Search

The article discusses the interest of New Zealand of building a strong relationship with the U.S. and its accommodation of China. It examines the transformation of power in the Asia-Pacific region such as the shift of the locus of global power to Asia and the changes within the region's distribution of power. It offers the analysis of Australian National University professor of strategic studies Hugh White and Hedley Bull on the major power relations and its implications on New Zealand policy.

Background: International and migrant students face specific challenges which may impact their mental health, well-being and academic outcomes, and these may be gendered experiences. The purpose of this scoping review was to map the literature on the challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries, with a gender lens. Methods: We searched 10 databases to identify literature reporting on the challenges, coping responses and/or supportive interventions for international and migrant nursing students in college or university programs in Canada, the United-States, Australia, New Zealand or a European country. We included peer-reviewed research (any design), discussion papers and literature reviews. English, French and Spanish publications were considered and no time restrictions were applied. Drawing from existing frameworks, we critically assessed each paper and extracted information with a gender lens. Results: One hundred fourteen publications were included. Overall the literature mostly focused on international students, and among migrants, migration history/status and length of time in country were not considered with regards to challenges, coping or interventions. Females and males, respectively, were included in 69 and 59% of studies with student participants, while those students who identify as other genders/sexual orientations were not named or identified in any of the research. Several papers suggest that foreign-born nursing students face challenges associated with different cultural roles, norms and expectations for men and women. Other challenges included perceived discrimination due to wearing a hijab and being a 'foreign-born male nurse', and in general nursing being viewed as a feminine, low-status profession. Only two strategies, accessing support from family and other student mothers, used by women to cope with challenges, were identified. Supportive interventions considering gender were limited; these included matching students with support services' personnel by sex, involving male family members in admission and orientation processes, and using patient simulation as a method to prepare students for care-provision of patients of the opposite-sex. Conclusion: Future work in nursing higher education, especially regarding supportive interventions, needs to address the intersections of gender, gender identity/sexual orientation and foreign-born status, and also consider the complexity of migrant students' contexts. [ABSTRACT FROM AUTHOR]

Background: Since the early 90s, patient navigation programs were introduced in the United States to address inequitable access to cancer care. Programs have since expanded internationally and in scope. The goals of patient navigation programs are to: a) link patients and families to primary care services, specialist care, and community-based health and social services (CBHSS); b) provide more holistic patient-centred care; and, c) identify and resolve patient barriers to care. This paper fills a gap in knowledge to reveal what is known about motivators and factors influencing implementation and maintenance of patient navigation programs in primary care that link patients to CBHSS. It also reports on outcomes from these studies to help identify gaps in research that can inform future studies.Methods: This scoping literature review involved: i) electronic database searches; ii) a web site search; iii) a search of reference lists from literature reviews; and, iv) author follow up. It included papers from Canada, the United States, the United Kingdom, Australia, New Zealand, and/or Western Europe published between January 1990 and June 2013 if they discussed navigators or navigation programs in primary care settings that linked patients to CBHSS.Results: Of 34 papers, most originated in the United States (n = 29) while the remainder were from the United Kingdom, Canada and Australia. Motivators for initiating navigation programs were to: a) improve delivery of health and social care services; b) support and manage specific health needs or specific population needs, and; c) improve quality of life and wellbeing of patients. Eleven factors were found to influence implementation and maintenance of these patient navigation programs. These factors closely aligned with the Diffusion of Innovation in Service Organizations model, thus providing a theoretical foundation to support them. Various positive outcomes were reported for patients, providers and navigators, as well as the health and social care system, although they need to be considered with caution since the majority of studies were descriptive.Conclusions: This study contributes new knowledge that can inform the initiation and maintenance of primary care patient navigation programs that link patients with CBHSS. It also provides directions for future research. [ABSTRACT FROM AUTHOR]

Background: People living in rural and remote communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. The aim of this paper was to describe the characteristics and outcomes of studies investigating innovative models of care for people living with chronic disease in rural areas of developed countries where a metropolitan comparator was included.Methods: An integrative systematic review was undertaken. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to understand the empirical and theoretical data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom.Results: Literature searching revealed 620 articles published in English between 1st January 2000 and 31st March 2019. One hundred sixty were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease; 27% (43) diabetes mellitus; 8% (12) chronic obstructive pulmonary disease; and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations.Conclusions: This integrated review reveals that the published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease. [ABSTRACT FROM AUTHOR]

