Search

In this paper, we analyze the extent to which low-income countries integrate into the global knowledge production network. We develop an (undirected) research collaboration model based on which we identify the drivers of global research collaboration using publication data of the field Business and Economics from the Web of Science and macroeconomic data from the United Nations Educational, Scientific and Cultural Organization Institute for Statistics. Network and dynamic panel regression techniques are employed. Our results show that (i) reciprocal preferential attachment and the homophily between countries reinforce scientific collaboration, (ii) there is no evidence that low-income countries are becoming better integrated into the global knowledge production over the years, despite their active participation in international reserach collaboration, while (iii) high-income countries show a basic willingness to cooperate with them, which, in turn, promotes the integration of low-income countries, although this willingness seems to decline; and (iv) as to low-income countries, they have little choice but to invest more in education and R&D in order to advance in the global knowledge production network. [ABSTRACT FROM AUTHOR]

Researchers based in poorer countries typically face major challenges in publishing their work in international journals, compared to those faced by researchers in the wealthier countries of Europe and North America. This paper studies this issue based on the experience of papers submitted to the Review of Development Economics, an important international development economics journal. It presents an analysis of submissions and success in publication, based on the fortunes of all papers submitted to the journal between 2015 and April 2022, disaggregated by the country in which the corresponding author is based. Authors based in low and middle income countries accounted for 33% of publications in this period, though they accounted for 61% of the submissions received. A main factor was that these papers were significantly less likely to be sent for review by the journal; if reviewed, they were also less likely to be accepted than papers from authors in high income countries, though that differential is much less stark. This analysis is presented in the interests of transparency and to encourage discussion, but also to raise issues the journal needs to address. The paper finishes by reviewing, based on co‐editor experience over this period, issues and potential responses. [ABSTRACT FROM AUTHOR]

WHO recently announced a process to review and potentially update the procedures for selecting essential medicines. This announcement presents an opportunity to reflect on the evolution of the WHO Model Lists of Essential Medicines (EML), including the composition of the stakeholders that shape priorities. We contextualised our findings within the broader history of the WHO EML to support future reforms to improve access to essential medicines. The current system allows individuals to propose a medicine for the WHO EML. This makes the EML reactive to applicant priorities. Almost all medicines (687/700; 98·1%) proposed to the WHO EML between 2003 and 2023 came from applicants in high-income countries. Most applications (210/700; 30·0%) were submitted by universities and research institutions, followed by non-governmental organisations (159/700; 22·7%), the UN system (158/700; 22·6%), professional associations (98/700; 14·0%), and the pharmaceutical industry (75/700; 10·7%). Between 1977 and 2023, over half of the Expert Committee members were from low-income and middle-income countries, with an increasing proportion in recent EML updates. Mainly, UN agencies acted as observers between 1977 and 2023. One central question emerges when evaluating whether applicants' geographical distribution translates to the WHO EML's intended purpose: for whom is the EML intended? Over the years, the geographical applicability has blurred. Defining a strategic vision for the WHO EML, including articulating a target audience and structured selection process, would strengthen decision-making processes by providing additional clarity, including to those implementing the guidance, mostly in low-income and middle-income countries. [ABSTRACT FROM AUTHOR]

