Risk management for second-hand clothing imports in least developed countries: Legislations and perception of public-sector corruption.

The second-hand clothing imports are very popular in the least developed countries (LDCs). The social health risk (SHR) associated with second-hand clothing products and the lack of relevant legislations in LDCs, however, bring substantial challenges. This article is therefore developed to explore the sterilization legislation design for second-hand clothing supply chains in LDCs. To address LDCs' different import requirements of fumigation, both the extended exporter responsibility (EER) legislation scheme and the extended importer responsibility (EIR) legislation scheme are considered. We also examine whether the perception of public-sector corruption in LDCs may affect the performance of sterilization legislation schemes. We compare the performance of sterilization legislation schemes under different public-sector corruption cases, different sterilization legislation structures, as well as market competition. Interestingly, our analyses show that the EER and EIR legislation schemes can achieve the same performance under a per unit SHR duty, no matter whether there is public-sector corruption or not. However, these two legislation schemes perform differently under the lump-sum SHR duty. Besides, with the presence of the public-sector corruption perception, the prospect of financial benefits from bribing the regulatory agency can induce the firm to choose a higher optimal sterilization level when the bribe is sufficiently small. These implications complement the extant knowledge on risk management of second-hand clothing in LDCs, and provide an important guidance regarding the design of sterilization legislations on second-hand clothing imports.

Barriers to safe anaesthesia care in South Asian countries: a virtual focus group discussion.

Objective: To identify barriers to safe anaesthesia practice across the South Asian region. METHODS: The qualitative study was conducted from September 2020 to August 2021 at the Department of Anaesthesiology at a leading medical university after getting exemption from the ethics review committee of the Pakistan Society of Anaesthesiologists. The sample comprised anaesthetists from 6 countries of the South Asian Association for Regional Cooperation. Data was collected through a focus group discussion held virtually using the Zoom app on September 22, 2020. The proceedings were transcribed and the data was subjected to thematic analysis. RESULTS: Of the 12 anaesthetists, 4(33.3%) were from India, 3(25%) from Pakistan, 2(16.7%) from Bangladesh, and 1(8.3%) each from Sri Lanka, Nepal and Afghanistan. There were 2 main themes identified; Safe anaesthesia and barriers to safe anaesthesia. They had 4 and 6 subthemes, respectively. The participants agreed that fresh medical graduates were not choosing anaesthesia as a preferred career specialty. One major concern raised was that qualified anaesthetists were leaving their countries for better-paid jobs abroad. Conclusion: The lack of a definition describing qualified anaesthetists in South Asian countries was pointed out. Lack of basic monitoring and drugs, brain drain, lack of ownership, lack of training programmes, lack of accountability, weak leadership, and disconnect between professional societies and governments were identified as the main barriers to safe anaesthesia.

Advancement and the existing landscape of forensic medicine in Africa: A comparison with developed countries.

This article explores the development and challenges of forensic medicine in Africa, comparing it to developed countries. It addresses limited resources, funding, and a shortage of trained professionals. The growth of forensic investigation capabilities and the challenges of funding and technology access are discussed. Training and education have improved, but disparities remain. Partnerships with developed countries and international organizations are crucial to bridge the gap. A comprehensive legal framework is important, but disparities exist among African countries. Harmonizing forensic laws would enhance cooperation. The role of forensic medicine in the criminal justice system is examined, emphasizing the need to build trust in forensic evidence. International collaboration and capacity building are key to advancing forensic medicine in Africa. Investments in infrastructure, funding, training, and legal frameworks are required. By leveraging partnerships, Africa can develop its forensic medicine capabilities for a fair and effective criminal justice system.

Global anaesthesia-related cardiac arrest rates in children: a systematic review and meta-analysis.

