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The killing of parents, frequently referred to as parricide, is a disturbing phenomenon that often generates widespread media coverage. Most of the scholarly literature on this topic has focused on biological offspring who kill mothers and fathers. Some analyses have examined juveniles and adults who kill their stepparents. To date, virtually no research exists on children who kill their adoptive parents because this type of victim-offender relationship has been absent from available homicide databases, thereby preventing such analyses. The present study is a content analysis of news reports of 46 cases of adopted children who killed their adoptive parents in several different countries. Data pertaining to offender and victim demographics, incident characteristics, and the processing of offenders from the initial charge through conviction and sentencing are examined. To the extent possible, media accounts are used to classify cases according to motives or circumstances leading to the killings. The article concludes with a comparison of profiles of children who kill adoptive parents in relation to those who kill biological parents, important observations that emerged from these news accounts, and discussion of possible explanations of parricide by adopted children, including adopted children syndrome, reactive attachment disorder, and biological risk factors. Limitations of this study and directions for future research are addressed. [ABSTRACT FROM AUTHOR]

Objective: The integration of quality indicators into the accreditation process has been recognized as a promising strategy worldwide. This study was to explore the implementation patterns of hospital accreditation through the lens of a systems-theory based model, and determine an international accreditation implementation typology.Design: A qualitative comparative study of five established international hospital accreditation systems was undertaken based on a systems-theoretic holistic healthcare systems relationship model. A set of key attributes relevant to three systems-theoretic model relationships guided data collection, comparison and synthesis.Setting: Hospital accreditation systems in five countries: America, Canada, Australia, Taiwan and France.Results: An accreditation implementation typology was developed based on the data synthesis of the similarities and differences among the relationships. A typology including five implementation types of hospital accreditation systems (TYPE I-V) was induced. TYPE I is a basic stand-alone accreditation system. The higher types represent stronger relationships among accreditation system, healthcare organizations and quality measurement systems. The five settings have shifted their accreditation approaches from the basic type (TYPE I).Conclusions: The implementation typology of hospital accreditation could serve as a roadmap for refining hospital accreditation systems toward an integrative approach for continuous quality improvement. [ABSTRACT FROM AUTHOR]

Purpose:The HOME FAST was developed and trialled in Australia as a screening tool designed to be used by any health professional to identify older people at increased risk of falls and to facilitate referral for more detailed assessment and intervention. This study aimed to evaluate the clinical utility of the HOME FAST from the perspective of users. Method:A mixed-methods approach using survey data (n = 32), focus group data (n = 46) and interview data (n = 5) from occupational therapists, physiotherapists, community nurses and other health professionals working in hospitals, community services and private practice, located in the UK, Canada and Australia. Data were integrated using a matrix of quantitative and qualitative data that aligned the findings with established theoretical constructs of clinical utility. Results:Findings across the data sources provide evidence of the clinical utility of the HOME FAST, and these findings align with theoretical constructs about how a tool such as the HOME FAST is adopted in practice. Conclusion:The HOME FAST can be used in a variety of international setting in developed countries and by different health professionals as a screening tool. A manual would assist in the consistent application of the HOME FAST.Implications for RehabilitationHazards in the home environment are a key contributor to falls risk for older peopleThe Home Falls and Accidents Screening Tool (HOME FAST) was designed for any health professional to screen older people at increased risk of falling because of home hazards.Even with psychometric evidence of the reliability and validity of a tool, it is critical that the tool can be easily adopted by clinicians (clinical utility), otherwise its applicability to practice and research is limited.An international mixed-method study has provided evidence of the clinical utility of the HOME FAST. [ABSTRACT FROM PUBLISHER]

Ethnopharmacological relevance The regulation policies of substances used in Chinese Herbal Medicine (CHM), have a direct influence on the ability of health providers to practice in the clinic. Aim of the study We set out to assess the truth behind the assumption that practice of CHM in the west is constrained by the regulations imposed by authorities in western countries. Materials and methods For the first part of our study we surveyed and compiled lists of banned and restricted Chinese Materia Medica (CMM) from six countries: USA, UK, Germany, Israel, Canada and Australia. Afterwards, we estimated the relevant importance of the 300 CMM most-commonly-prescribed to the practice of CHM according to prescriptions from 2,000,000 randomly selected patients, from the Taiwanese National Health Insurance Research Database (NHIRD). We then compared both lists and determined the clinical importance of the banned and restricted CMM. Results Except for regulations from Canada, most of the information of banned CMM proved to be difficult to organize. The USA was found to have the least amount of banned herbs, with 9 substances. Canada had the highest amount, with 98. In Germany, Australia, the UK, and Israel 10, 29, 36, 68 banned CMM were found, respectively. Apart from aristolochic acid containing substances, ma huang (麻黃, Ephedra sinica ) was the only CMM banned in all countries. Most of the banned CMM were not found to be among the most-commonly-prescribed according to the NHIRD. Conclusion Authorities should make this information more accessible. No clear relation exists between CHM regulations and any ‘Western’ common denominator, and the amount of banned CMM varied greatly among the surveyed countries. However, even among countries with a larger amount of banned CMM, the majority of these were in the bottom two-thirds in respect to the frequency of their use. Thus, regulations in some western countries surely influence the practice of CHM, however, the variability of CMM have been influenced by regulations only to a limited extent. [ABSTRACT FROM AUTHOR]

