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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]

Objective: Clarifying the distinctions between art-based creative activities in the domains of occupational therapy and art therapy in the context of stroke rehabilitation, while also describing the effects of art-based creative activities on stroke rehabilitation. Design: Scoping review. Data source: A systematic search was performed in nine databases (Web of Science, PubMed, EMBASE, Cochrane Library, CINAHL and four Chinese database) from their inception to December 2023. Review methods: The study included randomized and non-randomized controlled trials involving art-based creative activities, as well as qualitative research providing detailed intervention measures. The study focused on stroke patients, with primary outcomes related to patients' physiological recovery, psychological well-being, ADL, etc. Data extraction included information on intervention strategies and study results. Results: Seventeen studies were included, extracting six similarities and differences in creative activity between two domains. Creative activities were observed to have positive impacts on daily living activities, limb motor function, fine motor ability, and emotional well-being in stroke patients. Conclusion: Creative activities, whether in occupational therapy or art therapy, involve providing participants with tangible crafting materials for the creation of artistic works. Future stroke rehabilitation practices should tailor activities and intervention focus based on patients' rehabilitation needs, preferences, and cultural background. The current comprehensive analysis provides initial support for the potential positive role of creative activities in stroke rehabilitation, but further in-depth research is needed to confirm their effectiveness. [ABSTRACT FROM AUTHOR]

Background: Immunological responses to metal ions can occur in people with metal implantable devices. Nevertheless, patients are not routinely asked about metal hypersensitivity nor tested for it prior to surgical procedures. Moreover, we have not identified any published literature on patients' experiences with this condition. We undertook this study to better understand the experiences of patients with metal hypersensitivity and to determine what information would help them make an informed decision about implantable medical devices with metal compositions. Methods: This is a patient-oriented research using an interpretative phenomenological methodology. We enrolled 16 people from five countries (Canada, New Zealand, Spain, the UK, and the USA) who experienced metal hypersensitivity following implantable medical device. We collected data from in-depth, semi-structured interviews focused on pre-procedural patient education and postoperative experiences to elucidate the barriers and opportunities related to metal hypersensitivity. We analyzed the data using interpretative phenomenological analysis. Results: The majority were white biological women between the ages of 34 and 65. None of the participants were informed about immunological responses to metals in implants during the consenting process. They encountered many challenges when symptoms of metal hypersensitivity occurred. The outcomes for the few who had the implants removed were mixed. Conclusion: Hypersensitivity reactions to metal need to be discussed as part of the consenting process, and additional strategies are needed to mitigate this issue in the health system. [ABSTRACT FROM AUTHOR]

This article draws on Walter Bagehot's distinction between efficient and dignified institutions to examine an understudied facet of the monarchy in Canada: the Crown's role in Canadian foreign policy. The Canadian Crown acts in global affairs in two ways: through the efficient prerogative powers of the Crown exercised by Cabinet, and by means of the dignified "public diplomacy" performed by the office of the governor general. The article demonstrates that the Crown's prerogative powers remain the underlying authority that Canadian governments exercise when pursuing foreign policy objectives and acting in the world. The article then traces the growth of the vice-regal office's foreign policy functions, as well how the governor general's public diplomacy efforts contribute to Canada's global engagement. The article concludes with a brief discussion of King Charles III's place in Canadian foreign affairs as the head of state of multiple, independent realms. [ABSTRACT FROM AUTHOR]

Background: Infection prevention competencies are critical for successful job performance, career progression and robust performance of infection prevention and control programs. Aim/objective: Identify competency assessment tools available to infection preventionists and describe their characteristics, validation processes and reliability. Methods: A scoping review was conducted on five databases and grey literature from 1999 to 2022. A descriptive synthesis approach was undertaken to analyse the data. Finding/results: Seven tools that meet the inclusion criteria were identified. Of those, one tool was reviewed twice. All tools were developed in the United Kingdom, Canada, China and the United States, and were published between 2009 and 2022. All tools use a rating scale; and the most used method to assess competencies was self-assessment. Levels of competency were cited by five tools. Two tools provided information on validation methods and reliability tests for internal consistency. Discussion: Few competency assessment tools are available in the literature, and there is a lack of information on their development process. A global effort to develop an assessment tool that allows comparison across countries and cultures can be a step forward to propel infection preventionists' careers and enhance the efficacy of Infection Prevention and Control Programs. [ABSTRACT FROM AUTHOR]