Background: Indigenous children living in high income countries have a consistently high prevalence of mental health problems. We aimed to identify psychosocial risk and protective factors for mental health in this setting. Methods: A systematic review of studies published between 1996 and 2016 that quantitatively evaluated the association between psychosocial variables and mental health among Indigenous children living in high income countries was conducted. Psychosocial variables were grouped into commonly occurring domains. Individual studies were judged to provide evidence for an association between a domain and either good mental health, poor mental health, or a negligible or inconsistent association. The overall quality of evidence across all studies for each domain was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines. Results: Forty-seven papers were eligible (mainland US 30 [64%], Canada 8 [17%], Australia 7 [15%], Hawaii 4 [9%]), including 58,218 participants aged 4-20 years. Most papers were cross-sectional (39, 83%) and measured negative mental health outcomes (41, 87%). Children's negative cohesion with their families and the presence of adverse events appeared the most reliable predictors of increased negative mental health outcomes. Children's substance use, experiences of discrimination, comorbid internalising symptoms, and negative parental behaviour also provided evidence of associations with negative mental health outcomes. Positive family and peer relationships, high self-esteem and optimism were associated with increased positive mental health outcomes. Conclusions: Quantitative research investigating Indigenous children's mental health is largely cross-sectional and focused upon negative outcomes. Indigenous children living in high income countries share many of the same risk and protective factors associated with mental health. The evidence linking children's familial environment, psychological traits, substance use and experiences of discrimination with mental health outcomes highlights key targets for more concerted efforts to develop initiatives to improve the mental health of Indigenous children. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth. Methods: Fifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels. Results: Twenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains. Conclusion: There is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth. [ABSTRACT FROM AUTHOR]

Although seafood is considered to be an important part of a balanced diet, many national food consumption surveys suggest that seafood is not consumed in sufficient amounts. As consumers are moving to diversify their diet from animal-based protein, it is important to understand the factors influencing consumption of marine foods. This review aims to assess the characteristics of seafood consumers as well as the influences on seafood consumption in Europe, USA, Canada, Australia and New Zealand. Systematic search strategies were used to identify relevant journal articles from three electronic databases (PubMed, Web of Science and Embase). Three searches were carried out and identified 4405 unique publications from which 121 met the criteria for the review process. The reviewed studies revealed that seafood consumers were more likely to be older, more affluent and more physically active and were less likely to smoke compared with non-seafood consumers. Sex and BMI did not appear to have a directional association with seafood consumption. The most commonly reported barriers to seafood consumption were cost, followed by sensory or physical barriers, health and nutritional beliefs, habits, availability and cooking skills. The most commonly reported influences were beliefs about the contribution of seafood to health, environmental influences and personal preferences. Based on the findings of this review, future intervention strategies to increase seafood consumption may need to consider affordability and education in terms of health, nutrition and cooking skills. More research is needed to explore the effectiveness of specific interventions at increasing the consumption of seafood. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to address assumptions about the prevalence of change in human resource management (HRM) and organizational change literature, providing evidence from employee perceptions across three countries. The results indicate change was commonplace even before the pandemic disruptions of 2020. Design/methodology/approach: Given this study's exploratory, employee perspective, a cross-sectional self-report survey was used. Three survey panel samples were collected in 2017: US (n = 718), Australia (n = 501) and New Zealand (n = 516). Analysis of variance was used to test whether the prevalence of change differed significantly between countries or specific groups of employees. An analysis of comments on change types and emotional response provides further insights. Findings: The paper provides evidence of the ubiquity of change: 73% of employees are experiencing change at work and 42% perceived it as moderate to massive, with little variation between countries. Employees commonly experience more than one change, with those experiencing large amounts of change reporting predominantly negative emotional impacts. Research limitations/implications: The research provides a snapshot across three countries during a prosperous and relatively stable period, providing a point of comparison for the turbulent times we have faced in 2020" as the publication date will be 2021 the current text may not work as well. Since change can be arduous, the authors recommend that HRM researchers consider change prevalence as a contextual factor, and practitioners heed employee reactions to change, particularly during periods of significant change. Originality/value: In providing foundational evidence of change ubiquity in contemporary workplaces, this paper enables more accurate discussions regarding change. [ABSTRACT FROM AUTHOR]

