less fruits and vegetables, and flexible working is necessary for the Great Britain health services.

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.

The authors discuss their research on the effectiveness of automated measurement of blood pressure (BP) in primary care patients with systolic hypertension (SH) in eastern Canada. They measured the BP of 555 patients with SH using a manual office BP measuring device and a BpTRU automated BP monitor. They found that the white coat response seen using the manual BP monitor was eliminated with the use of the BpTRU. They also observed different systolic BP between awake ambulatory BP minus automated office BP and awake ambulatory BP minus manual office BP.

The article focuses on proposals to use plain packaging for cigarette products. The British Department of Health questions the merit of plain packaging as an initiative to reduce smoking by young people. Public opinion research undertaken by the Canadian government discovered that cigarette packages that were 100% covered in a graphic health warning were more effective in communicating the risks of smoking. Professor Mike Daube supports the move to plain packaging of cigarettes.

The article presents news briefs regarding world health issues. The opinions of Alan Johnson, the Secretary of State for Health in Great Britain, regarding a policy by the National Health Service (NHS) in Great Britain which denies NHS treatment to patients who pay for medications privately is mentioned. The number of children who die from diarrhea worldwide on an annual basis is mentioned. A study being done by the organization the Canadian Partnership Against Cancer in which 300,000 people will be followed for 30 years to study how a person's lifestyle and genetics impacts their development of cancer is discussed.

This article reports on a study from Canada that showed patients with severe Alzheimer's disease who are living at home and are treated with donepezil stabilise or decline more slowly that patients given a placebo. Donepezil is approved for use in the U.S. and Canada for use in mild to severe cases of the disease but is not approved in Great Britain except for moderate cases. Study author Sandra Black of the University of Toronto says that North American researchers were suspicious of the decision by the National Institute for Health and Clinical Excellence (NICE) in Great Britain to forbid the drug's use in mild and severe cases which prompted the research.

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]

Offers public health in Great Britain and medical news briefs. The UN Food and Agriculture Organization is worried about the threat of famine in east Africa. The prevalence of obesity has increased in Canada. The World Health Organization is concerned that antimalarial drugs made with artemisinin will increase resistance. The UK clinical aptitude test (UKCAT) is required for dental and medical school applicants. The Department of Health is reviewing charges for hospital patients' telephone calls. The BMA and the British Beer and Pub Association are opposed to a partial ban on smoking in pubs serving food.

The article reports on the British government's plan to stockpile oseltamivir, in case there is an influenza epidemic. Professor Joe Collier, St. George's Hospital Medical School in London, comments on the decision to purchase 14.6 million doses of Roche's antiviral drug. Canada's federal health minister, Ujjal Dosanjh, believes that oseltamivir will not prevent the flu. Information about the increased demand for and production of oseltamivir is given.