Technology-facilitated abuse (TFA) is a significant, harmful phenomenon and emerging trend in intimate partner violence. TFA encompasses a range of behaviours and is facilitated in online spaces (on social media and networking platforms) and through the misuse of everyday technology (e.g. mobile phone misuse, surveillance apps, spyware, surveillance via video cameras and so on). The body of work on TFA in intimate relationships is emerging, and so this scoping review set out to establish what types of abuse, impacts and forms of resistance are reported in current studies. The scoping review examined studies between 2000 and 2020 that focused on TFA within intimate partnerships (adults aged 18+) within the setting of any of these countries: the UK and Ireland, USA, Canada, New Zealand and Australia. The databases MEDLINE, CINAHL and Scopus were searched in December 2020. A total of 22 studies were included in the review. The main findings were that TFA is diverse in its presentation and tactics, but can be typed according to the eight domains of the Duluth Power & Control Wheel. Impacts are not routinely reported across studies but broadly fall into the categories of social, mental health and financial impacts and omnipresence. Similarly, modes of resistance are infrequently reported in studies. In the few studies that described victim/survivor resistance, this was in the context of direct action, access to legal or professional support or in the identification of barriers to resistance. [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]

Relationships between siblings have been described as the longest lasting an individual can have, yet siblings both can and do become estranged from one another in adulthood. An online survey was disseminated to individuals who had sought support from the charity Stand Alone, which supports individuals who are experiencing family estrangement. Individuals estranged from one full genetic sister and/or brother were asked to describe the relationship in their own words. Open-text responses were thematically analysed from 291 respondents. Family systems were described as being characterised by estrangements, alliances and conflicts; there was variation in the participant's preferences regarding reconciliation; and most respondents focused on describing their sibling's challenging or disappointing characteristics and behaviour. The fact that siblings both can and do become estranged challenges commonly held assumptions about family relationships, confirming that they are not necessarily or always life-long, significant or supportive. [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]

Background: People who use drugs with life-limiting illnesses experience substantial barriers to accessing palliative care. Demand for palliative care is expected to increase during communicable disease epidemics and pandemics. Understanding how epidemics and pandemics affect palliative care for people who use drugs is important from a service delivery perspective and for reducing population health inequities. Aim: To explore what is known about communicable disease epidemics and pandemics, palliative care, and people who use drugs. Design: Scoping review. Data sources: We searched six bibliographic databases from inception to April 2021 as well as the grey literature. We included English and French records about palliative care access, programs, and policies and guidelines for people ⩾18 years old who use drugs during communicable disease epidemics and pandemics. Results: Forty-four articles were included in our analysis. We identified limited knowledge about palliative care for people who use drugs during epidemics and pandemics other than HIV/AIDS. Through our thematic synthesis of the records, we generated the following themes: enablers and barriers to access, organizational barriers, structural inequity, access to opioids and other psychoactive substances, and stigma. Conclusions: Our findings underscore the need for further research about how best to provide palliative care for people who use drugs during epidemics and pandemics. We suggest four ways that health systems can be better prepared to help alleviate the structural barriers that limit access as well as support the provision of high-quality palliative care during future epidemics and pandemics. [ABSTRACT FROM AUTHOR]

Objective : The aim of this study was to examine internal responsiveness and estimate minimally important differences (MIDs) for CLEFT-Q scales. Design : In this prospective cohort study, participants completed the CLEFT-Q appearance and health-related quality of life (HRQL) scales before and six months after cleft-related surgery. Setting : Seven cleft centres in Canada, USA and UK participated. Patients/Participants : Patients were ages 8–29 years with CL/P. Interventions : Patients underwent rhinoplasty, orthognathic or cleft lip scar revision surgery. Main Outcome Measure(s) : Internal responsiveness was examined using Cohen's d effect sizes (ESs) based on the following interpretation: 0.20–0.49 small, 0.50–0.79 moderate and ≥ 0.80 large. MIDs were estimated using two distribution-based approaches. Results : Participants had a rhinoplasty (n = 31), orthognathic (n = 21) or cleft lip scar revision (n = 18) surgery. Most participants were males (56%) and aged 8–11 years (41%). Following rhinoplasty, ESs were larger for the nose (0.92, p = 0.001) and nostrils (0.94, p < 0.001) scales than for the face scale (0.51, p = 0.003). MIDs ranged between 6.2–10.4. For orthognathic surgery, larger ES was observed for the jaws scale (1.80, p < 0.001) compared with the teeth (1.16, p < 0.001), face (1.15, p = 0.001) and lips (0.94, p < 0.001) scales. MIDs ranged between 5.9–14.4. In the cleft lip scar revision sample, the largest ES was observed for the nose scale (0.76, p = 0.03), followed by lips (0.58, p = 0.009) and cleft lip scar (0.50, p = 0.043) scales. MIDs ranged between 6.4–12.3. Conclusions : CLEFT-Q detected change in key outcomes for three cleft-specific surgeries, providing evidence of its responsiveness. Estimated MIDs will aid in interpreting this PROM. [ABSTRACT FROM AUTHOR]