Purpose: Low- and middle-income countries (LMICs) are underrepresented in ophthalmic research, despite carrying the highest burden of visual impairment. To assess the representation of local authors in global ophthalmic research, this cross-sectional, bibliometric analysis measured the proportion of LMIC-affiliated authorship in LMIC-based ophthalmic research. Methods: We sampled original, primary research conducted in LMICs and published in 1 of 7 high-impact ophthalmic journals between 2017 and 2021. For each article, we extracted the number and name of country study site(s), country affiliation(s) of first and last author, proportion of LMIC-affiliated authors, funding sources, and study design. Results: Of the 1,333 studies exclusively conducted in LMICs, 89.4% of first authors and 80.6% of last authors were exclusively LMIC-affiliated. Representation of LMIC-affiliated first authors were lower in studies based in low-income countries (25.0%) or in sub-Saharan Africa (26.5%), published in journals with higher impact factors (68.0% in Ophthalmology), funded by high-income countries (HICs) (41.4%), or conducted in both LMICs and HICs (27.1%). The United States, United Kingdom, and Australia had the 3rd, 6th, and 8th largest shares of last authors. There were only 12 single-country studies conducted in low-income countries, namely Ethiopia, the Gambia, Guinea, Liberia, the Niger, and Sierra Leone. Of these countries, only three held first authorship and one held last authorship. Conclusions: Although LMIC-based ophthalmic research has demonstrated higher local authorship representation compared to other fields, underrepresentation can be exacerbated by country income level, journal "prestige," and degree of HIC involvement. These discrepancies highlight the need for more equitable data ownership in global ophthalmic research. [ABSTRACT FROM AUTHOR]

Depression is a leading cause of disability and poor health worldwide and is expected to rank first worldwide by 2030. The aim of this study is to analyze the transition and trend of depression burden in China and various income-level countries by utilizing the Global Burden of Disease (GBD) database and the Joinpoint regression model. This analysis seeks to comprehend the variations in the burden of depression across different income regions and evaluate their developmental patterns. Based on the GBD 2019 open dataset, this study extracted data on YLD (Years Lived with Disability), DALY (Disability-Adjusted Life Years), and incidence related to depression. The analysis focused on the period between 1990 and 2019, covering global data and distinguishing between high-income, upper-middle-income, lower-middle-income, low-income countries, and China. We utilized the Joinpoint regression model to fit the spatiotemporal trend changes among different income-level countries. Pairwise comparisons were conducted to examine the parallelism and to determine if the differences in trend changes among various regions were statistically significant. From 1990 to 2019, the age-standardized YLD and DALY for depression female were higher than that in male. The YLD total change rate of depression men was higher than that of women. China exhibited the largest disparity in total YLD change rates between genders, reaching 0.08. During 1990 to 2019, the incidence of depression in 2005–2019 increased among females in middle to high-income countries, low-income countries, and China as compare to that of 1990–2005. Notably, China shown the most increase the incidence rate of females (from −0.4 % to 0.84 %). China experienced the most significant change in the YLD of depression during this period (AAPC = 0.45, 95 % CI = 0.41, 0.48, P < 0.01). China's YLD/Incidence rate was higher compared to the global, HICs, UMCs, LMCs, and LICs. In China, the YLD/incidence rate of depression began to rise in 1994, peaking around 2010, and then gradually declining. Since 2010, the growth rate of depression DALYs in China has been higher than the global average, high-income countries, upper-middle-income countries, lower-middle-income countries, and low-income countries. The DALY's AAPC value for the HLCs was the highest (AAPC = 0.24, 95 % CI = 0.22, 0.25, P < 0.01). The UMCs, in comparison to other regions, incidence rate had the highest AAPC value (AAPC = 0.48, 95 % CI = 0.46, 0.50, P < 0.01). Given the significant variations in the burden of depression across countries with different income levels, future strategies aimed at reducing the burden of depression should adopt tailored and differentiated approaches according to each country's specific needs and developmental stages. • Gender Disparities: From 1990 to 2019, the study reveals higher age-standardized YLD and DALY for depression among women compared to men. However, the total change rate for men's YLD was higher than for women. • China's Unique Burden: China exhibited the most significant disparity in total YLD change rates between genders, reaching 0.08. Additionally, it experienced a notable increase in the incidence rate among females, reaching 1.24. • Global and Regional Trends: The research uncovers variations in depression burden among different income countries. High-income countries showed higher age-standardized YLD rates, while low-income countries exhibited the highest change rate in depression incidence. • Gender and Income Disparities: Highlighting gender and income-related variations in depression burden underscores the need for targeted interventions based on socioeconomic and gender-specific factors. [ABSTRACT FROM AUTHOR]