BACKGROUND: Neonates and infants have a higher perioperative risk of cardiac arrest and mortality than adults. The Human Development Index (HDI) ranges from 0 to 1, representing the lowest and highest levels of development, respectively. The relation between anaesthesia safety and country HDI has been described previously. We examined the relationship among the anaesthesia-related cardiac arrest rate (ARCAR), country HDI, and time in a mixed paediatric patient population. METHODS: Electronic databases were searched up to July 2022 for studies reporting 24-h postoperative ARCARs in children. ARCARs (per 10,000 anaesthetic procedures) were analysed in low-HDI (HDI<0.8) vs high-HDI countries (HDI≥0.8) and over time (pre-2001 vs 2001-22). The magnitude of these associations was studied using systematic review methods with meta-regression analysis and meta-analysis. RESULTS: We included 38 studies with 5,493,489 anaesthetic procedures and 1001 anaesthesia-related cardiac arrests. ARCARs were inversely correlated with country HDI (P<0.0001) but were not correlated with time (P=0.82). ARCARs did not change between the periods in either high-HDI or low-HDI countries (P=0.71 and P=0.62, respectively), but were higher in low-HDI countries than in high-HDI countries (9.6 vs 2.0; P<0.0001) in 2001-22. ARCARs were higher in children aged <1 yr than in those ≥1 yr in high-HDI (10.69 vs 1.48; odds ratio [OR] 8.03, 95% confidence interval [CI] 5.96-10.81; P<0.0001) and low-HDI countries (36.02 vs 2.86; OR 7.32, 95% CI 3.48-15.39; P<0.0001) in 2001-22. CONCLUSIONS: The high and alarming anaesthesia-related cardiac arrest rates among children younger than 1 yr of age in high-HDI and low-HDI countries, respectively, reflect an ongoing challenge for anaesthesiologists. SYSTEMATIC REVIEW PROTOCOL: PROSPERO CRD42021229919.

Hybrid discrete-time-continuous-time models and a SARS CoV-2 mystery: Sub-Saharan Africa's low SARS CoV-2 disease burden.

Worldwide, the recent SARS-CoV-2 virus has infected more than 670 million people and killed nearly 67.0 million. In Africa, the number of confirmed COVID-19 cases was approximately 12.7 million as of January 11, 2023, that is about 2% of the infections around the world. Many theories and modeling techniques have been used to explain this lower-than-expected number of reported COVID-19 cases in Africa relative to the high disease burden in most developed countries. We noted that most epidemiological mathematical models are formulated in continuous-time interval, and taking Cameroon in Sub-Saharan Africa, and New York State in the USA as case studies, in this paper we developed parameterized hybrid discrete-time-continuous-time models of COVID-19 in Cameroon and New York State. We used these hybrid models to study the lower-than-expected COVID-19 infections in developing countries. We then used error analysis to show that a time scale for a data-driven mathematical model should match that of the actual data reporting.

What works in sanitation promotion?

Promotion appears to be the least effective but is nevertheless often the only available, means to achieve increased access to sanitation services, especially at scale, in lower-income countries. A cursory examination of the history of past and present approaches to sanitation promotion, including sanitation marketing, community development, community-led total sanitation and public health, shows that they have a variety of features and characteristics which make them distinctive. Unfortunately, rigorous evaluation has not kept pace with this proliferation of approaches, so it is difficult to recommend any one approach over the others, based on empirical performance in a range of circumstances. However, I argue that a 'hybrid' approach which exhibits a number of salient features from all of the previous approaches is likely to be a good bet. I present a recent example of such a hybrid programme which proved to significantly increase the rate of improved sanitation coverage through promotion (without subsidy of any kind) at scale in Tanzania. I suggest other sanitation promotion programs may want to think about adopting similar practices in their own programming going forward.

Emerging environmental contaminants: A global perspective on policies and regulations.