Objective: CLEFT-Q is a condition-specific patient-reported outcome measure (PROM) for patients with cleft lip and/or palate (CL/P). The aim of this study was to examine the cross-sectional construct validity of the CLEFT-Q scales. Design: Construct validity was assessed through a prospective study that tested hypotheses regarding correlations of scores with other PROMs that measure related constructs. Setting: Seven cleft centres in Canada, the USA, and UK were involved. Patients/Participants: Patients were aged eight to 29 years with CL/P. Interventions: Before undergoing rhinoplasty, orthognathic, cleft lip scar revision, and alveolar bone graft, participants were asked to complete the following PROMs: CLEFT-Q (9 scales), Child Oral Health Impact Profile (socio-emotional subscale) and Cleft Hearing Appearance and Speech Questionnaire (features 1 subscale). Main Outcome Measure(s): The correlation coefficients examining the relationship between the scales were the main outcome measures. Correlations (Spearman) were calculated and interpreted as follows: <0.3 weak, 0.30 to 0.50 moderate, ≥0.50 strong. Results: Participants (n = 177) were mostly male (61%) and aged between eight and 11 years (42%). Overall, 38 of 52 (73%) hypotheses tested were supported. More specifically, 20 of 26 (77%) hypotheses about correlations between the appearance scales were supported, two of three (67%) hypotheses about correlations between the health-related quality of life scales were supported, and 16 of 23 (70%) hypotheses about correlations between the appearance and health-related quality of life scales were supported. Conclusions: Cross-sectional construct validity of the CLEFT-Q scales adds further evidence of the psychometric properties of this instrument. [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]

This paper considers how three jurisdictions, Canada, the United States and the United Kingdom, have sought to reconcile freedom of religion with equality rights, particularly in the commercial context, and particularly in relation to sexual orientation. The recent decisions of the United Kingdom Supreme Court and United States Supreme Court form the backdrop for that discussion. It is argued that the former made piecemeal, and misleading, use of American case law, and a fuller consideration of that jurisdiction's position was warranted, and would have led to a different view of the recent American decision. It argues that the United Kingdom Supreme Court was in error in viewing a message on a cake ordered from a baker as an example of the baker's expression, leading it to an incorrect conclusion at odds with statutory mandates in the commercial sphere around refusals of service. Both high court decisions risk undermining progress on the equality front. [ABSTRACT FROM AUTHOR]

This article utilises data from two parallel mixed-methods projects to examine attitudes to queer identity among heterosexual Muslim and Christian young adults aged between 18 and 25 in Canada and the UK. Drawing on questionnaires, interviews and video diaries, our analysis revealed the enormous complexity regarding how participants made sense of their, largely contextually mediated, attitudes. A qualitative approach enabled us to carefully consider how these attitudes are forged, formulated and embodied, offering greater nuance and detail compared with attitudinal approaches focused solely on quantitative data. Responses by these young Muslim and Christian participants explore the fluidity and movement in the attitudes expressed, further emphasising complexity. [ABSTRACT FROM AUTHOR]

Social participation in out-of-home activities is important for people living with dementia, yet little is known about such participation. The aim of this study was to explore and compare out-of-home participation among people living with dementia in four countries by assessing different types of places of participation visited or no longer visited. A cross-sectional design was used to gather self-reported experiences concerning out-of-home participation among people with mild stage dementia living in Canada (n = 29), Sweden (n = 35), Switzerland (n = 35) and the UK (n = 64). Interviews were conducted using the Participation in ACTivities and places OUTside the Home for older adults (ACT-OUT) instrument. Participants still visited 16 (Median) places out of a possible total of 24, and they had abandoned 5 (Median) places. Neighbourhood was the place most participants still visited, whereas 50% of them had stopped going to a Sports facility, with no significant differences between country samples regarding how many participants had abandoned that place (Fisher's exact test, p > 0.01). There were significant differences between country samples in the frequency of present participation and abandonment of the Hospital, Dentist's office, Cemetery, Garden, and Forest (Fisher's exact test, all p < 0.01). Although the participants still visited a variety of places, they had stopped going to places previously visited, which indicates reductions in participation, posing an inherent risk to well-being. The similarities and differences across samples from the four countries suggest that healthcare services and access to public transport may contribute to the complex interactional process of out-of-home participation for people living with dementia. The findings highlight the need for initiatives targeting specific types of places to support continued participation in society, especially places at a higher risk of abandonment such as places for recreation and physical activity. [ABSTRACT FROM AUTHOR]