This article revisits the relationship between economic growth and exchange rate misalignments. We aim to test whether undervaluation's impact on growth depends on institutional quality, as suggested in the previous literature. In our analysis, we focus on recent decades characterized by globalization. We use the framework of cross-country growth regressions estimated using the recently developed two-stage instrumental variable method, which allows accounting for cross sectional dependence. In addition, we use external instruments to address the potential endogeneity between economic growth and undervaluation. Our results confirm the positive relationship between undervaluation and growth across all income groups from low-income to high-income countries. The role of institutions in the transmission of undervaluation on growth appears consistently only among lower-middle-income countries. Therefore, while our results point to the positive effects of undervaluation, the support for the hope that countries can successfully compensate for poor institutional quality via the undervaluation of currencies is weaker and limited to specific stages of economic development. [ABSTRACT FROM AUTHOR]

The study set out to investigate whether transparency can mitigate the negative effects volatile capital flows have on growth using cross-section panel data from 21 sub-Saharan African countries from 2000 to 2019. Using the IVQR model, the study finds that at 75th quantile, poor growth performance in SSA is explained mostly by the volatility in debt net inflows compared to other categories of capital, while portfolio net inflow contributes most significantly to the low-level growth for low and medium income countries. Focusing on the interaction between transparency and capital net inflows, the study finds evidence that transparency reduces most of the negative effects of the volatility in debt net inflow compared to other categories of capital inflow. Thus, the study provides evidence that transparency can reduce the negative effects of volatile capital inflows on growth by a significant amount, which varies depending on the type of capital inflow. The implication is that the extent transparency dampens the negative impact of volatile capital flows depend on both the capital type and the level of income of the country concerned. Regarding FDI and FPI, transparency is most effective in reducing volatility of the flow for low income countries, while for debt flows transparency penalizes the volatility of flows for high income countries. On this basis, it recommends that central banks should adopt transparency as a policy tool, particularly in SSA economies with probably low initial transparency to help mitigate the harmful effects of large and volatile capital inflows. [ABSTRACT FROM AUTHOR]

Climate change mitigation is a pressing global challenge that requires reducing CO2 emissions without hindering economic growth. Using an extended Kaya identity, Logarithmic Mean Divisia Index (LMDI), and Tapio decoupling indicator, this paper investigates the spatio-temporal variations, drivers, and decoupling of CO2 emissions from economic growth in 150 countries from 1990 to 2019, considering regional disparities and income-based inequalities. The findings reveal increasing CO2 emissions between 1990 and 2019, with notable fluctuations in certain 5-year intervals. CO2 emission growth varied significantly by region, with countries like China, the USA, India, and Japan experiencing rapid increases. Economic growth emerged as the primary driver of CO2 emission growth, and its impact strengthened over time. Population growth also contributed significantly to CO2 emissions, particularly in middle- and low-income countries. The study identifies energy and carbon intensity as crucial mitigating factors that weaken CO2 emissions, offering hope for effective climate change mitigation. Furthermore, the degree of decoupling between economic growth and CO2 emissions varied among countries in the same region, with high-income countries demonstrating stronger decoupling compared to upper-middle-income countries, which accounted for 71% of global CO2 emission increase. These findings underline the imperative of accounting for income levels and regional differences in formulating CO2 emission mitigation strategies. Also, the study emphasizes the pressing necessity for cohesive global coordination to facilitate the transition toward a low-carbon economy. Such collaborative endeavors are paramount in our collective pursuit to combat climate change effectively, safeguarding the well-being and sustenance of our planet for future generations. As policymakers, it is imperative to integrate these insights into decision-making processes to chart a sustainable and resilient course forward. [ABSTRACT FROM AUTHOR]

