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Cardiovascular surgery in Panama has depended on constant contributions and support from other developed countries. Although cardiac surgery has reached important milestones, cardiac surgery training is still evolving. Here, we provide a look into both the development and training of cardiac surgery in the Republic of Panama and the importance of international training.

Many developed countries rely, to varying degrees, on competition among private health plans to obtain affordable and high-quality health insurance for their residents. Incorporating beneficiary-level competitive bidding into these healthcare systems can better align the incentives of these health plans, increase their willingness to enroll, and serve the sickest and most vulnerable patients while keeping costs manageable. We identify two digitally enabled program designs that allow private insurance plans to competitively bid to enroll individual beneficiaries. Compared with those used in existing entitlement programs, these designs always make a larger share of the beneficiary population profitable to enroll, thereby increasing willingness of the plans to enroll the most costly beneficiaries and improving access to care. On simulating the conditions of existing real-word healthcare entitlement programs, we found that these new designs actually tend to lower the tax burden in up to 83% of simulations. The research findings suggest that these new designs hold great promise in achieving the dual aim of improved access and lower costs. We believe that findings from this research can guide policymakers implement policies that will enroll more beneficiaries and cost the taxpayers less.

The incidence of atherosclerotic cardiovascular disease has increased in the developed countries. Dyslipidemia is a primary major risk factor for atherosclerotic cardiovascular disease and LDL lowering is one of the main objectives. Although treatment goals for dyslipidemias should be personalized in every patient, statins are cost-effective in primary and secondary prevention of atherosclerotic cardiovascular disease. New treatments with higher power and greater decreases in LDL, PSCK9 inhibitors, have made a new breakthrough in atherosclerotic cardiovascular disease treatment. The 2019 guidelines for de management of dyslipidemias: lipid modification to reduce cardiovascular risk (European Society of Cardiology/European Atherosclerosis Society) with the level of evidence and the strength of the recommendations can facilitate the best decisions and benefits to our patients in clinical practice.

Despite huge advances in the diagnosis and treatment of pediatric cancers over the past several decades, it remains one of the leading causes of death during childhood in developed countries. The development of new targeted treatments for these diseases has been hampered by two major factors. First, the extremely heterogeneous nature of the types of tumors encountered in this age group, and their fundamental differences from common adult carcinomas, has made it hard to truly get a handle on the complexities of the underlying biology driving tumor growth. Second, a reluctance of the pharmaceutical industry to develop products or trials for this population due to the relatively small size of the 'market', and a too-easy mechanism of obtaining waivers for pediatric development of adult oncology drugs based on disease type rather than mechanism of action, led to significant difficulties in getting access to new drugs. Thankfully, the field has now started to change, both scientifically and from a regulatory perspective, in order to address some of these challenges. In this review, we will examine some of the recent insights into molecular features which make pediatric tumors so unique and how these might represent therapeutic targets; highlight ongoing international initiatives for providing comprehensive, personalized genomic profiling of childhood tumors in a clinically-relevant timeframe, and look briefly at where the field of pediatric precision oncology may be heading in future.

This paper considers one altruistic developed country and several heterogeneous developing countries. We demonstrate that the lack of coordination between countries in tackling climate change finds an optimal solution if developing countries can expect to receive development aid transfers from the developed country. The mechanism requires a sufficiently high level of altruism and specific timing, but a global coalition is not necessary. We also show that the developed country may democratically assign a delegate who is more altruistic than its median voter in order to benefit from the efficiency gain generated by positive development aid transfers., Environmental and Resource Economics, 84 (1), ISSN:0924-6460, ISSN:1573-1502

DMT2 is the most common type of diabetes in the world. In developed countries, dia¬betes affects people over 65 years old. However, in Asia, the younger generation is also affected and the age onset of diabetes has declined. Several factors that may lead to early diabetes is changes in consumption and activity patterns. However, that should be noted that pestisides expusure by food and environmental pollutants can even be the reason behind the increasing incidence of type-2 diabetes mellitus. This study aims to provide a systematic review of the impact of pesticide exposure on the incidence of type-2 diabetes, especially at a young age. We performed articles search using Science Direct, Spinger Link, ProQuest, Pubmed and Scopus databases published since 2010 until 2020. In total, 10 scientific articles included in this study. Pesticide exposure is determined by the nature of the sources. Most studies showed a strong association between organochlorine pesticides and also the incidence of diabetes. The average age of the entire study was 43 years this has proven that there is a decrease in the onset of age of people with DMT2 in Asia. The results show that organochlorine pesticides had an impact on the incidence of DMT2 at a younger age. Someone with high levels of organochlorines serum will had a high blood glucose levels. Race may also effect the incidence of diabetes, it need to be assessed experimentally.