Background: Family caregivers provide the majority of palliative care. The impact of family caregiving on employment and finances has received little research attention in the field of palliative care. Aim: The aim of this study was to explore perspectives and experiences of combining paid employment with palliative care family caregiving, and to assess the availability and suitability of employment support across three countries – the United Kingdom (UK), Aotearoa New Zealand and Canada. Design: A qualitative descriptive study design was used. Semi-structured interviews were held with 30 key informants with professional or personal experience in palliative care from the UK (n = 15), Aotearoa New Zealand (n = 6) and Canada (n = 9). Interviews were recorded, transcribed and analysed using the principles of thematic analysis. Results: Four main themes were identified: (1) significant changes to working practices are required to enable end of life family carers to remain in work; (2) the negative consequences of combining caregiving and employment are significant, for both patient and carer; (3) employer support for working end of life caregivers is crucial but variable and; (4) national, federal and government benefits for working end of life family carers are necessary. Conclusion: Supporting carers to retain employment whilst providing care has potential benefits for the patient at end of life, the caregiver, and the wider economy and labour market. Employers, policymakers and governments have a role to play in developing and implementing policies to support working carers to remain in employment. [ABSTRACT FROM AUTHOR]

The racial demographic shift occurring in many Western countries provides a unique context to study the reactions of a high-power group (White people) to the potential loss of their privileged position in society. Three experiments (N = 77, N = 302, N = 555) conducted in Canada, the US, and the UK showed that White people who are reminded about the ongoing demographic changes and who see race relations as a zero-sum game whereby any gains by minorities must come at the expense of the majority, experience stronger collective angst and, to a lesser extent, fear (but not anger). In turn, collective angst, but not the other negative group-based emotions, fuels their motivation to protect the existing intergroup hierarchy by withdrawing support for progressive social movements and increases anti-immigration sentiments. Downregulating the existential threat experienced by White majorities in the face of a racial demographic shift may be one way to reduce acrimonious behavioral intentions aimed at preserving their place in the social hierarchy. [ABSTRACT FROM AUTHOR]

Non-fatal strangulation is commonly reported by women who have experienced intimate partner violence and it has been identified as both an immediate risk to health and life but also a risk for future serious harm and even death. While some Australian states and Canada have followed the lead of American states in introducing criminal offences of non-fatal strangulation the United Kingdom is yet to do so. Non-fatal strangulation offences have come with challenges of definition and identification. The success of criminal justice responses requires an understanding of the ways in which women understand and describe their non-fatal strangulation victimisation. We analyse 24 women's experiences of non-fatal strangulation as a basis for considering how to ensure that jurisdictions considering introduction of a new non-fatal strangulation offence or reform of an existing offence do not reproduce obstacles to prosecution and legal recognition and suggest a model definition of non-fatal strangulation for an offence. [ABSTRACT FROM AUTHOR]

We used a structured interview to explore approaches to comprehensive hemophilia and arthropathy care among 24 healthcare professionals (HCPs) from multidisciplinary teams (MDTs) in Canada and the UK. Represented MDTs typically comprise a hematologist, nurse, physiotherapist, and sometimes an orthopedic surgeon; pediatric (and some adult) MDTs also include a social worker/psychologist. HCPs emphasized the centrality of a team approach, facilitated through MDT meetings and involvement of all MDT members in patient care. In both countries, nurses and physiotherapists play critical, multifaceted roles. Respondents agreed that MDTs are crucial for successful transitioning, which can be facilitated by close collaboration between pediatric and adult MDTs, even when they are not co-located. Physiotherapists are instrumental in providing non-pharmacological pain relief. Hematologists or physiotherapists typically make orthopedic referrals, with the nurse, physiotherapist and hematologist working together in patient preparation for (and follow-up after) surgery. MDT best practices include a non-hierarchical team approach, ensuring that all MDT members know all patients, and regular MDT meetings. Together, these real-life insights from the MDT perspective emphasize the value of the MDT approach in comprehensive hemophilia care. [ABSTRACT FROM AUTHOR]

