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Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40–65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups. Plain language summary: Sexual health and sexual wellbeing services for midlife women in high income countries Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives. Access to Sexual Health and Sexual Wellbeing (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective of this systematic review was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high income countries. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their HealthCare Professionals (HCPs), and the over-arching effect of stigma, social connections, and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities, and financial incentives for under-served groups to access services. The appetite for education about SHSW and SHSW services among midlife women and their HCPs should be capitalised upon, and utilised to improve research, public health messaging, interventions and access to holistic services, particularly for midlife women from under-served groups. [ABSTRACT FROM AUTHOR]

Introduction: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care. The majority of patients with chronic non-malignant pain (CNMP) are managed by their general practitioner (GP). Recent qualitative studies have examined the issue of opioid prescribing for CNMP from a GP viewpoint. The aim of this study is to identify and synthesise the qualitative literature describing the factors influencing the nature and extent of opioid prescribing by GPs for patients with CNMP in primary care. Methods: MEDLINE, Embase, PsycINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986 to February 2018. The full text of included articles was reviewed using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researchers and themes organised using Thematic Network Analysis. Themes were constructed in a hierarchical manner, basic themes informed organising themes which informed global themes. A theoretical model was derived using global themes to explain the interplay between factors influencing opioid prescribing decisions. Results: From 7020 records, 21 full text papers were assessed, and 13 studies included in the synthesis; 9 were from the United States, 3 from the United Kingdom and 1 from Canada. Four global themes emerged: suspicion, risk, agreement and encompassing systems level factors. These global themes are inter-related and capture the complex decision-making processes underlying opioid prescribing whereby the physician both consciously and unconsciously quantifies the risk–benefit relationship associated with initiating or continuing an opioid prescription. Conclusion: Recognising the inherent complexity of opioid prescribing and the limitations of healthcare systems is crucial to developing opioid stewardship strategies to combat the rise in opioid prescription morbidity and mortality. [ABSTRACT FROM AUTHOR]

Hemophilia is a bleeding disorder caused by a single absent/defective gene and characterized by a lack of functional clotting factors. People with hemophilia may experience joint damage, pain, and psychological impairments, all of which could contribute to reduced health-related quality of life (HRQoL). The current standard of care is clotting factor replacement, which is associated with regular infusions; therefore, alternative treatments such as gene therapy (GT) are in development. GT involves the delivery of a functional copy of the clotting factor 8/9 gene by a single infusion into the patient's cells, enabling them to produce their own clotting factor VIII/IX. The impact of treatment on patients' HRQoL can be assessed using hemophilia-specific patient-reported outcome (PRO) measures. Since these measures were designed before the advent of GT, there is a need for updated individualized PRO measures. Patient groups and regulatory authorities emphasize the need for increased patient engagement when considering clinical trial design. Here, we provide patients' perspective on undergoing GT and discuss how to capture the patient voice when measuring the therapy's transformative impact. [ABSTRACT FROM AUTHOR]

A content analysis of values in dominant culture magazines in the United States, Canada and Great Britain during 1957-59, 1967-69 and 1970-72 indicated a priority on instrumentalism and little shifting in overall value preference over time. This appears to be contrary to predictions made by counterculture observers that Western society was changing rapidly toward a countercultural ideology. A similar analysis of the underground press in the same countries during 1967-69 and 1970-72 revealed a marked shift from expressive priorities during the earlier period to political priorities during the later period. These findings and their implications are discussed. [ABSTRACT FROM AUTHOR]

People affected by rarer forms of dementia often have a long and difficult experience obtaining a diagnosis and appropriate support, impacting family, employment and social relationships, quality of life and wellbeing. For this population progressive cognitive symptoms affect skills other than memory and disproportionately occur under the age of 65 years, often resulting in misdiagnosis and lack of appropriate care pathways. The objective of this study will be to better understand the subjective experience of the time period from first noticing symptoms to obtaining a formal diagnosis, through to accessing support, and onward to the present time. Through the concurrent use of line drawings and video-recorded interviews we will collect the stories of people living with different rarer dementias and/or family members who are care partners in Canada and the United Kingdom. Narrative and visual analysis will be used in parallel to methodologically explore how line drawing and verbal discourse interact and inform each other to construct knowledge, and how the use of drawing lines might enrich research interviews and increase accessibility of research participation. This novel research approach may also have implications for clinical interviewing, support services, and public engagement. To the best of our knowledge, this is the first study to retrospectively explore over time the experiences of people affected by rarer forms of dementia from initial symptoms—to diagnosis—to accessing support—to the present, using visual and verbal methodologies. [ABSTRACT FROM AUTHOR]