Abstract. Background: Few studies have examined the effect of pandemics on suicide-related outcomes. Aims: We examined whether suicidal ideation levels among the general population changed owing to the COVID-19 pandemic by tracking individuals between January and April 2020. Method: We used a prospective observational longitudinal design ( n = 6,683) and stratified sampling to conduct online surveys of the general adult population in Japan before (baseline) and during the pandemic (follow-up). Results: Suicidal ideation levels were significantly lower during than before the pandemic; however, the effect size was very small. Participants who were younger, with unstable employment, without children, with low income, and receiving psychiatric care were more likely to have higher suicidal ideation levels during the pandemic. Limitations: Because this was an Internet survey and subject to selection bias, the sample was not necessarily representative of the Japanese population. At the time of the survey, COVID-19 cases and deaths in Japan were relatively lower than in other developed countries. The dropout rate may have affected the results. Conclusion: Although the short-term impact of the COVID-19 pandemic on suicidal ideation is limited, relatively young and economically vulnerable individuals are more likely to show exacerbated suicidal ideation during the pandemic.

Objectives: To analyze the incidence and overall survival rate of patients with vulvar cancer in Poland, based on the reporting data from the National Health Fund. Material and methods: The incidence of vulvar cancer in Poland in 2008–2016 (9-year follow-up period) by voivodship and the number of patients undergoing combined hospital treatment were analyzed. For the group of patients treated systemically, overall survival (OS) probability was calculated using the Kaplan-Meier estimation method. Results: In the period 2008–2016 in Poland, the diagnosis of malignant neoplasm of the vulva (C51% group) was made in 29,702 patients. The mean annual prevalence rate per 100,000 inhabitants was 8.3 ± 1.2 for Poland. The largest numbers of patients were reported in Mazowieckie and Slaskie voivodeships and the lowest in Opolskie and Podlaskie voivodeships. The median overall survival of patients treated with the combined method in 2008–2016 in Poland was 64.7 months (95% Cl: 58.0–70.0). One-year survival rate was observed in 77.6% of patients, 2-year in 64.4%, 3-year in 58%, over 5 years — 54.22%. Conclusions: In the years 2008–2016 in Poland, based on the data reported to the National Health Fund, the incidence of vulvar cancer was 4 times higher than the statistics of the National Cancer Registry, the WHO or the USA, which indicates either substantive or reporting errors. In Poland, 54% of patients treated with the combined therapy survive over 5 years which is a much lower result compared to highly developed countries.

INTRODUCTION The stillbirth rate (SBR) is an important public health indicator. We studied the distribution of maternal and fetal characteristics and time trends of the SBR at KK Women’s and Children’s Hospital (KKH), Singapore, from 2004 to 2016 based on various definitions of stillbirth. METHODS Data was obtained from the Data Warehouse and Stillbirth Reporting System of KKH from 2004 to 2016. SBRs were calculated based on three definitions (fetal deaths at ≥ 20 weeks, 24 weeks or 28 weeks of gestation per 1,000 total births) and were described with maternal and fetal characteristics, and by year. RESULTS From 2004 to 2016, the SBR declined by 44.7%, 25.5% and 18.9% based on Definitions I, II and III, respectively. The SBR at KKH in 2016 was 5.2 (Definition I), 4.1 (Definition II) and 3.0 (Definition III) per 1,000 total births. The SBR was significantly higher in women aged ≥ 35 years, nulliparas and female fetuses. The number of live births at 24–27+6 weeks of gestation was more than four times higher than that of stillbirths (822 vs. 176). There were 104 (12.7%) neonatal deaths during this gestation period, giving a high survival rate of 87.3%. CONCLUSION The SBR in KKH is relatively lower than that in other developed countries. There is a need to consider revising our hospital and national definitions of the stillbirth lower boundary from 28 weeks to 24 weeks of gestation. This would allow us to make better comparisons with other developed countries, in line with improvements in healthcare.