Using a panel dataset of contract‐year observations for Major League Baseball (MLB) players, this study looks to understand how job security affects incentives for worker performance. Prior works have found evidence of diminished performance when job security is high in the early years of guaranteed contracts (shirking) and heightened performance when job security is low at the end of contracts when players are hoping to secure new contracts (opportunistic behavior). The focus of this study is on how socio‐economic background interacts with job security to influence performance. Theory and empirical evidence suggest that workers from disadvantaged socio‐economic backgrounds may care more about job security, which could subsequently lead the performance of such workers to be more affected by changes to job security. This hypothesis is tested empirically. In testing this indirectly, evidence of stronger impacts of job security on performance of MLB players from lower income countries relative to those from higher income countries is found. To directly test this hypothesis, data on player socio‐economic backgrounds is hand‐collected. The performance of players from less‐advantaged socio‐economic backgrounds is found to be more affected by job security. Given that job security is common in many work settings, these findings have implications for workers and employers both inside and outside of sports. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has wrought unprecedented disruption on global economies, leading to widespread income insecurity among individuals and households. This study investigates the impact of the pandemic on income insecurity across different income groups and assesses the role of social protection measures in mitigating these effects. Using cross-country data, we analyze the prevalence of income reduction and the effectiveness of social assistance programs in high-income, upper middle-income, lower middle-income, and low-income countries. Our findings reveal significant variations in income insecurity and social protection responses across these groups. the pandemic had a significant impact on household incomes globally, with lower-middle-income countries experiencing the most significant income reductions. The average per capita transfer amounts show a general decrease over time, which could be due to the economic strain on governments and the need for more sustainable social protection programs. The correlation between transfer amounts and the proportion of households with reduced income indicates that countries with higher income reduction rates tended to have lower average per capita transfer amounts, suggesting a potential lack of adequate support for those in need. The study highlights the importance of robust social safety nets in cushioning the economic blow of the pandemic, particularly for vulnerable populations in lower-income countries. [ABSTRACT FROM AUTHOR]

There are marked disparities in cancer survival in low‐income countries compared to high‐income countries, yet population‐based data in the first is largely lacking. In this study, data from the national cancer registry of Rwanda were examined for 542 patients diagnosed with eight of the most common cancers of adults stomach (C16), colorectum (C18‐20), liver (C22), breast (female) (C50), cervix (C53), ovary (C56), prostate (C61), and non‐Hodgkin lymphomas (C82‐85) between 2014 and 2017. Subjects were randomly selected for active followed‐up to calculate 1‐, 3‐, and 5‐year observed and relative survival (RS) by cancer type and stage. Overall, 53.7% of cases had died within 5 years of diagnosis. Five‐year RS varied by malignancy and ranged from 17.6% (95% confidence interval [CI]: 6.7%–32.6%) for liver cancer to 68% (CI: 51.6%–79.8%) for cancers of the prostate. Stage was assigned for 71.6% of patients (n = 388 of 542), with over half (58%) having advanced stage (III/IV) at diagnosis. For all except liver and ovary, stage was a strong predictor of survival; for example, three‐year observed survival was 90.9% and 44.8% (p‐value:.002) for early and advanced breast cancer, respectively. This study demonstrates that stage specific survival can be obtained from population based cancer registries in sub Saharan Africa, data that are invaluable for international benchmarking, and for local planning and evaluation of cancer control programs. [ABSTRACT FROM AUTHOR]

