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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]

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]

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 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]

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 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]

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 problem of staff-to-staff bullying and its consequences in the health care sector has given rise to urgent knowledge needs among health care employers, union representatives, and professional associations. The purpose of this scoping review is to increase the uptake and application of synthesized research results of interventions designed to address bullying among coworkers within health care workplaces. The scoping review’s methodology uses an adapted version of the Arksey and O’Malley framework to locate and review empirical studies involving interventions designed to address bullying in health care workplaces. The findings of the review reveal eight articles from three countries discussing interventions that included educative programming, bullying champions/advocates, and zero-tolerance policies. The reported evaluations extend beyond bullying to include organizational culture, trust in management, retention rates, and psychosocial health. The most promising reported outcomes are from participatory interventions. The results of the review make a compelling case for bullying interventions based on participatory principles. [ABSTRACT FROM PUBLISHER]

Some children adopted under the now discredited period of closed adoption were never told of their adoptive status until it was revealed to them in adulthood. Yet to date, this ‘late-discovery’ experience has received little research attention. Now a new generation of ‘late discoverers’ is emerging as a result of (heterosexual couple) donor insemination (DI) practices. This study of 25 late-discovery participants of either adoptive or (heterosexual couple) DI offspring status reveals ethical concerns particular to the lateness of discovery. Most of the participants were Australian, with the remainder from the UK, USA and Canada. All were asked to give an ‘open’ account of their experience, with four themes or suggestions provided on request. These accounts were added to those available in relevant publications. The analysis employed a hermeneutic phenomenological methodology and all accounts were analysed using an ethical perspective developed by Walker (2006, 2007). The main themes that emerged were: disrupted personal autonomy, betrayal of deep levels of trust and feelings of injustice and diminished self-worth. The lack of recognition of concerns particular to late discovery has resulted in late discoverers (i) feeling unable to regain a sense of personal control, (ii) significantly disrupted relationships with those closest to them and others, including community and institutions, and (iii) feelings of diminished value and self-worth. [ABSTRACT FROM PUBLISHER]

Intimate partner violence (IPV) is a global public health concern with significant physical, emotional, and economic costs. Persuading IPV perpetrators to change their behavior could play an important role in ending violence. This article reviews and analyzes 16 campaigns targeting IPV perpetrators, created in the United States, Canada, United Kingdom, Australia, and New Zealand. Two well-known models, the Transtheoretical (Stages of Change) model and Protection Motivation theory (PMT), are combined to create the analytical framework. For each stage of change, the most salient PMT variables are outlined, the people found in that stage are described, and the most effective strategies for persuasion are posited. Together, these two models would suggest that future campaigns targeting IPV perpetrators should place a stronger emphasis on the benefits of changing and place a greater focus on increasing perpetrators’ confidence that they can abstain from violence. [ABSTRACT FROM PUBLISHER]

Coverage with evidence development (CED) has been developed as a response to the uncertainty in evidence when new technologies, including pharmaceuticals, are introduced into the market. Rather than deny coverage for these technologies or grant them unlimited coverage, CED attempts to ensure that patients' access to new medications is not prevented but is managed in a coordinated way, while also generating additional evidence to reduce any uncertainty about the value of the medications. CED projects are currently operating in Australia, Canada, the United Kingdom, and the United States. However, decision-making about these projects is haphazard, and basic information about the projects is not publicly available. As a new policy development there are many unanswered policy questions, and no organized comprehensive strategy seems to be in place in any country for resolving these questions. Until these policy issues have been addressed, CED will have difficulty achieving its potential. [ABSTRACT FROM AUTHOR]