The media play a key role in informing public opinion during refugee crises. Representations of refugees in the media shape public understanding of what a 'refugee' is and policy decisions over who to include or to exclude. Although extensive literature has examined representations of refugees in news media, few systematic comparative investigations look at discourses across types of immigration countries. In this article, the author compares news coverage of the Syrian refugee crisis in Canada and the UK, to consider how media discourse is affected by a nation's historical relationship with and current policies of immigration. The author follows existing literature in arguing that the dominant discourses in the newspapers racialize refugees through a 'victim–pariah' couplet, and further argues that this shared model of racialized representation serves the particular nation-building projects and asylum regimes in the two countries. In addition, a comparison between coverage in newspapers that represent divergent political orientations shows that news stories that attempt to 'give voice' to refugees are more prevalent in the more left-leaning newspapers in both countries. Nonetheless, these attempts to 're-humanize' refugees do not invalidate the Orientalist image of refugees as passive victims without agency and history. [ABSTRACT FROM AUTHOR]

Objective: The concepts important to children and young adults who undergo treatments for facial differences are not well-defined. Measurement of treatment outcomes from the patient's perspective is necessary to ensure goals of treatment are met. We aimed to identify concepts important to children and young adults with facial differences through a qualitative study. Design: An interpretive description qualitative approach was followed. Semistructured interviews were conducted, transcribed verbatim, and coded using a line-by-line approach. Qualitative analysis led to the development of a conceptual framework of outcomes important to patients. Setting: Interviews were conducted in Canada and the United Kingdom at home, by telephone, or in the hospital. Participants: Participants (N = 72) were recruited between May and June 2014 from craniofacial clinics at the Hospital for Sick Children (Toronto) and Great Ormond Street Hospital (London). Participants included anyone with a visible and/or functional facial difference aged 8 to 29 years and fluent in English, excluding patients with a cleft. The sample included 38 females and 34 males, with a mean age of 13.9 years, and included 28 facial conditions (11 facial paralysis, 18 ear anomalies, 26 skeletal conditions, and 17 soft tissue conditions). Results: Analysis led to identification of important concepts within 4 overarching domains: facial appearance, facial function, adverse effects of treatment, and health-related quality of life (psychological, social, and school function). Conclusions: Our study provides an understanding of concepts important to children and young adults with facial differences. [ABSTRACT FROM AUTHOR]

Background: End-of-life doulas are emerging as a potentially important new form of community-based caregiving in the global North, yet we know little about this form of care. The aim of our study was to solicit the perspective of key stakeholders and early innovators in community-based end-of-life care about the development and practices of end-of-life doulas. Methods: We conducted 22 semi-structured interviews with participants in four countries where end-of-life doulas are most active: Australia, Canada, the United States, and the United Kingdom. Findings: This article focuses on participants' description of the end-of-life doula role and attendant practices, and our findings provide the first detailed taxonomy of the end-of-life doula role and specific services on the basis of the perspective of subject experts in four countries. We situate our findings within literature on the professionalization of caregiving, with particular attention to nomenclature, role flexibility and boundary blurring, and explicit versus tacit knowledge. We also discuss the importance of jurisdictional considerations as the end-of-life doula movement develops. Discussion: We speculate that the end-of-life doula role is potentially experiencing common developmental antecedents similar to other now-professionalized forms of caregiving. Our findings contribute substantial new information to the small body of empirical research about the end-of-life doula role and practices, provide critical firsthand insight as the movement develops, and are the first research to explore end-of-life doulas from a comparative international perspective. [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]

In recent years, the Supreme Courts of Canada and the United Kingdom have decided very similar cases on the permissibility of high fees for access to adjudication. The outcomes of the cases were similar: the fees were struck down. In the Canadian case, they were held to infringe s 96 of the Constitution Act, 1867; in the United Kingdom, they were said to be a violation of the common law right of access to courts not authorized by statute. Yet a comparison of the reasoning of the two supreme courts is instructive. While the UK Supreme Court forthrightly and thoughtfully engaged with the impact of the fees at issue on the Rule of Law, the Canadian one failed to do so and instead relied on a strained interpretation of a constitutional provision of questionable relevance. This suggests that, perhaps surprisingly, legality review, being less bound up with constitutional text and causing courts less anxiety about its legitimacy, can allow the courts better to canvass the real issues cases implicating constitutional rights and principles present than constitutionality review. [ABSTRACT FROM AUTHOR]

The vast majority of research and efforts towards greater care coordination have taken place at the level of single, sovereign organizations, or at the level of networks formed to address the need for cross-organizational collaboration. The recently emerging ecosystem level of analysis and intervention is still under-researched, with few if any available innovation practices that match the complexity experienced at the level of care ecosystems. Beginning with the challenge of care coordination, we discuss what care ecosystems are and how they can be defined and describe the possibilities and opportunities that come when viewing care coordination through an ecosystem lens. We underpin our plea for an ecosystem approach to health and social care coordination with seven lessons, which we draw from an extensive study of 15 care ecosystem cases from seven different countries. We end the paper with an appeal for further research in this promising field. [ABSTRACT FROM AUTHOR]