Emerging contaminants include many synthetic or natural substances, such as pharmaceuticals and personal care products, hormones, and flame retardants that are not often controlled or monitored in the environment. The consumption or use of these substances is on an ever-rising trend, which dangerously increases their prevalence in practically all environmental matrices. These contaminants are present in low environmental concentrations and cause severe effects on human health and the biota. The present review analyzed 2012-2022 years papers via PubChem, science direct, National Center for Biotechnology Information, web of science on the legislations and policies of emerging contaminants globally. A state-of-the-art review of several studies in the literature focus on examining and evaluating the emerging contaminants and the frameworks adopted by developed and developing countries to combat the release of emerging contaminants and form footprints towards water sustainability which includes water availability, usage patterns, generation and pollution management, the health of aquatic systems, and societal vulnerability. The paper aims to provide a comprehensive view of current global policies and framework regarding evaluating and assessing the chemicals, in light of being a threat to the environment and biota. The review also highlights the future global prospects, including current governmental activities and emerging contaminant policy measures. The review concludes with suggestions and way forward to control the inventory and disposal of emerging contaminants in the environment.

The impact of climate disaster on international trade: Evidence from developed and developing countries.

A climate disaster can be devastating, but its challenges and losses provide some opportunities to other countries. Therefore, in this paper, we examine the impact of climate risk on international trade with a particular focus on developed and developing countries. Using a large sample of 160 countries between 2006 and 2019, we find that climate disaster is positively associated with high international trade. An increase in the climate disaster index will lead to an increase of about 5.9% in imports as a proportion of GDP. This is significant given that the mean of imports of the sample countries is 48%. Regarding the flow of trade, importation is likely to increase by about 6.7% and export to decrease by 0.65% after the occurrence of climate disasters in developing countries. Conversely, we did not find significant changes in imports and a weak association with exports for developed countries. We attribute this differential impact of climate disasters between developed and developing countries to the preparedness and risk mitigation mechanism in developed countries. The result suggests that the long-term effect of climate disasters increasing overall international trade is due to increasing imports in developing countries. Additional analyses demonstrate the robustness of these results to different model specifications and measurements of variables. Our results imply that climate change and its associated natural disasters offer more trade opportunities for developed countries than developing countries, highlighting the climate injustices between the high and low climate change contributors.

Evaluation of the research trends on perfluorinated compounds using bibliometric analysis: knowledge gap and future perspectives.

Detection of perfluorinated compounds (PFCs) in the environment has been a global concern because of the risk they pose due to their endocrine-disruptive properties. This study analyzed the global trends and research productivity of PFCs from 1990 to 2021. A total number of 3256 articles on PFCs were retrieved from the Web of Science focusing on different environmental and biological matrices. An increase in the productivity of research on PFCs was observed during the survey period which indicates that more research and publications on this class of contaminants are expected in the future. Evaluating the most productive countries and the number of citations per country on PFCs research shows that China and the United States of America were ranked in first and second places. It was also observed that research on PFCs received the most attention from scientists in developed countries, with little research emerging from Africa. Hence, research on PFCs in developing countries, especially low-income countries should be promoted. Consequently, more research programs should be implemented to investigate PFCs in countries and regions where research on these contaminants is low. The study will help researchers, government agencies and policymakers to tailor future research, allocation of funds to PFCs research and countries' collaboration.

Scaling up breastfeeding in England through the Becoming Breastfeeding Friendly initiative (BBF).

Breastfeeding is the most accessible and cost-effective activity available to public health and has been shown to be one of the most effective preventive measures mothers can take to protect their children's health. Despite the well-documented benefits, the UK has one of the lowest breastfeeding rates in the world. The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University. It provides an evidence-based process to help countries assess their breastfeeding status and readiness to scale up, and identifies concrete measures countries can take to sustainably increase breastfeeding rates, based on data-driven recommendations. BBF is grounded in the Breastfeeding Gear Model complex adaptive systems framework which is made up of eight simultaneous conditions that sustain breastfeeding. In 2018, a committee of multi-agency stakeholders implemented the BBF process in England, collecting evidence to score the 'gear' components of England's breastfeeding environment against 54 benchmarks. The Training and Programme Delivery gear received the highest score, attributable to existing learning outcomes for health professionals and practitioners, peer supporters and specialist services, although there is a need for greater coordination and integration. The lowest scores were given for Promotion and Coordination, Goals and Monitoring due to the lack of a dedicated national strategy for breastfeeding and poor sharing of localised strategies and programmes. The process generated clear recommendations highlighting the need for more robust routine infant feeding data collection and reporting, and the necessity for strengthening leadership, monitoring and oversight to scale up and sustain breastfeeding.