Background: Health systems globally promote appropriate prescribing by healthcare providers and safe and effective medicine use by consumers. Rx for Change, a publicly available database, provides access to systematic reviews regarding best practices for prescribing and using medicines. Despite the value of the database for improving prescribing and medicine use, its use remains suboptimal. This study aimed to develop a training program for five medicine-focused organisations in Canada and Australia to facilitate the use and understanding of the Rx for Change database.Methods: Four steps were undertaken: 1) key informant interviews were completed across all organisations to understand the knowledge user perspective; 2) a directed content analysis was completed of the interview transcripts and proposed training was developed; 3) a second round of feedback on the proposed training by knowledge users was gathered; and 4) feedback was integrated to develop the final training.Results: Sixteen key informant interviews with knowledge users were conducted. Themes for training content included the scope of, navigation and strategies for using Rx for Change (generic content) and practical examples on incorporating evidence within their workplace context (tailored content). The final training consisted of an informational video, a 60-minute face-to-face workshop and two post-training reminders.Conclusions: A method of engaging knowledge users in the development of a training program to improve the use of an on-line database of systematic reviews was established and used to design training. Next steps include the delivery and evaluation of the training. [ABSTRACT FROM AUTHOR]

Background: The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries.Methods: We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys.Results: Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50-69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries.Conclusions: Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese. [ABSTRACT FROM AUTHOR]

Previous research has established that student outcomes are strongly associated with the socioeconomic composition of a school, also known as school socioeconomic status. Less is known, however, about the ways in which the relationship varies for different students, schools and national education systems. Here, we conduct a secondary analysis of an international dataset to examine the strength of the relationship between school socioeconomic status and achievement in math and reading for Canada and Australia. The history, economy and culture of these two countries are similar, as are many aspects of their education systems. One important difference, however, is the degree to which their education systems are marketised. Our findings show that in both countries, school socioeconomic status is strongly associated with academic achievement for all students, regardless of their individual socioeconomic status. Nevertheless, the relationship between school socioeconomic status and academic achievement is substantially stronger in Australia than in Canada. We conclude that student outcomes are more equitable in Canada than in Australia, and suggest that this may be due to differences in the ways in which the two education systems are funded and structured. [ABSTRACT FROM PUBLISHER]

sutcliffe k., caird j., kavanagh j., rees r., oliver k., dickson k., woodman j., barnett-paIge e. & thomas j. (2012) Comparing midwife-led and doctor-led maternity care: a systematic review of reviews. Journal of Advanced Nursing 68(11), 2376-2386. Abstract Aims. A report of a systematic review of reviews which examines the impact of having midwives-led maternity care for low-risk women, rather than physicians. Background. A rising birth rate, increasing complexity of births, and economic constraints pose difficulties for maternity services in the UK. Evidence about the most effective, cost-effective, and efficient ways to give maternity services is needed. Data sources. Searches were carried out in August-September 2009 of ten electronic databases, 16 key nursing and research websites, and reference lists of 56 relevant reviews. We also contacted 38 experts for information. No date restrictions were employed. Review methods. A narrative review of systematic reviews or 'meta review' was conducted using transparent and systematic procedures to limit bias at all stages. Systematic reviews that compared midwife-led care during pregnancy and birth with physician-led care were eligible for inclusion. Results. Three meta-analytic reviews were included. Midwife-led care for low-risk women was found to be better for a range of maternal outcomes, reduced the number of procedures in labour, and increased satisfaction with care. For some maternal, foetal, and neonatal outcomes reviews found no evidence that care led by midwives is different to that led by physicians. No adverse outcomes associated with midwife-led care were identified. Conclusions. For low-risk women, health and other benefits can result from having their maternity care led by midwives rather than physicians. Moreover, there appear to be no negative impacts on mothers and infants receiving midwife-led care. [ABSTRACT FROM AUTHOR]