The clinical symptoms of dementia include difficulty with speech, poor short-term memory, and changes in behavior. These symptoms can affect how the person with dementia understands and performs in social interactions. This qualitative review investigated how people with mild to moderate dementia managed social connections. A systematic search of social science databases retrieved 13 articles; data were synthesized using thematic analysis. Results established the work undertaken by people with dementia to maintain and present a social persona seen as socially acceptable. Interpretations are contextualized within Goffman and Sabat's theories on "self." People with dementia were agentic in impression management: undertaking work to maintain recognized social roles, while being aware of when their illness led to others discrediting them. Wider recognition of strategies used to maintain a social self could inform interventions designed to increase capability and confidence in co-managing social connections following dementia diagnosis. [ABSTRACT FROM AUTHOR]

In the 1920s, guanidine, the active component of Galega officinalis, was shown to lower glucose levels and used to synthesize several antidiabetic compounds. Metformin (1,1 dimethylbiguanide) is the most well-known and currently the only marketed biguanide in the United States, United Kingdom, Canada, and Australia for the treatment of non-insulin-dependent diabetes mellitus. Although phenformin was removed from the US market in the 1970s, it is still available around the world and can be found in unregulated herbal supplements. Adverse events associated with therapeutic use of biguanides include gastrointestinal upset, vitamin Bi 2 deficiency, and hemolytic anemia. Although the incidence is low, metformin toxicity can lead to hyperlactatemia and metabolic acidosis. Since metformin is predominantly eliminated from the body by the kidneys, toxicity can occur when metformin accumulates due to poor clearance from renal insufficiency or in the overdose setting. The dominant source of metabolic acidosis associated with hyperlactatemia in metformin toxicity is the rapid cytosolic adenosine triphosphate (ATP) turnover when complex I is inhibited and oxidative phosphorylation cannot adequately recycle the vast quantity of H + from ATP hydrolysis. Although metabolic acidosis and hyperlactatemia are markers of metformin toxicity, the degree of hyperlactatemia and severity of acidemia have not been shown to be of prognostic value. Regardless of the etiology of toxicity, treatment should include supportive care and consideration for adjunct therapies such as gastrointestinal decontamination, glucose and insulin, alkalinization, extracorporeal techniques to reduce metformin body burden, and metabolic rescue. [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]

It is frequently of interest to estimate the time that individuals survive with a disease, that is, to estimate the time between disease onset and occurrence of a clinical endpoint such as death. Epidemiologic survival data are commonly collected from either an incident cohort, whose members' disease onset occurs after the study baseline date, or from a cohort with prevalent disease that is followed forward in time. Incident cohort survival data are limited by study termination, while prevalent cohort data provide biased (left-truncated) survival data. In this article, we investigate the advantages of a study design featuring simultaneous follow-up of prevalent and incident cohorts to the estimation of the survivor function. Our analyses are supported by simulations and illustrated using data on survival after myotonic dystrophy diagnosis from the United Kingdom Clinical Practice Research Datalink (CPRD). We demonstrate that the NPMLE using combined incident and prevalent cohort data estimates the true survivor function very well, even for moderate sample sizes, and ameliorates the disadvantages of using a purely incident or prevalent cohort. [ABSTRACT FROM AUTHOR]

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

The withdrawal of the UK from the EU, if and when it occurs, will likely imply that Canada must conclude a new bilateral trade agreement with the UK. In light of recent trends toward an increasing politicization of trade negotiations, this policy brief assesses the respects in which a Canada–UK agreement could become politically controversial. Drawing on explanations for the politicization of recent trade deals, it identifies potential flashpoints for political conflict in the Canada–UK trade relationship. It then discusses how policy-makers can channel trade-related controversies into the policy process in an inclusive and evidence-based manner. [ABSTRACT FROM AUTHOR]

In the midst of a wider resurgence of feminist activism, it is timely to ask whether current efforts to address gender-based violence (GBV) on campus are adequate. This guest editors' introduction to the special issue considers whether our attention should be on transforming, rather than simply adapting, university environments. While critiquing adaptive approaches rooted in "compliance culture", it sets out key elements of transformative approaches to GBV on campus. It introduces the articles in this special issue and their discussions about efforts to transform university environments in Canada, America and the United Kingdom. It finishes by highlighting enduring barriers to transformational work and areas for further investigation in our efforts to make institutions of higher education safe for all. [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]

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]