Background: Postpartum haemorrhage (PPH) is an obstetric emergency. While PPH-related deaths are relatively rare in high-resource settings, PPH continues to be the leading cause of maternal mortality in limited-resource settings. We undertook a systematic review to identify, assess, and synthesise cost-effectiveness evidence on postpartum interventions to prevent, diagnose, or treat PPH. Methods and findings: This systematic review was prospectively registered on PROSPERO (CRD42023438424). We searched Medline, Embase, NHS Economic Evaluation Database (NHS EED), EconLit, CINAHL, Emcare, Web of Science, and Global Index Medicus between 22 June 2023 and 11 July 2024 with no date or language limitations. Full economic evaluations of any postpartum intervention for prevention, detection, or management of PPH were eligible. Study screening, data extraction, and quality assessments (using the CHEC-E tool) were undertaken independently by at least 2 reviewers. We developed narrative syntheses of available evidence for each intervention. From 3,993 citations, 56 studies were included: 33 studies of preventative interventions, 1 study assessed a diagnostic method, 17 studies of treatment interventions, 1 study comparing prevention and treatment, and 4 studies assessed care bundles. Twenty-four studies were conducted in high-income countries, 22 in upper or lower middle-income countries, 3 in low-income countries, and 7 studies involved countries of multiple income levels. Study settings, methods, and findings varied considerably. Interventions with the most consistent findings were the use of tranexamic acid for PPH treatment and using care bundles. In both cases, multiple studies predicted these interventions would either result in better health outcomes and cost savings, or better health outcomes at acceptable costs. Limitations for this review include that no ideal setting was chosen, and therefore, a transferability assessment was not undertaken. In addition, some sources of study uncertainty, such as effectiveness parameters, were interrogated to a greater degree than other sources of uncertainty. Conclusions: In this systematic review, we extracted, critically appraised, and summarised the cost-effectiveness evidence from 56 studies across 16 different interventions for the prevention, diagnosis, and treatment of PPH. Both the use of tranexamic acid as part of PPH treatment, and the use of comprehensive PPH bundles for prevention, diagnosis, and treatment have supportive cost-effectiveness evidence across a range of settings. More studies utilizing best practice principles are required to make stronger conclusions on which interventions provide the best value. Several high-priority interventions recommended by World Health Organization (WHO) such as administering additional uterotonics, non-pneumatic anti-shock garment, or uterine balloon tamponade (UBT) for PPH management require robust economic evaluations across high-, middle-, and low-resource settings. Author summary: Why was this study done?: There are wide array of interventions available to prevent, diagnose, and treat postpartum haemorrhage (PPH). The decision on which interventions governments should invest in is challenging, particularly when resources are scarce. Systematic reviews on the cost-effectiveness of interventions can assist this decision-making process by providing clear comparisons between options. What did the researchers do and find?: This is, to our knowledge, the first systematic review of economic evaluations covering prevention, diagnosis, and treatment of PPH. We identified 56 relevant studies across 16 interventions and summarised the findings from these studies in a comparable way. We found consistent evidence that adding tranexamic acid to PPH treatment, and the use of comprehensive care bundles combining preventative, diagnostic, and treatment interventions, are cost-effective. What do these findings mean?: The use of tranexamic acid for PPH treatment has been shown to be either cost-saving or highly cost-effective across multiple settings. The combination of multiple interventions into a care bundle is promising—available data suggests these approaches can be cost-effective. Sixteen World Health Organization (WHO) recommendations on the prevention, identification of treatment of PPH do not yet have robust cost-effectiveness evidence. Study limitations include that no ideal setting was chosen to compare interventions in, and that some sources of study uncertainty were interrogated to a greater extent than others. [ABSTRACT FROM AUTHOR]

Background Kidney transplantation (KT) is the preferred modality of kidney replacement therapy with better patient outcomes and quality of life compared with dialytic therapies. This study aims to evaluate the epidemiology, accessibility and availability of KT services in countries and regions around the world. Methods This study relied on data from an international survey of relevant stakeholders (clinicians, policymakers and patient advocates) from countries affiliated with the International Society of Nephrology that was conducted from July to September 2022. Survey questions related to the availability, access, donor type and cost of KT. Results In total, 167 countries responded to the survey. KT services were available in 70% of all countries, including 86% of high-income countries, but only 21% of low-income countries. In 80% of countries, access to KT was greater in adults than in children. The median global prevalence of KT was 279.0 [interquartile range (IQR) 58.0–492.0] per million people (pmp) and the median global incidence was 12.2 (IQR 3.0–27.8) pmp. Pre-emptive KT remained exclusive to high- and upper-middle-income countries, and living donor KT was the only available modality for KT in low-income countries. The median cost of the first year of KT was $26 903 USD and varied 1000-fold between the most and least expensive countries. Conclusion The availability, access and affordability of KT services, especially in low-income countries, remain limited. There is an exigent need to identify strategies to ensure equitable access to KT services for people with kidney failure worldwide, especially in the low-income countries. [ABSTRACT FROM AUTHOR]