CoA remains one of the most common congenital heart diseases and is associated with significant morbidity and mortality and if untreated. We aim to evaluate the safety, feasibility, and outcomes of endovascular stenting of Coarctation of the aorta (CoA) in a developing country with limited resources and compare it to available benchmarks.A retrospectively review of all patients who underwent endovascular stent repair of aortic coarctation at our tertiary center since 2009 was done.18 patients were identified, sixteen had native CoA, while two had recurrent CoA. mean age at the time of procedure was 21.2 ± 9.8 years (range 10-45 years), and 12(66%) patients were males. The mean follow-up duration was 4 ± 2.8 years. Post stenting, the average ascending-to-descending aorta systolic gradient decreased by 42.9 ± 20.4 mmHg (p 0.001). After the intervention, 13(72.2%) patients achieved normal BP while 5(27.8%) had residual hypertension. Fourteen patients received bare-metal stents, and four had covered stents. Attempted stent implantation was successful in all patients. Our procedural success rate was 94%. On follow-up, no dissections or aneurysmal changes were detected, four patients underwent re-expansion of the stent, one patient with suboptimal stenting result required surgery 6 months after stenting, and two patients had minor post-operative complications.Endovascular stenting for de-novo or recurrent CoA in children and adults at a tertiary center in a developing country is feasible and safe with outcomes comparable to developed countries. A multidisciplinary team approach is paramount in achieving good results and low complication rates in limited-resource settings.

This study investigated the nexus between greenhouse gas (GHG) emission, renewable energy, forest area, total patents, and research and development (R&D) expenditures in developed and developing countries from 1995 to 2018. The Dumitrescu and Hurlin non-causality test explored two-way causality between GHG and total patents (developed countries), R&D expenditures, and total patents (developed countries). The one-way causality was found from GHG to renewable energy (developed countries), renewable energy to the number of patents (developed countries, developing countries), GHG to R&D expenditures (developed countries), R&D expenditures to renewable energy (developed countries), renewable energy to GHG (developing countries), GHG to the total number of patents (developing countries), and renewable energy to R&D expenditures (developing countries). The Pooled Mean Group estimator revealed the reduction in GHG due to utilization of renewable energy in developed and developing countries. Moreover, the GHG reduction was also found due to an increase in the forest area in developed and developing countries. Environmental quality can be improved by fixing the target of renewable energy share in the total energy mix, provision of subsidy to environment-friendly projects, efficient energy use, increase in the forest cover, implementation of environmental standards, and promotion of environment-friendly products by using media.

Foreign aid is one of the most important policy tools that developed countries used to help poor countries improve population well-being and facilitate economic and institutional development. However, the effectiveness of aid as an instrument of development has been questioned several times, especially for its deleterious effects on governance. This study examines the effect of foreign aid on economic complexity in developing countries. Using annual data for 78 developing countries over the period 1990-2017, the empirical findings show that foreign aid exerts a negative effect on economic complexity. Although the effect of aid on economic complexity differs across donors, we also find a U-shaped relationship between foreign aid and economic complexity. In addition, the empirical results of this paper show that democracy mitigates the negative effect of foreign aid on economic complexity. Thus, in order to benefit from the effects of foreign aid for better economic complexity, the governments of developing countries would benefit from putting more effort into improving democracy.

In this paper we empirically investigate the drivers of genuine FDI inflows in advanced economies for the period 1985–2018. Our contribution to the existing literature is two-fold. First, we use newly available data of genuine FDI flows analysing the role of statistical artefacts, such as special purpose entities and financial round-tripping in headline FDI data. Second, we augment the traditional analysis on the drivers of FDI inflows in advanced economies by considering a range of potential factors which are under the policy makers’ control, i.e. measures that proxy for a country's quality of economic structures. Our results show that it is important to get the data right. In particular, more recently, total FDI data became increasingly distorted thus prompting misspecifications if not cleaned beforehand. Moreover, we suggest that there is a significant empirical relation between the quality of a host country's economic structures and FDI inflows. Our findings are robust to various economic specifications.

We examine the effects of limited investor attention on stock returns by using Google search volume index to measure investor attention. We also investigate whether national culture and market development have any role in this relationship. We find that the impact of investor attention on stock returns is not consistent throughout the world. The direction and significance of the impact vary from country to country. We also find that investor attention is more significant in individualistic countries, countries with high uncertainty avoidance, and developed countries. Furthermore, we find that the impact of abnormal returns on investor attention is more consistent across countries. One-week lagged absolute abnormal returns can positively predict investor attention in sixteen countries. Our results also show that investor attention returns to normal levels in three weeks in individualistic countries and countries with low uncertainty avoidance. Copyright (c) 2021, Borsa _Istanbul Anonim S,irketi. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NCND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

In the last decades, we have been watching a remarkable increase in survival of children with congenital heart disease (CHD), due to advances in surgical and medical management, leading to a significant growth in the number of adolescents and young adults with the disease. In developed countries, the number of adults with CHD surpasses the number of children with CHD. Unfortunately, prolonged survival has been achieved at a high cost, as an expressive number of patients continue to suffer from [...]