The diagnostic process promises a label that validates patients' embodied experiences and a road map for living with and treating illness. Drawing on 31 qualitative interviews with women and men in Canada and the United Kingdom who have been diagnosed with fibromyalgia (FM), in this article, I examine the participants' experiences of the diagnostic process and how they feel about receiving this label. The interviews reflect that the FM label is plagued by uncertainty because the diagnosis is based on the absence of verifiable pathology. The respondents' narratives also reveal that FM is a vague diagnosis that includes a multitude of symptoms, overlaps with several other diagnoses, and results in feelings of doubt regarding whether it is the correct label. Thus, the participants' narratives reflect that the FM diagnosis is largely an empty promise because it fails to provide definitive answers or confer meaning and legitimacy to their illness experiences. [ABSTRACT FROM AUTHOR]

Background: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. Objective: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators' selection and use of published texts and film. Methodology: This study employed discourse analysis. Participants and research context: A total of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. Findings: The desire to understand others and how to care compassionately characterised educators' choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance of connecting with others as a central component of compassionate caring, 10 identified the burden of caring, 24 identified themes of abandonment and of failure to see the suffering person and 15 narratives showed a discourse of only showing compassion to those 'deserving' often understood as the suffering person doing enough to help themselves. Discussion: These findings are mostly consistent with work in moral philosophy emphasising the particular or context and perception or vision as well as the necessity of emotions. The narratives themselves are used by nurse educators to help explicate examples of caring and compassion (or its lack). Conclusion: To feel cared about people need to feel 'visible' as though they matter. Nurses need to be alert to problems that may arise if their 'moral vision' is influenced by ideas of desert and how much the patient is doing to help himself or herself. [ABSTRACT FROM AUTHOR]

The purpose of this article is to measure and compare the volume and the trend of strike activity in five countries: Australia, Canada, Great Britain, Sweden, and the United States. Such a comparison ought to throw light on a number of pertinent and persistent questions which have been frequently asked but never satisfactorily answered: (1) As the labor movement grows older, larger, and more powerful, what is the effect upon the frequency of strikes and the length of strikes? In other words, is the inherent tendency of trade unionism belligerent or conciliatory? Our total judgment of unionism will depend to a considerable extent on the answer to this question. (2) Is the strike problem more severe in the United States than elsewhere and, if so, why? (3) In general, what are the economic and political institutions conducive to a high, or low, volume of strike activity? (4) Is there any valid theory of strikes explaining their underlying causes? [ABSTRACT FROM AUTHOR]

The article focuses on the use of evidence-based psychotherapy (EBP) in Canada. It comments on the use of cognitive behavioral therapy (CBT) in treating mild and moderate depression and can also help cancer patients cope with chemotherapy or assist overweight people with weight management. It mentions that EBP like CBT have limited availability in public health care systems due to the investment of time and resources. It talks about improve access to EBP in Britain's National Health Service.

Theater-based interventions are a viable prevention strategy for changing sexual health knowledge, attitudes, and behaviors related to HIV prevention. However, few studies have explored interventions in English-speaking, high-income countries such as the United States, Canada, or the United Kingdom. This article critically reviews the literature to identify key characteristics of theater-based HIV prevention strategies used for adolescents in school-settings in the United States, Canada, and the United Kingdom. Specifically, we identify the theatrical approach used in HIV prevention interventions, the behavioral theories that inform such interventions, and the study design and results of existing evaluation studies conducted in school settings. In the 10 articles reviewed, we found limited grounding in theory and the use of nonrigorous study design. To strengthen the evidence and practical application of theater-based HIV prevention interventions, we highlight three specific recommendations for practitioners and researchers: (1) define and operationalize the theater approach and techniques used, (2) ensure theater-based interventions are grounded in theory, and (3) conduct rigorous evaluation of theater-based interventions. These recommendations are key to strengthening future research on and implementation of theater-based interventions for HIV prevention. [ABSTRACT FROM AUTHOR]