Background WHO estimates that seasonal influenza epidemics result in three to five million cases of severe illness (hospitalisations) every year. We aimed to improve the understanding of influenza-associated hospitalisation estimates at a national and global level. Methods We performed a systematic literature review of English- and Chinese-language studies published between 1995 and 2020 estimating influenza-associated hospitalisation. We included a total of 127 studies (seven in Chinese) in the meta-analysis and analyzed their data using a logit-logistic regression model to understand the influence of five study factors and produce national and global estimates by age groups. The five study factors assessed were: 1) the method used to calculate the influenza-associated hospitalisation estimates (rateor time series regression-based), 2) the outcome measure (divided into three envelopes: narrow, medium, or wide), 3) whether every case was laboratory-confirmed or not, 4) whether the estimates were national or sub-national, 5) whether the rates were based on a single year or multiple years. Results The overall pooled influenza-associated hospitalisation rate was 40.5 (95% confidence interval (CI) = 24.3-67.4) per 100 000 persons, with rates varying substantially by age: 224.0 (95% CI = 118.8-420.0) in children aged 0-4 years and 96.8 (95% CI = 57.0-164.3) in the elderly aged >65 years. The overall pooled hospitalisation rates varied by calculation method; for all ages, the rates were significantly higher when they were based on rate-based methods or calculated on a single season and significantly lower when cases were laboratory-confirmed. The national hospitalisation rates (all ages) varied considerably, ranging from 11.7 (95% CI = 3.8-36.3) per 100 000 in New Zealand to 122.1 (95% CI = 41.5-358.4) per 100 000 in India (all age estimates). Conclusions Using the pooled global influenza-associated hospitalisation rate, we estimate that seasonal influenza epidemics result in 3.2 million cases of severe illness (hospitalisations) per annum. More extensive analyses are required to assess the influence of other factors on the estimates (e.g. vaccination and dominant virus (sub)types) and efforts to harmonize the methods should be encouraged. Our study highlights the high rates of influenza-associated hospitalisations in children aged 0-4 years and the elderly aged 65+ years. [ABSTRACT FROM AUTHOR]

Background: It is widely acknowledged that there is a global divide on health care and health research known as the 10/90 divide. Methods: A retrospective survey of articles published in the BMJ, Lancet, NEJM, Annals of Internal Medicine & JAMA in a calendar year to examine the contribution of the developing world to medical literature. We categorized countries into four regions: UK, USA, Other Euro-American countries (OEAC) and (RoW). OEAC were European countries other than the UK but including Australia, New Zealand and Canada. RoW comprised all other countries. Results: The average contribution of the RoW to the research literature in the five journals was 6.5%. In the two British journals 7.6% of the articles were from the RoW; in the three American journals 4.8% of articles were from RoW. The highest proportion of papers from the RoW was in the Lancet (12%). An analysis of the authorship of 151 articles from RoW showed that 104 (68.9%) involved authorship with developed countries in Europe or North America. There were 15 original papers in these journals with data from RoW but without any authors from RoW. Conclusions: There is a marked under-representation of countries in high-impact general medical journals. The ethical implications of this inequity and ways of reducing it are discussed. [ABSTRACT FROM AUTHOR]

The aim of this study is to identify the most prolific countries in the field of special education and to discuss the widespread impact of their papers by taking into account the country's h-index. Through a bibliometric analysis, the data were collected in the Web of Science Core Collection category "Education, Special" in the Social Science Citation Index during 2011-2020. The 25 most prolific countries in the field of special education were determined in terms of paper productivity, and it was seen that the leading country was undisputedly the USA (54.42%). Meanwhile, a strong positive correlation was found between the h-index and the number of papers published by the countries (r=0.864). On the other hand, when the ranking in terms of the number of papers was reconfigured by the h-index, it was relatively changed. The possible reasons for this change for the countries with the most changing rankings were discussed by considering some definitive criteria such as the journal quartiles, the percentage of international and domestic, and the percentage of open access papers. This study reports a positive correlation between the quality and quantity in the field of special education for the publications of countries. It has been shown that where the positive correlation deviates, then especially, the journal quartiles, the percentage of international collaboration and the percentage of open access papers have a significant effect. The bibliometric findings may be useful to enrich the discussion about the widespread impact of papers and debate whether the use of h-index is acceptable for cross-national comparisons.