Neonatal and child mortality - are they different in developing and developed countries?

Aim is to present the neonatal and child mortality in high-(HIC) and low-income (LIC) countries and possible influence of COVID-19 pandemic. In recently published sustainable development goals (SDGs) report and other sources the data on infant and under-five mortality (U-5MR) in HIC and LIC are presented. SDG 3.2 has targeted elimination of preventable child mortality, reduction of neonatal mortality rate (NMR) to less than 12 per 1,000 live births, and reduction of U-5MR to less than 25 per 1,000 live births by 2030. Negative influence of COVID-19 pandemic on performance of SDG 3.2 has been discussed. The lowest NMR was in HIC, almost 10 times lower than in LIC and sub-Saharan Africa (SSA). Data on the U-5MR between HIC and LIC are even worse because the difference was between 13 and 15 times lower in HIC. More children are dying after the neonatal period in LIC. In HIC, NMR comprises 56.3% of U-5MR, while in LIC it is 40.3%, and in SSA, it is 36.8%. Births attended by skilled birth personnel in HIC was 99.0% and in LIC it was only 58.6%, which might affect early NMR. The COVID-19 pandemic is affecting the delivery of perinatal health, with possible negative effects on stillbirth rates, NMR, U-5MR, maternal mortality rates, and many other indicators. The gap of the NMR and U-5MR between HIC and LIC has increasing tendency regardless of COVID-19 pandemic, affecting adversely perinatal health indicators in HIC and LIC.

Enhancing International Cancer Organization Collaborations: King Hussein Cancer Center and Princess Margaret Cancer Centre Model for Collaboration.

Collaborative partnerships, which link two health organizations with shared characteristics to achieve common goals and to improve healthcare quality, are becoming increasingly common in oncology. The purpose of this study is to review the collaboration between King Hussein Cancer Center (KHCC) and Princess Margaret Cancer Centre (PM). The context, input, process, and product (CIPP) model, a quasi-experimental form of program evaluation, has been applied to the KHCC-PM collaboration. This model is well suited to evaluate complex collaborations as it does not assume linear relationships. Data sources include stakeholders' judgements of the collaboration, assessment of achievements, and informal interviews with key participants involved in the program. KHCC and PM are recognized as high-caliber comprehensive cancer centers, with a common goal of delivering high-quality care to patients. Through personal relationships among faculty in the centers and the perceived opportunities for mutual benefit, KHCC and PM signed a memorandum of understanding in 2013 to enter into a formal partnership. This partnership has been an evolving process that started with collaboration on education and grew to include clinical care. Research is an area for potential future collaboration. Enabling factors in the collaboration include dedication of individuals involved, trusting relationships amongst faculty, and the reciprocal nature of the relationship. Challenges have been financial, competing interests, and the absence of a successful collaborative model to follow. The KHCC and PM collaboration has been successful. A strategic plan is being developed and followed to guide areas of expansion.

Comparison of fertilizer use efficiency in grain production between developing countries and developed countries.

BACKGROUND: The investigation of chemical fertilization intensity (FI) and efficiency can provide basal data for decision-making in food production and environmental impact assessments of fertilization. The present study aimed to compare trends of the FI and efficiency during 1961-2018 in developed and developing countries using a simple method. RESULTS: The FI in China increased rapidly from approximately 5 kg ha-1 in 1961 to the highest value of 282 kg ha-1 in 2014, and then decreased to approximately 231 kg ha-1 in 2018. Although the fertilizer allocation efficiency (FAE) showed a slight downward trend, a slight upward trend was observed for fertilizer integrated efficiency (FIE). FIs in India, Iran and Turkey continuously increased from 5 kg ha-1 in 1961 to 116, 49(148 in 2006),120 kg ha-1 in 2018, respectively, whereas FAEs showed a significant fluctuation around horizontal direction or downward trends and their FIEs showed a slight fluctuation downward. The FIs of Britain, Germany and France, excluding USA, increased rapidly from approximately 200-400 kg ha-1 in 1960s to peaks of 430-530 kg ha-1 in 1980s, decreasing to 150-340 kg ha-1 around 2010, and then increased to the current level of 200-350 kg ha-1 , whereas FAEs and FIEs increased rapidly. CONCLUSION: France and Germany were found to have moderate chemical fertilizer input and the highest FIE. Thus, their experiences of ecological agricultures in both countries could provide good examples for developing countries to follow. In brief, models of FAE and FIE are an easier way of reflecting fertilizer efficiencies in developed and developing countries. © 2021 Society of Chemical Industry.