Background Hemodialysis (HD) is the most commonly utilized modality for kidney replacement therapy worldwide. This study assesses the organizational structures, availability, accessibility, affordability and quality of HD care worldwide. Methods This cross-sectional study relied on desk research data as well as survey data from stakeholders (clinicians, policymakers and patient advocates) from countries affiliated with the International Society of Nephrology from July to September 2022. Results Overall, 167 countries or jurisdictions participated in the survey. In-center HD was available in 98% of countries with a median global prevalence of 322.7 [interquartile range (IQR) 76.3–648.8] per million population (pmp), ranging from 12.2 (IQR 3.9–103.0) pmp in Africa to 1575 (IQR 282.2–2106.8) pmp in North and East Asia. Overall, home HD was available in 30% of countries, mostly in countries of Western Europe (82%). In 74% of countries, more than half of people with kidney failure were able to access HD. HD centers increased with increasing country income levels from 0.31 pmp in low-income countries to 9.31 pmp in high-income countries. Overall, the annual cost of in-center HD was US$19 380.3 (IQR 11 817.6–38 005.4), and was highest in North America and the Caribbean (US$39 825.9) and lowest in South Asia (US$4310.2). In 19% of countries, HD services could not be accessed by children. Conclusions This study shows significant variations that have remained consistent over the years in availability, access and affordability of HD across countries with severe limitations in lower-resourced countries. [ABSTRACT FROM AUTHOR]

Background Worldwide, the uptake of peritoneal dialysis (PD) compared with hemodialysis remains limited. This study assessed organizational structures, availability, accessibility, affordability and quality of PD worldwide. Methods This cross-sectional study relied on data from kidney registries as well as survey data from stakeholders (clinicians, policymakers and advocates for people living with kidney disease) from countries affiliated with the International Society of Nephrology (ISN) from July to September 2022. Results Overall, 167 countries participated in the survey. PD was available in 79% of countries with a median global prevalence of 21.0 [interquartile range (IQR) 1.5–62.4] per million population (pmp). High-income countries (HICs) had an 80-fold higher prevalence of PD than low-income countries (LICs) (56.2 pmp vs 0.7 pmp). In 53% of countries, adults had greater PD access than children. Only 29% of countries used public funding (and free) reimbursement for PD with Oceania and South East Asia (6%), Africa (10%) and South Asia (14%) having the lowest proportions of countries in this category. Overall, the annual median cost of PD was US$18 959.2 (IQR US$10 891.4–US$31 013.8) with full private out-of-pocket payment in 4% of countries and the highest median cost in LICs (US$30 064.4) compared with other country income levels (e.g. HICs US$27 206.0). Conclusions Ongoing large gaps and variability in the availability, access and affordability of PD across countries and world regions were observed. Of note, there is significant inequity in access to PD by children and for people in LICs. [ABSTRACT FROM AUTHOR]

Background Conservative kidney management (CKM) describes supportive care for people living with kidney failure who choose not to receive or are unable to access kidney replacement therapy (KRT). This study captured the global availability of CKM services and funding. Methods Data came from the International Society of Nephrology Global Kidney Health survey conducted between June and September 2022. Availability of CKM, infrastructure, guidelines, medications and training were evaluated. Results CKM was available in some form in 61% of the 165 responding countries. CKM chosen through shared decision-making was available in 53%. Choice-restricted CKM—for those unable to access KRT—was available in 39%. Infrastructure to provide CKM chosen through shared decision-making was associated with national income level, reported as being "generally available" in most healthcare settings for 71% of high-income countries, 50% of upper-middle-income countries, 33% of lower-middle-income countries and 42% of low-income countries. For choice-restricted CKM, these figures were 29%, 50%, 67% and 58%, respectively. Essential medications for pain and palliative care were available in just over half of the countries, highly dependent upon income setting. Training for caregivers in symptom management in CKM was available in approximately a third of countries. Conclusions Most countries report some capacity for CKM. However, there is considerable variability in terms of how CKM is defined, as well as what and how much care is provided. Poor access to CKM perpetuates unmet palliative care needs, and must be addressed, particularly in low-resource settings where death from untreated kidney failure is common. [ABSTRACT FROM AUTHOR]