Introduction: Healthcare organisations serve clients from diverse Indigenous and other ethnic and racial groups on a daily basis, and require appropriate client-centred systems and services for provision of optimal healthcare. Despite advocacy for systems-level approaches to cultural competence, the primary focus in the literature remains on competency strategies aimed at health promotion initiatives, workforce development and student education. This paper aims to bridge the gap in available evidence about systems approaches to cultural competence by systematically mapping key concepts, types of evidence, and gaps in research. Methods: A literature search was completed as part of a larger systematic search of evaluations and measures of cultural competence interventions in health care in Canada, the United States, Australia and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched from 2002 to 2015. Overall, 109 studies were found, with 15 evaluating systems-level interventions or describing measurements. Thematic analysis was used to identify key implementation principles, intervention strategies and outcomes reported. Results: Twelve intervention and three measurement studies met our inclusion criteria. Key principles for implementing systems approaches were: user engagement, organisational readiness, and delivery across multiple sites. Two key types of intervention strategies to embed cultural competence within health systems were: audit and quality improvement approaches and service-level policies or strategies. Outcomes were found for organisational systems, the client/practitioner encounter, health, and at national policy level. Discussion and implications: We could not determine the overall effectiveness of systems-level interventions to reform health systems because interventions were context-specific, there were too few comparative studies and studies did not use the same outcome measures. However, examined together, the intervention and measurement principles, strategies and outcomes provide a preliminary framework for implementation and evaluation of systems-level interventions to improve cultural competence. Identified gaps in the literature included a need for cost and effectiveness studies of systems approaches and explication of the effects of cultural competence on client experience. Further research is needed to explore the extent to which cultural competence improves health outcomes and reduces ethnic and racially-based healthcare disparities. [ABSTRACT FROM AUTHOR]

Background Physical inactivity rates have remained high worldwide since 2001. Public policies are an essential upstream lever to target individual physical activity (PA) behaviour. However, implementers have different strategies and face implementation challenges that are poorly understood. The present study analyzes the implementation processes of public policies to promote PA in terms of: (i) the policies covered and their legal quality, (ii) the actors and stakeholders involved in the implementation process and (iii) the used implementation strategies (vertical, horizontal or a mix). Methods A scoping review was systematically conducted (registered Open Science Framework: osf.io/7w84q/), searching 10 databases and grey literature until March 2022. Of the 7741 titles and abstracts identified initially, 10 studies were included. Results The current evidence includes high-income countries (USA, n  = 7; UK, New Zealand and Oman, n  = 1 each). Policy areas covered are education (school sector) and PA promotion in general (national PA plans or city-wide approaches). The legal classification ranges from laws (school sector) to coordination and budgeting to non-legally binding recommendations. The jurisdictions covered were federal (n  = 4), state (n  = 1), county (n  = 1), school district (n  = 1) and city (n  = 3). Implementation strategies for city-wide approaches are characterized by a coordinated approach with vertical and horizontal integration; federal PA policies by a mix of implementation strategies; and the school sector by a strict horizontal top-down integration without the involvement of other actors. Conclusion Implementation strategies differ by policy field. Therefore, continuous evaluation of the implementation process is necessary to align policy implementation with policy goals to promote individual PA behaviour. [ABSTRACT FROM AUTHOR]

The COVID-19 crisis has led to widespread temporary school closures and a deep economic recession. School closures have threatened children's ability to learn and later return to school well prepared. The impact of the economic recession is going to be even more devastating: first for students, but also for the ability of some Catholic schools to maintain their enrollment and remain sustainable financially in countries where they do not benefit from government support. This paper, the first in a set of two, looks at some of the likely impacts of the COVID-19 crisis on Catholic Schools in developed countries with a particular focus on the United States, a country not only hard hit by the crisis but also where Catholic schools are especially vulnerable to downturns. While Catholic schools may be able to respond to the immediate challenge of school closures among others through distance learning options, their ability to maintain enrollment during the economic downturn is less clear. How schools will respond to the twin challenges of ensuring learning during school closures and beyond, and remaining affordable for families at a time of economic stress, may affect whether they are able to maintain their comparative advantage. A key aim of the paper is to make Catholic school teachers and leaders aware of some of the discussions on how to respond to the crisis, and provide links to online resources that may be useful. [For Part II of the series, see EJ1278501.]