A nation-wide study on the common reasons for infant formula supplementation among healthy, term, breastfed infants in US hospitals.

In-hospital infant formula supplementation of breastfed infants reduces breastfeeding duration, yet little is known about common reasons for infant formula supplementation. We examined the three most common reasons for in-hospital infant formula supplementation of healthy, term, breastfed infants in the US reported by hospital staff. Hospital data were obtained from the 2018 Maternity Practices in Infant Nutrition and Care survey (n = 2045), which is completed by hospital staff. An open-ended question on the top three reasons for in-hospital infant formula supplementation was analyzed using thematic qualitative analysis and the frequencies for each reason were reported. The top three most common reasons for in-hospital infant formula supplementation reported by hospital staff included medical indications (70.0%); maternal request/preference/feelings (55.9%); lactation management-related issues (51.3%); physical but non-medically indicated reasons (36.1%); social influences (18.8%); perceived cultural/societal/demographic factors (8.2%) and medical staff/institutional practices (4.7%). These findings suggest that a variety of factors should be considered to address unnecessary infant formula supplementation. Lactation management support delivered in a timely and culturally sensitive manner and targeted to mother-infant dyads with potential medical and physical indications may reduce unnecessary in-hospital infant formula supplementation.

The COVID-19 pandemic, the Sustainable Development Goals on health and education and "least developed countries" such as Nepal.

In 2015, the United Nations (UN) declared 17 Sustainable Development Goals (SDGs) and 169 targets to be achieved by 2030, but the COVID-19 pandemic has stalled the world's progress in pursuing them. This article explores how the pandemic has impacted the public health and education sectors of the world's poorest 46 countries, identified by the UN as "least developed countries" (LDCs). Applying the theoretical lens of international political economy, the author first considers the historical, political and economic causes behind the pre-pandemic underdevelopment of LDCs' public health and education sectors. Next, he examines how the international support mechanisms forged in 2015 for the timely achievement of the SDGs have been affected by the pandemic, especially in the areas of health (SDG 3) and education (SDG 4). Based on a number of purposively selected international and national policy documents as well as a few related texts, the author uses the case of Nepal as an example to demonstrate what has particularly hampered LDCs' sustainable development - and indeed continues to do so during the ongoing pandemic. He identifies three main adverse factors: (1) the privatisation of health and education; (2) a lack of governmental accountability; and (3) dysfunctional international support mechanisms. The article appeals for a more egalitarian global collaboration and full accountability of LDC governments in the joint effort to achieve a sustainable recovery from the pandemic.