Every day minority migrant nurses (MMNs) work shoulder to shoulder with domestic nurses in health care settings worldwide. Published studies offer reports of research where work-life experiences of MMNs have been explored. The following literature review focuses on experiences of perceived prejudice and discrimination as described by MMNs. Background and significance of the topic are described and the purpose of the review is presented, followed by definitions of relevant terms, search strategy, and theoretical considerations. Feagin and Eckberg's discrimination typology is the framework used to organize MMNs' reported experiences of perceived prejudice and discrimination. A theory-linked summary, including policy, practice, and research implications, concludes the article. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists can improve the quality of life of people receiving palliative care through the management of communication and swallowing difficulties (dysphagia). However, their role in this domain is poorly defined and little is understood about the current international professional practice in this field. Aims: To examine how speech and language therapists perceive their role in the delivery of palliative care to clients, to discover current international speech and language therapist practices and to explore the similarities and differences in speech and language therapists’ practice in palliative care internationally. This will inform professional clinical guidelines and practice in this area.Design:Anonymous, non-experimental, cross-sectional survey design.Participants:Speech and language therapists working with adult and paediatric palliative care populations in Republic of Ireland, United Kingdom, United States, Canada, Australia and New Zealand where the speech and language therapist profession is well established. Method: Purposive and snowball sampling were used to recruit participants internationally using gatekeepers. An online survey was disseminated using Survey Monkey (http://www.surveymonkey.com). Results: A total of 322 speech and language therapists responded to the survey. Speech and language therapist practices in palliative care were similar across continents. Current speech and language therapist practices along with barriers and facilitators to practice were identified. The need for a speech and language therapist professional position paper on this topic was emphasised by respondents. Conclusion: Internationally, speech and language therapists believe they have a role in palliative care. The speech and language therapist respondents highlighted that this area of practice is under-resourced, under-acknowledged and poorly developed. They highlighted the need for additional research as well as specialist training and education for speech and language therapists and other multidisciplinary team members in the area of palliative care. [ABSTRACT FROM AUTHOR]

The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase. [ABSTRACT FROM PUBLISHER]

Domestic/Family Violence Death Reviews (D/FVDRs) have been established in a number of high-income countries since 1990 as a mechanism to inform prevention-focused interventions to reduce domestic/family violence. D/FVDRs differ in their structure, governance, case identification processes and inclusion criteria, review measures, and outputs. Outside of the United States, the extent of heterogeneity across and within countries has not been explored. This study comprised an international comparison of D/FVDRs and their core elements to inform the establishment of D/FVDRs in other developed countries, and potentially low- and middle-income countries where violence is a leading cause of death. Such a review is also a necessary foundation for any future evaluation D/FVDRs. The review identified 71 jurisdictions where a D/FVDRs had been established in the past two decades, 25 of which met the inclusion criteria. All D/FVDRs examined stated a reduction in deaths as a goal of the review process; however, none reported an actual reduction. The focus of the D/FVDRs examined was on intimate partner homicides; however, more recently established D/FVDRs include other familial relationships. Almost one third of the D/FVDRs examined reported changes to the domestic/family system that occurred as a result of recommendations made from the review process. While similar in many ways, D/FVDRs differ along a number of important dimensions that make it difficult to identify best practices for jurisdictions considering the establishment of such an initiative. To share knowledge, existing networks should be expanded nationally and internationally to include jurisdictions that may be considering this initiative. [ABSTRACT FROM AUTHOR]

The article discusses a study on the perception of nursing students/ educators on the contribution of ethics education to ethical competence of nursing students. It addresses questions including how they look at general contribution of ethics education, contribution of ethics education to ethical competence and features of ethics education needed to promote ethical competence. It suggests that ethics education adds to the ethical awareness and ethical reasoning competencies of nursing students.

The purpose of this article is to provide specific recommendations to enhance physician engagement in health care organizations. It summarizes the evidence on physician engagement, drawing on peer-reviewed articles and reports from the gray literature, and suggests an integrative framework to help health care managers better understand and improve physician engagement. While we examine some other international examples and experiences, we mainly focus on physician engagement in Canada, the United States, and the United Kingdom. Physician engagement can be conceptualized as an ongoing two-way social process in which both the individual and organizational/cultural components are considered. Building on several frameworks and examples, we propose a new integrative framework for enhancing physician engagement in health care organizations. We suggest that in order to enhance physician engagement, organizations should focus on the following strategies: developing clear and efficient communication channels with physicians; building trust, understanding, and respect with physicians; and identifying and developing physician leaders. We propose that the time is now for health care managers to set aside traditional differences and historical conflicts and to engage their physicians for the betterment of their organizations. [ABSTRACT FROM AUTHOR]

The historiography of asylums and insanity is dense, and some topics have received much scholarly attention but others, such as insanity among children, have been largely neglected. Children by no means formed the majority of asylum populations, but they still suffered from mental impairment and were admitted to these institutions in significant numbers. Identifying the various experiences of insane children is the central goal of this research, but the asylum will not be the sole emphasis. The focus is to place child mental deficiency within a broader context of extramural care. By examining workhouses, the role of family, and philanthropic attempts to deal with insane children, this article will move beyond current historical thinking on the topic; traditional views of childhood, insanity and charity will be challenged, and will show that a much wider world than the locality was accessible to the insane child. [ABSTRACT FROM PUBLISHER]