[ ]lessons learned from previous pandemics helped catalyze COVID19 preparedness in several countries 2 Scientists in China identified and shared genetic sequencing of SARS-CoV-2 on January 10, allowing international jump starts in testing technology (South Korea) and vaccine development (e g , United States, United Kingdom) [ ]of the 2015 SARS (severe acute respiratory syndrome) epidemic, South Korea established the Infectious Disease Control Center, which later distributed COVID-19 testing guidelines before the first confirmed South Korean case 2 Responses in Hong Kong, Taiwan, and South Korea used technology- including mobile phone data, credit card records, and closed-circuit TV recordings-to help identify, isolate, and contact trace COVID-19-positive individuals 2 Despite encroachment on individual privacy and liberties, public recall of SARS and MERS (Middle East respiratory syndrome) facilitated adherence to these procedures 2 Unlike the fragmented US health care system, universal health care access in all other developed nations facilitated support of pandemic responses [ ]strong central coordination is essential to COVID-19 mitigation and precision public health

Background: The high occurrence of psychiatric disorders amongst adolescents within the Juvenile Justice System (JJS) has been confirmed. Most of the available data are from developed countries and some of them focus on just a single psychiatric disorder which may not be representative of the situation in low-income countries, hence the need for more studies in developing countries, including Nigeria. Aim: The study aimed to determine the prevalence of psychiatric disorders amongst adolescent residents of a correctional facility. Setting: The study was carried out at a Borstal Institution in North-Central Nigeria. Methods: A descriptive cross-sectional study design was used. One hundred and twenty adolescents were assessed using the socio-demographic pro forma questionnaire designed by the researcher and the Kiddies Schedule for Affective Disorders and Schizophrenia (KSADSPL). Data were analysed using EPI-INFO 4.06 d version 6.04 software. Results: A total of 62.5% of the male respondents were older than 15 years. The percentage of respondents with a psychiatric disorder was 82.5%. The rate of psychiatric disorders was high with disruptive behaviour disorders being the most common at 40.8%, others were substance use disorders (15.8%), anxiety disorders (14.2%), psychosis (6.7%) and mood disorders (5%). Conclusion: This study has established a high prevalence rate of psychiatric disorders amongst incarcerated adolescents. This is in line with the findings of numerous studies worldwide. This study has identified the need to increase awareness and knowledge about the high morbidity of mental disorders in growing juvenile detainee populations. This will allow early identification of adolescents at risk of psychiatric disorders and ensure efficient resource distribution of both JJS service and mental healthcare. Effective and appropriate interventions have shown to improve overall health, quality of life and reduce the rate of recidivism amongst incarcerated juveniles.

BACKGROUND Stroke and diabetes (DM) are significant interrelated healthcare issues but there is a dearth of data on the prevalence of DM among Australia's regional stroke population. AIMS We aimed to determine the prevalence of DM in stroke patients at a large regional centre, including sub-analyses on stroke subtypes, glycaemic control and renal function in ischaemic stroke (IS). METHODS We conducted a retrospective analysis of all patients (n = 323) with IS or transient ischaemic attack (TIA) admitted to Ballarat Base Hospital from January 2015 to December 2016. Demographic data, cardiovascular risk factors, aetiology/territory of IS, pre-morbid DM status, indicators of glycaemic control and renal impairment were recorded. RESULTS DM was present in 28.5% of IS and TIA patients including 4% being newly diagnosed. Among diabetic IS patients, 45.3% had poor glycaemic control (HbA1c ≥7.0%) while 16% had moderate to severe renal impairment (eGFR of

Survival rates for out-of-hospital cardiac arrest (OHCA) patients in the UK are low compared with other developed countries. UK ambulance services are in an important position to influence these survival rates by improving their ‘chain of survival’ (Nolan et al, 2006). A paramedic-led resource, with enhanced technical and non-technical skills specialising in OHCAs, has been shown to improve patient outcomes in this population group in the UK. The author proposes that this concept should be considered by all UK ambulance services to improve OHCA patient survival.

Bejel, caused by Treponema pallidum subsp. Endemicum (TEN), is a locally transmitted disease among children and juveniles in hot and dry regions. The number of adult cases of TEN infection outside of endemic areas has recently increased. We clinically examined five cases of TEN infection among adult cases previously reported in Japan. TEN infection mainly developed among young to middle-aged men who have sex with men (MSM). The clinical features of cases of TEN infection were similar to those of primary- and secondary-stage T. pallidum subsp. pallidum (TPA) infection. Genital lesions were common as the primary lesion. The clinical features and laboratory parameters of cases of TEN infection were similar to those of TPA infection. Most of the isolated strains had the A2058G mutation in 23S rDNA, which is responsible for resistance to macrolides. We also performed the systemic literature review of the TEN cases outside the endemic countries. The recent reported cases diagnosed with molecular methods shared the clinical features, occurred in young-to middle-aged sexually active persons in urban areas of developed countries and often accompanied with genital lesions, which were distinct from the classic description of bejel. This case series and the literature review provides important clinical insights and will contribute to the clinical detection of this rarely identified disease in developed countries. The surveillance of treponematoses, including TEN infection, using molecular diagnostic techniques is also warranted in developed countries, for the purpose of grasping the epidemic situation and control the local transmission.

Incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing globally and the human papillomavirus (HPV) has been linked to this increase. This study aimed to present a comprehensive overview of OPSCC trends in incidence rates by age group and investigate differences in risk factors profile. Netherlands Cancer Registry data from 1989-2018 were analyzed to calculate the annual percentage change (APC) over European standardized incidence rates by gender and age group using joinpoint regression software. Smoking, alcohol drinking and HPV-status were available for 2015-2018. During 1989-2018, 13 048 cases of OPSCC were reported with a male-to-female ratio of 2.1:1. The overall incidence rate increased by 5.4% (APC) annually from 1989 to 1996 but slowed thereafter by 1.2%. Significant declines were found in patients of 35-44 years (APCs -3.7%). Adults aged 45-59 years displayed significant increases from 1989 to 2001, followed by a significant decline. In patients >= 60 years, the incidence rates increased overall, with APC for women being consistently higher than men. The data on HPV status was available for 69% of the patients, of whom 47% were HPV+. Smoking and alcohol consumption were more prevalent, that is 75 and 76 % respectively. The declining trends of OPSCC for Dutch people aged 35-44 years from 1989 to 2018 and for those aged 45-59 years from 2002 onwards are inconsistent to trends reported elsewhere in the developed countries. The prevalence of smoking and drinking alcohol was quite high in all age groups, whereas the proportion of HPV-positivity was relatively low.

We employ the treatment effect model to examine whether equity market crises are significantly associated with economic growth. By using a variety of indicators of equity market crises, our empirical results show that they have significantly reduced economic growth, especially in developed countries and when the stock market price dropped by 50% or more. This adverse effect was aggravated by the onset of the 2008 global financial crisis. Our empirical results also show that the most important channels of this adverse effect of equity market crises on aggregate growth are consumption and investment.

Food waste has become a global issue that has received increased attention. Food waste at the household level is a major source of food loss in developed countries. While culture is an important factor shaping people’s behavior, comparison of food waste behaviors across countries and regions are still limited. This study uses primary data covering the US, Canada, the UK, and France to understand and compare consumers’ food waste behaviors. While we found some common drivers for food waste behavior appliable to all countries, such as age, eating away from home, and using expiration dates, we confirmed that consumers behave significantly different across countries. For example, personal factors such as employment status, household size, and environmental concerns are only found significant in certain countries. Similarly, while convenience-driven consumers tend to waste more across countries, only European consumers who are price and advertising conscious tend to increase their food waste frequency. Moreover, many well-known food waste prevention actions, such as making a shopping list, preserving and freezing food, and being willing to consume leftovers, only appear to work in certain countries.

Recent studies have highlighted the unequal labour market effects of the COVID-19 crisis in advanced economies. We contribute to this literature by drawing on a new survey of almost 40,000 adults in 14 advanced as well as emerging economies conducted in August 2020. We show that while labour market impacts are, on average, more severe in emerging markets, these are less unequally distributed than in advanced economies. In line with the findings of existing studies for advanced economies, we document that job losses in emerging markets are also concentrated among the young, less educated and those with lower levels of income before the pandemic. However, we find that the likelihood of job losses falls less sharply with income in emerging markets than in advanced economies. Drawing on a similar survey conducted in 2010 we show that, unlike the Global Financial Crisis, the COVID-19 crisis disproportionately hit women. Job losses also appear to me more concentrated among the young now than during the Global Financial Crisis.

Nutritional dermatoses are traditionally taught in the context of developing countries, famine, population displacement, and limited access to healthcare. In the United States, nutritional dermatoses may be underdiagnosed and lead to increased morbidity and utilization of hospital resources. These findings underscore the need for providers in developed nations to be able to identify these deficiencies. Dermatologists play a critical role in the diagnosis and management of nutritional deficiencies as they often present with cutaneous findings. Part two of this review series will focus on the epidemiology, impact, manifestations, and diagnosis of B-complex vitamins that can present with cutaneous findings, including thiamine, riboflavin, niacin, pyridoxine, and biotin.