This study aimed to review and synthesise existing literature that investigated the experience of overseas-trained health professionals (OTHPs) in rural and remote areas of destination countries. A systematic literature review was conducted using electronic databases and manual search of studies published from January 2004 to February 2011. Data were analysed from the final 17 original report articles that met the inclusion criteria. The reviewed research studies were conducted in Australia, Canada, New Zealand, the UK and the USA. Overseas-trained medical practitioners were the most frequently researched (n = 14); two studies involved nurses and one study included several health professionals. Three main themes emerged from the review and these were: (i) expectations; (ii) cultural diversity; and (iii) orientation and integration to rural and remote health work environment. The OTHPs were expected to possess the appropriate professional and cultural skills while they themselves expected recognition of their previous experiences and adequate organisational orientation and support. A welcoming and accepting community coupled with a relaxed rural lifestyle and the joy of continued patient care resulted in successful integration and contributed to increased staff retention rates. Recognition of expectations and cultural diversity by all parties and comprehensive orientation with sufficient organisational support are important elements in the integration of OTHPs and subsequent delivery of quality health care to people living in rural and remote areas. [ABSTRACT FROM AUTHOR]

Background: We aimed to make individual patient data from the International Stroke Trial (IST), one of the largest randomised trials ever conducted in acute stroke, available for public use, to facilitate the planning of future trials and to permit additional secondary analyses.Methods: For each randomised patient, we have extracted data on the variables assessed at randomisation, at the early outcome point (14-days after randomisation or prior discharge) and at 6-months and provide them as an analysable database.Results: The IST dataset includes data on 19 435 patients with acute stroke, with 99% complete follow-up. Over 26.4% patients were aged over 80 years at study entry. Background stroke care was limited and none of the patients received thrombolytic therapy.Conclusions: The IST dataset provides a source of primary data which could be used for planning further trials, for sample size calculations and for novel secondary analyses. Given the age distribution and nature of the background treatment given, the data may be of value in planning trials in older patients and in resource-poor settings. [ABSTRACT FROM AUTHOR]

Objective: To systematically review and critically appraise the economic evaluations of one to one interventions to reduce sexually transmitted infections (STIs) and teenage conceptions. Design: Systematic review. Data Sources: Search of four electronic bibliographic databases from 1990 to January 2006. Search keywords included teenage, pregnancy, adolescent, unplanned, unwanted, cost benefit, cost utility, economic evaluation, cost effectiveness and all terms for STIs, including specific diseases. Review Methods: We included studies that evaluated a broad range of one to one interventions to reduce STIs. Outcomes included major outcomes averted, life years and quality adjusted life years (QALY). All studies were assessed against quality criteria. Results: Of 3,190 identified papers, 55 were included. The majority of studies found one to one interventions to be either cost saving or cost effective, although one highlighted the need to target the population to receive post-exposure prophylaxis to reduce transmission of HIV. Most studies used a static approach that ignores the potential re-infection of treated patients. Conclusion: One to one interventions have been shown to be cost saving or cost effective but there are some limitations in applying this evidence to the UK policy context. More UK research using dynamic modelling approaches and QALYs would provide improved evidence, enabling more robust policy recommendations to be made about which one to one interventions are cost effective in reducing STIs in the UK setting. The results of this review can be used by policy makers, health economists and researchers considering further research in this area. [ABSTRACT FROM AUTHOR]

Background: Most abortions occur due to unintended pregnancy. Unintended pregnancies are linked to poor health outcomes. Canada receives immigrants from countries with disparate sexual and reproductive health contexts which may influence abortion rates post-migration. We examined the association between abortion and region of birth and birth order among Canadian immigrants. Methods: We conducted a population-based person-years (PY) cohort study in Ontario, Canada using administrative immigration (1991–2012) and health care data (1991–2013). Associations between induced abortion and an immigrant's region of birth were estimated using poisson regression. Rate ratios were adjusted for age, landing year, education, neighborhood income quintile and refugee status and stratified by birth order within regions. Results: Immigrants born in almost all world regions (N = 846,444) were 2–5 times more likely to have an induced abortion vs. those born in the US/Northern & Western Europe/Australia & New Zealand (0.92 per 100 PY, 95% CI 0.89–0.95). Caribbean (Adjusted Rate Ratio [ARR] = 4.71, 95% CI 4.55–4.87), West/Middle/East African (ARR = 3.38, 95% CI 3.26–3.50) and South American (ARR = 3.20, 95% CI 3.09–3.32) immigrants were most likely to have an abortion. Most immigrants were less likely to have an abortion after vs. prior to their 1st birth, except South Asian immigrants (RR = 1.60, 95% CI 1.54–1.66; RR = 2.23, 95% CI 2.12–2.36 for 2nd and 3rd vs 1st birth, respectively). Secondary analyses included further stratifying regional models by year, age, education, income quintile and refugee status. Conclusions: Induced abortion varies considerably by both region of birth and birth order among immigrants in Ontario. [ABSTRACT FROM AUTHOR]

Reports on a congress of the International Medical Informatics Association which brought together many experts in health informatics as measures are being taken around the world to create a seamless way to share clinical data; The two important and interdependent challenges that need to be overcome before any patient in any country has a national electronic health record; The budget granted the National Programme for IT in the UK; How the UK plan differs from others such as that in Canada and Australia; Need for systems to allow for the transfer of information across borders; Role of clinicians in developing systems they can use easily.