Human nutrition is a growing field with an increasing job market and high demand for university study, yet graduates report feeling underprepared for and unaware of potential job opportunities. This scoping review aimed to identify employment initiatives used in undergraduate programs to support an evidence-based approach to the development of future initiatives for human nutrition courses. The scoping review following PRISMA-ScR criteria was initially conducted in October 2018 and updated in April 2020. Search terms were selected to identify studies that reported on employability or work-readiness embedded within the course curriculum for undergraduate students. Fourteen papers met the eligibility criteria. Papers included were from Australia (9), United Kingdom (2), United States (1), New Zealand (1) and Germany (1). Papers described initiatives fitting broad categories of placements, project-based industry collaboration, practice-based eLearning, mentoring and building graduate attributes. Placements were the most common type of initiative and project-based industry collaboration demonstrated the highest levels of student and employer satisfaction. The success of initiatives was often attributed to incorporating diverse approaches to real-world, problem-solving skills. Mentoring and eLearning were used to promote employability soft skills, while industry-based placements provided students with practical experience. Placement in specific workplace settings should be representative of the diverse job options for nutrition graduates. Human nutrition degrees should consider incorporating strategies that develop soft skills and project-based skills while exposing students to diverse workplace settings within industry.

The premise of this brief opinion piece is that the fundamental paradigm of education appeared with Plato. It is that there is a co-location in time and space of learners, teachers, and resources. The absence of any of these elements can lead to shortcomings in the meaning of the term "to be educated". Recent events such as COVID-19 demonstrate that the paradigm is subject to challenge but that its premises are firmly established. It is recognised that there are complex philosophical and theoretical arguments surrounding distance education debates. It is not possible in a short article like this to canvass all the possible philosophical positions that affect education. Pointers to these debates are referenced in the article. For the purpose of this article, "philosophy" is taken to mean that department of knowledge or study that deals with ultimate reality, or with the general causes and principles of things. More narrowly, it is the study of general principles of some particular branch of knowledge, experience, or activity--in this case, distance education or flexible learning. "Theory" is taken to mean a scheme or system of ideas or statements held as an explanation or account of a group of facts or phenomena.

As a theoretical paradigm, the use of economics has domi-nated legal analysis both in academia and the courts in the United States for the last three decades. This popularity, though, does not extend to most other jurisdictions. Judge Richard Posner, one of the pioneers of the law and economics movement, developed a model comparing the structures of the legal profession in the United States, the United Kingdom, and continental Europe to ex-plain the lack of the use of law and economics in the latter two regions compared with the United States. This paper compares the use of economic analysis in judicial decisions in the United States with the extent of such use in two other common law jurisdictions: Australia and New Zealand. Judge Posner s model is used to examine the structure of the legal professions in Australia and New Zealand to predict the extent to which law and economics is used by each jurisdiction's respective judiciary. It is observed that Australian courts do not use eco-nomic analysis to any great extent, with senior members of the ju-diciary adopting an explicitly negative view of the value of economic reasoning in resolving legal disputes. Even those judges who attempt to apply economic tools to justify their decisions tend to do so in a simplistic fashion that does not draw on the full ad-vantages such an approach offers and does nothing to counteract the claims of the paradigm's critics. New Zealand's judiciary has demonstrated a more receptive attitude, with little if any hostility expressed openly (unlike Australia), with notable senior members of the judiciary openly advocating for the courts to make greater use of economic reasoning in resolving legal disputes. These find-ings are in line with the expectations formed under Judge Posner's model. Further observations are made regarding the legal education systems in the United States, Australia and New Zealand, finding that law and economics is taught to a greater extent in line with the use of economic reasoning in the respective court system. While it is difficult to draw conclusions as to any causal relationship, an explanation is suggested that judicial attitudes, especially in Aus-tralia and New Zealand, have a strong influence on the extent to which law and economics is taught in law schools. Australia's and New Zealand's systems of legal education are much more focused, by necessity, on fundamental legal knowledge useful for a career in law, a restriction that does not exist to the same extent in the United States. The popularity of law and economics courses in Australia and New Zealand reflects the judicial attitudes observed in this paper's main analysis. [ABSTRACT FROM AUTHOR]

A series of tests on cold-formed high-strength stainless steel square and rectangular hollow sections subjected to web crippling is presented in this paper. The types of stainless steel investigated in this study were high strength austenitic and duplex material. The measured web slenderness value of the hollow sections ranged from 16.5 to 49.7. The tests were carried out under four loading conditions considered in the American Specification and Australian/New Zealand Standard for cold-formed stainless steel structures, namely end-one-flange, interior-one-flange, end-two-flange, and interior-two-flange loading conditions. The web crippling test strengths were compared with the design strengths obtained using the American, Australian/New Zealand, and European Specifications for stainless steel structures. In addition, the North American Specification for cold-formed carbon steel structural members was also used to predict the web crippling strengths and compared with the test results. It is shown that the design strengths predicted by the specifications are either unconservative or very conservative. Hence, a unified web crippling equation with new coefficients for cold-formed high strength stainless steel square and rectangular hollow sections is proposed in this paper. It is shown that the proposed web crippling equation is safe and reliable. [ABSTRACT FROM AUTHOR]