La pandémie de COVID-19, les Objectifs de développement durable en matière de santé et d'éducation et les « pays les moins avancés ¼ comme le Népal ­ En 2015, l'Organisation des Nations unies (ONU) a défini 17 Objectifs de développement durable (ODD) et 169 cibles à atteindre d'ici 2030, mais la pandémie de COVID-19 a freiné les progrès réalisés au niveau mondial. Cet article explore l'impact de la pandémie sur les secteurs de la santé publique et de l'éducation dans les 46 pays les plus pauvres du monde, identifiés par l'ONU comme les « pays les moins avancés ¼ (PMA). En appliquant l'approche théorique de l'économie politique internationale, l'auteur examine d'abord les causes historiques, politiques et économiques du sous-développement des secteurs de la santé publique et de l'éducation dans les PMA avant la pandémie. Ensuite, il examine comment les mécanismes de soutien international forgés en 2015 pour la réalisation des ODD ont été affectés par la pandémie, en particulier dans les domaines de la santé (ODD 3) et de l'éducation (ODD 4). En s'appuyant sur un certain nombre de documents de politique internationale et nationale sélectionnés à propos, ainsi que de quelques textes additionnels, l'auteur utilise le cas du Népal pour illustrer ce qui a particulièrement entravé le développement durable des PMA ­ et continue de l'entraver pendant la pandémie en cours. Il identifie trois principaux facteurs défavorables : (1) la privatisation de la santé et de l'éducation ; (2) le manque de responsabilité gouvernementale ; et (3) le dysfonctionnement des mécanismes de soutien international. L'article lance un appel en faveur d'une collaboration mondiale plus égalitaire et d'une responsabilisation totale des gouvernements des PMA dans l'effort commun pour parvenir à une reprise durable suite à la pandémie.

Low birth weight trends in Organisation for Economic Co-operation and Development countries, 2000-2015: economic, health system and demographic conditionings.

BACKGROUND: Low birth weight rates are increasing in both developed and developing countries. Although several maternal factors have been identified as associated with low birth weight, little is known of economic or organization factors influencing this increase. This study aims to ascertain the twenty-first century relationships between the contextual country factors and low birth weight rates. METHODS: We analyse trends of low birth weight rates in Organisation for Economic Co-operation and Development (OECD) countries. Data from 2000 to 2015 were obtained from the OECD data base. Their relationships with demographic and economic variables, health habits, woman-related preventive measures, health care system organization and funding, health care work force and obstetric care were analysed using random-effects linear regression. RESULTS: Low birth weight rates are higher in Southern Europe (7.61%) and lower in Northern Europe (4.68%). Low birth weight rates escalated about 20% in Southern Europe and to less extent in Easter Europe (7%) and Asian/Oceanian countries, while remained stable in America, Central Europe and Northern Europe. Investment in health care, private health system coverage, ratios of paediatricians and obstetricians, average length of admission due to pregnancy or birth and Caesarean section rate were associated with higher low birth weight rates. Factors associated with lower low birth weight rates were health care coverage, public health system coverage, hospitals per million inhabitants, and ratios of health care workers, physicians, midwives and nurses. CONCLUSIONS: In OECD countries, LBW rates are related to contextual country characteristics such as GDP per capita, which is inversely related to LBW rate. Health care system factors, including health care coverage or investment in public health system, are directly associated with lower LBW rates.

Association between nurse work environment and severe maternal morbidity in high-income countries: A systematic review and call to action.

AIM: To identify evidence related to association between the nurse work environment and severe maternal morbidity in high-income countries. DESIGN: Quantitative Systematic review. DATA SOURCES: Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, PubMed/Medline, and Scopus were systematically searched for studies published in English from January 1990-December 2019. Studies were selected based on a priori eligibility criteria. REVIEW METHODS: Two independent reviewers used a two-phase screening process. First, the reviewers assessed the eligibility of studies based on titles and abstracts; followed by assessing the full text of all remaining studies based on the eligibility criteria. An adapted version of the Joanna Briggs Institute data extraction tool was created to extract relevant information from studies reviewed during the second screening phase. RESULTS: Of the 535 de-duplicated articles examined by two independent reviewers, there were no eligible empirical studies that assessed the association between nurse work environment and severe maternal morbidity. CONCLUSION: There is a critical gap in knowledge regarding how characteristics of the nurse work environment may influence severe maternal morbidity in high-income countries. Future directions for nursing research include using available maternal health surveillance hospital-level data, conducting high-quality studies, and using evidence-based frameworks to guide future studies. Future directions for nursing practice include leveraging professional learning communities for nursing education and training and leveraging quality improvement initiatives. IMPACT: As the first known systematic review of its kind, this 'empty review' provides evidence of a lacking body of literature on the association between nurse work environment, as a modifiable organizational characteristic and preventable severe maternal morbidity in high-income countries. This article provides a call to action in the form of five recommendations for future nursing research and practice, which could serve to elucidate research, practice, and policy opportunities to reduce preventable severe maternal morbidity in high-income countries.