Introduction: Occupation-focused models are one method of integrating occupation into occupational therapy education programmes. They offer a theoretical basis for practice by providing explanations about the process and practice of the profession. Method: This exploratory study used a quantitative research framework to investigate which occupation-focused models are included in occupational therapy programmes, the rationale for their inclusion and how the models are integrated into curricula. A survey was sent to 193 occupational therapy programmes in Australia, Canada, the United Kingdom and the United States. Results: The response rate was 33.8% (n = 65). The data showed that each programme included between 3 and 10 occupation-focused models. The Canadian Model of Occupational Performance and Engagement and the Model of Human Occupation were included in 98.5% of all curricula surveyed. Conclusion: The educators used a multilayered decision-making process to determine which occupation-focused models to include in a curriculum. The instructional methods varied, but most programmes used practice placement education as a teaching strategy. Further research is required into how curriculum design influences a practitioner's future use of occupation-focused models in practice. A better understanding is needed of how professional practice education affects students' values and attitudes towards the use of occupation-focused models. [ABSTRACT FROM AUTHOR]

The article reports on events and changes related to the judicial system of several countries including Australia, Canada and Great Britain. It states that Victoria and New South Wales released publications that recommend changes to the complex trial system of Australia on criminal cases. It adds that the Law Society published reports regarding evidence presentation in England and the European Union (EU). Moreover, it offers information on the Coroners and Justice Act of 2009 of Great Britain.

The article presents an opinion on the Canada Supreme Court's judgment in the case entitled "Blank v. Canada (Minister of Justice)", regarding litigation privilege. The Supreme Court ruled that litigation privilege ends when the proceedings that gave rise to it are completed. The implications of the judgment on the procedure and practice of law in Canada, Australia, and Great Britain are discussed.

N-benzylpiperazine (BZP) is the active ingredient in recreational 'party' or 'p.e.p.' pills, which are used to provide a stimulant, euphoric effect akin to that of methylenedioxymethamphetamine (NDMA, 'ecstasy'). BZP predominantly affects dopamine neurotransmission in a similar fashion to known 'drugs of abuse', such as methamphetamine and cocaine, which strongly suggests BZP has abuse liability. BZP is illegal in many countries including the United States of America and Australia, yet it remains legal in the United Kingdom, Canada and New Zealand. There has been little research, to date, on the neurological consequences of high dose or chronic exposure of BZP. Here we provide a comprehensive review of the information currently available on BZP and suggest a need for further research into the mechanisms of action, long-term effects and potentially addictive properties of BZP. [ABSTRACT FROM AUTHOR]

Study Objective. Suicide is a serious health problem that is shaped by a variety of social and mental health factors. A growing body of research connects the arts to positive health outcomes; however, no previous systematic reviews have examined the use of the arts in suicide prevention and survivorship. This review examined how the arts have been used to address suicide prevention and survivorship in nonclinical settings in Australia, Canada, the United Kingdom, and the United States of America. Design and Setting. Ten bibliographic databases, five research repositories, and reference sections of articles were searched to identify published studies. Articles presenting outcomes of interventions conducted between 2014 and 2019 and written in English, were included. Primary Results. Nine studies met inclusion criteria, including qualitative, quantitative randomized controlled trials, quantitative nonrandomized, quantitative descriptive, and mixed-methods studies. The programs studied used film and television (n = 3), mixed-arts (n = 3), theatre (n = 2), and quilting (n = 1). All nine interventions used the arts to elicit emotional involvement, while seven also used the arts to encourage engagement with themes of health. Study outcomes included increased self-efficacy, awareness of mental health issues, and likelihood for taking action to prevent suicide, as well as decreases in suicidal risk and self-harming behaviors. Conclusions. Factors that influence suicide risk and survivorship may be effectively addressed through arts-based interventions. While the current evidence is promising with regard to the potential for arts programs to positively affect suicide prevention and survivorship, this evidence needs to be supplemented to inform recommendations for evidence-based arts interventions. [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]

A secondary analysis of 25 national surveys of voting behavior in Australia, Britain, Canada, and the United States provides support in 21 instances for the thesis that status inconsistency between occupational class and socio-religious group increases liberal or left of center tendencies. Britain appears to be an exception to the pattern, possibly reflecting the relatively homogeneous religious composition of the British population, and a resulting lack of saliency of socio-religious group status. [ABSTRACT FROM AUTHOR]