Background: The substantial increase in the complexity of breast cancer care in the last few decades has resulted in significant improvements in survival rates and also in the quality of life of breast cancer survivors. However, across Europe there are variations in outcomes and access to the latest techniques. Whilst much of this variance is due to differences in health economies between European member states, training variation may also play a part. Training in breast cancer surgery varies greatly across Europe, not only in its basal discipline (general surgery, gynaecology or plastic surgery) but also in the length of training and whether there is any requirement for specialist training. Several countries have been leading the way in training breast specialist surgeons (the USA, the UK, Australia and New Zealand) with dedicated 1- or 2-year fellowships either within or in addition to standard training. Access to such training is limited and consequently many women in Europe are still treated by generalists, potentially denying them access to the best care. This paper reviews the issues surrounding training provision in breast surgery and some of the challenges which need to be addressed to improve the current situation. Summary: Breast surgery training in Europe is of variable quality and duration, which may result in variations in the quality of care received by patients with breast cancer. Specialist training standards are urgently required which should be adopted by all European member states. Excellent models are available in the USA, the UK and Australia and New Zealand on which to base this training. Key Messages: The quality of training in breast surgery needs to be upgraded and harmonised across Europe. [ABSTRACT FROM AUTHOR]

Background: Lone parents and their children experience higher than average levels of adverse health and social outcomes, much of which are explained by high rates of poverty. Many high income countries have attempted to address high poverty rates by introducing employment requirements for lone parents in receipt of welfare benefits. However, there is evidence that employment may not reduce poverty or improve the health of lone parents and their children.Methods: We conducted a systematic review of qualitative studies reporting lone parents' accounts of participation in welfare to work (WtW), to identify explanations and possible mechanisms for the impacts of WtW on health and wellbeing. Twenty one bibliographic databases were searched. Two reviewers independently screened references and assessed study quality. Studies from any high income country that met the criteria of focussing on lone parents, mandatory WtW interventions, and health or wellbeing were included. Thematic synthesis was used to investigate analytic themes between studies.Results: Screening of the 4703 identified papers and quality assessment resulted in the inclusion of 16 qualitative studies of WtW in five high income countries, USA, Canada, UK, Australia, and New Zealand, covering a variety of welfare regimes. Our synthesis found that WtW requirements often conflicted with child care responsibilities. Available employment was often poorly paid and precarious. Adverse health impacts, such as increased stress, fatigue, and depression were commonly reported, though employment and appropriate training was linked to increased self-worth for some. WtW appeared to influence health through the pathways of conflict and control, analytical themes which emerged during synthesis. WtW reduced control over the nature of employment and care of children. Access to social support allowed some lone parents to manage the conflict associated with employment, and to increase control over their circumstances, with potentially beneficial health impacts.Conclusion: WtW can result in increased conflict and reduced control, which may lead to negative impacts on mental health. Availability of social support may mediate the negative health impacts of WtW. [ABSTRACT FROM AUTHOR]

If any engineering courses are unlikely to be transferable between Australasian and overseas universities, one could argue that civil engineering capstone design courses with a strong practical engineering focus would be the least likely. This analysis considers two capstone design courses in the US and New Zealand. The analysis examines the approaches each university has taken to improve design education through simulating professional practice. The two approaches are superficially very different with different course structure and course requirements. In addition the emphasis on site and project, and the consequent dependence on country-specific matters related to regulation and codes, would lead one to expect low transferability. Closer analysis shows that the learning objectives of the courses are relatively similar and that the relationship between site and design are key for both. The challenges faced by the two approaches have much in common, reflecting similar student experiences, and so high transferability. The paper provides details on learning objectives and challenges faced at the two programs to aid others who wish to analyse capstone design experiences across multiple universities. The conclusion is that transferability between these two design experiences is high. The implication is that, through similar forces for educational change in both countries, internationalisation of engineering education is high. [ABSTRACT FROM AUTHOR]