Human Biobanking in Developed and Developing Countries: An Ethico-Legal Comparative Analysis of the Frameworks in the United Kingdom, Australia, Uganda, and South Africa.

Although the concept of biobanking is not new, the open and evolving nature of biobanks has created profound ethical, legal, and social implications, including issues around informed consent, community engagement, secondary uses of materials over time, ownership of materials, data sharing, and privacy. Complexities also emerge because of increasing international collaborations and differing national positions. In addition, the degrees and topics of concern vary as legislative, ethical, and social frameworks differ across developed and developing countries. Implementing national laws in an internationally consistent manner is also problematic. However, these concerns should not cause countries, especially developing countries, to lag behind as this novel wave of research gains momentum, particularly while several biobank initiatives are already underway in the developing world. As the law has always struggled to keep up with the fast-evolving scientific arena, this article seeks to identify the ethico-legal frameworks in place in the United Kingdom, Australia, Uganda, and South Africa, for human biobank research, in an attempt to compare and contextualize the approaches to human biobanking in specific developed and developing countries.

Rural emergency departments: A systematic review to develop a resource typology relevant to developed countries.

OBJECTIVE: Despite low patient numbers, rural emergency departments have a similar diversity of case presentations as urban tertiary hospitals, with the need to manage high-acuity cases with limited resources. There are no consistent descriptions of the resources available to rural emergency departments internationally, limiting the capacity to compare clinical protocols and standards of care across similarly resourced units. This review aimed to describe the range of human, physical and specialist resources described in rural emergency departments in developed countries and propose a typology for use internationally. DESIGN AND SETTING: A systematic literature search was performed for journal articles between 2000 and 2019 describing the staffing, access to radiology and laboratory investigations, and hospital inpatient specialists. RESULTS: Considerable diversity in defining rurality and in resource access was found within and between Australia, New Zealand, Canada and USA. DISCUSSION: A typology was developed to account for (a) emergency department staff on-floor, (b) emergency department staff on-call, (c) physical resources and (d) access to a specialist surgical service. This provides a valuable tool for relevant stakeholders to effectively communicate rural emergency department resources within a country and internationally. CONCLUSION: The proposed five-tiered typology draws together international literature regarding rural emergency department services. Although further research is required to test this tool, the formation of this common language allows a base for effective communication between governments, training providers and policy-makers who are seeking to improve health systems and health outcomes.

Monitoring breastfeeding indicators in high-income countries: Levels, trends and challenges.

Monitoring indicators of breastfeeding practices is important to protect and evaluate the progress of breastfeeding promotion efforts. However, high-income countries lack standardized methodology to monitor their indicators. We aimed to update and summarize nationally representative annual estimates of breastfeeding indicators in high-income countries and to describe methodological issues pertaining to the data sources used. A review was conducted through population-based surveys with nationally representative samples or health reports from nationally representative administrative data of electronic surveys or medical records. Methodological aspects and rates of all breastfeeding indicators available were summarized by country. The median and annual growth of breastfeeding in percentage points within countries with time-series data were estimated. Data from 51 out of 82 high-income countries were identified. The data were obtained through surveys (n = 32) or administrative data (n = 19). Seventy-one percent of countries have updated their indicators since 2015. Ever breastfed was the indicator most frequently reported (n = 46), with a median of 91%. By 6 months of age, the median equals 18% for exclusive and 45% for any breastfeeding. At 12 months, the median of continued breastfeeding decreased to 29%. The annual growth rate for ever breastfed, exclusive and any breastfeeding at 6 months and continued at 12 months varied from 1.5 to -2.0, 3.5 to -3.1, 5.0 to -1.0 and 5.0 to -1.9, respectively, with positive changes for most countries. Stronger interventions are needed to promote breastfeeding in high-income countries as a whole, and investments are required to monitor trends with standardized methodologies.