Brivudin, ((E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU) can be considered the gold standard for the treatment of varicella-zoster virus (VZV) infections, such as herpes zoster (shingles). It is available for clinical use in most European countries (except for the UK) and over the whole world (except for the US and Canada). Besides VZV its activity spectrum also includes various other herpesviruses, such as herpes simplex virus type 1 (HSV-1). Its activity against VZV and HSV-1 depends on phosphorylation by the virus-encoded thymidine kinase (TK). In its active form (BVDU TP or BVDU 5'-triphosphate), it can act as both substrate and inhibitor of the viral (i.e., HSV-1) DNA polymerase. It has proven to be effective against herpes zoster, including post-herpetic neuralgia (PHN). It is contra-indicated in patients concomitantly treated by 5-fluorouracil (FU), since its degradation product, (E)-5-(2-bromovinyl)uracil, is inhibitory to the catabolism of FU, which may enhance the toxicity of the latter. A new compound, the bicyclic nucleoside analogue (BCNA) Cf-1743, has been described, which is a more potent inhibitor of VZV replication than BVDU and which does not interfere with the catabolism of FU. It is applicable orally, as its 5'-valine ester FV-100 (Fermavir), but has not (yet) been marketed for clinical use. [ABSTRACT FROM AUTHOR]

At the outset of the Thatcher/Reagan era, the employment and labor law systems across six Anglo- American countries could be divided into three pairings: the Wagner Act model of the United States and Canada; the Voluntarist system of collective bargaining and strong unions in the United Kingdom and Ireland; and the highly centralized, legalistic Award systems of Australia and New Zealand. The authors argue that there has been growing convergence in two major areas: First, of labor law toward a private ordering of employment relations in which terms and conditions of work and employment are primarily determined at the level of the enterprise; and second, of individual employment rights, toward a basket of minimum standards that can then be improved upon by the parties. The greatest similarity is found in Canada, the United Kingdom, New Zealand, and Australia. Ireland retains a greater degree of public ordering, while the United States diverges in favoring the interests of employers over those of employees and organized labor. The authors explore reasons for the convergence. [ABSTRACT FROM AUTHOR]

This comparative study examines survey data from 464 call centers in the United States, 167 in the United Kingdom, and 387 in Canada to explore two questions: whether institutional differences shape employers' choices of ways to improve work force flexibility, both numerical and functional; and whether strategies for numerical flexibility and functional flexibility are related. The results suggest that institutional differences across these liberal market economies--specifically, in dismissal regulations and union strength--did affect how employers chose to achieve work force flexibility. For example, the use of part-time workers was more common in countries with more stringent rules regulating dismissals. Organizational characteristics also mattered, with outsourced firms being more likely than in-house firms to use part-time workers. Evidence also suggests that managers used numerical flexibility and functional flexibility strategies as substitutes: higher employee job discretion was associated with both lower dismissal rates and a lower likelihood of temporary use. [ABSTRACT FROM AUTHOR]

The first decade of the new millennium saw the governments of Canada and the United Kingdom enact criminal legislation intended to hold corporations accountable for negligently killing workers and/or members of the public. Drawing empirically from document analyses and semistructured interviews, as well as theoretical insights concerning the crisis-prone tendencies of capital, this article demonstrates how both laws were conceived in ways that spatio-temporally delimited the 'problem' of corporate killing and re-secured the (neoliberal) capitalist status quo. In so doing, we argue that the inability of the state to hold powerful corporations and corporate actors to account for their serious offending presents strategic opportunities for demanding improved accountability measures and changes to a system responsible for so much bloodshed and killing. [ABSTRACT FROM AUTHOR]

This study assesses whether civic association activity has declined in four Western democracies: Canada, the Netherlands, the United Kingdom, and the United States. Influential accounts of decreasing civic engagement in the United States lead to the expectation of similar patterns in the other three nations. The authors test this hypothesis using data from time-use surveys of adult national samples for the mid-1960s to the late 1990s. One major finding is a clear decline in association activity in the United States, especially after 1975, but relative stability in the other three countries. Equally important are further results indicating that the American decline pertains only to women. Findings are sustained even after controlling for social background characteristics and four other activities (television watching, paid work, childcare, and physical activity). The analysis casts doubt on the theory that declining civic association activity in the United States reflects generational differences. Possible explanations for the reduced activity among American women, including lower levels of state support, are considered. [ABSTRACT FROM AUTHOR]

We examine gender differences in the relative poverty of men and women in eight industrialized countries. The analyses are based on data from the Luxembourg Income Study, which includes data from the United States, Canada, Australia, the United Kingdom, West Germany, Sweden, Italy, and the Netherlands. We examine the importance of the gender-specific demographic compositions of marriage, parenthood, and employment in accounting for differences in men's and women's poverty rates, both within and across countries. The cross-national comparisons suggest that the relative importance of demographic characteristics differs by country and that factors such as religion, culture, and government policies also help determine the gap between women's and men's poverty rates. [ABSTRACT FROM AUTHOR]