The article discusses the power and privilege dynamics that exist in pediatric anesthesia care globally. It highlights the disparities in access to safe and high-quality care between different countries, which are influenced by social determinants of health, economic factors, and political causes. The article identifies poverty, healthcare system fragility, geography and rural-urban divide, extremes of age in patients, poor prioritization of surgical care, race, gender, and colonial legacy as factors that perpetuate inequity in pediatric anesthesia care. The authors emphasize the need for collaboration and investment in strengthening healthcare systems to address these disparities and promote equity in pediatric anesthesia care. [Extracted from the article]

The number of new cancer cases in Commonwealth countries rose by 35% between 2008 and 2018, but progress in cancer control has been slow in many low-income and lower-middle-income member states. We aimed to examine cancer outcomes and priority areas in the Commonwealth to provide insight and guidance on prioritisation of efforts to improve cancer survival and make the best use of scarce resources. We adapted a previously developed microsimulation model of global cancer survival for 11 cancer sites (oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, breast, cervix uteri, and prostate). All 56 Commonwealth countries were included and classified based on the 2020 World Bank Income groups (low-income, lower-middle-income, upper-middle-income, and high-income countries) and Commonwealth geographical areas. We modelled the number of incident cancer cases in each Commonwealth country in 2020, based on age group-specific estimates of incidence rates from GLOBOCAN 2020. We simulated 5-year net survival for each patient, accounting for the stage at diagnosis (I–IV), availability of specific treatment and imaging modalities, and quality of care (based on residual differences in expected versus observed survival after accounting for the availability and effectiveness of treatment and imaging modalities). We also simulated counterfactual policy scenarios, in which we scaled up various aspects of cancer care to the mean level of high-income countries to estimate the comparative effectiveness of different policies. Incident cancers in the Commonwealth accounted for an estimated 14·3% of global diagnosed cancer cases in 2020 among the 11 cancers modelled (1 610 000 Commonwealth cases [95% UI 1 556 000–1 674 000] of 11 227 000 global cases [11 069 000–11 406 000]) and are estimated to increase to 17·3% in 2050 due to population growth (3 330 000 [3 154 000–3 539 000] of 19 308 000 [18 706 000–19 911 000]). The 5-year net survival across 11 cancers combined in 2020 was 30·7% (95% UI 22·4–38·6) in Commonwealth countries, ranging from 4·1% (0·04–15·2) in low-income countries, 17·8% (3·7–30·9) in lower-middle-income countries, 33·1% (23·7–46·0) in upper-middle-income countries, to 59·0% (57·8–60·2) in high-income countries. Among single treatment policies, scaling up access to radiotherapy had the largest survival impact in low-income countries, surgery had the largest impact in lower-middle-income and upper-middle-income countries, and targeted therapy had the largest impact in high-income countries. By geographical area, improving radiotherapy availability was estimated to have the largest impact in Africa, surgery in Asia, targeted therapy in the Caribbean and the Americas and Europe, and quality of care in the Pacific Commonwealth countries. Comparing packages of scaling up the availability of all treatment modalities versus imaging modalities, expanding availability of imaging yielded the largest benefits in high-income countries, and in the Caribbean and the Americas, Europe, and the Pacific, whereas expanding treatment yielded larger benefits in all other income groups and geographical areas. We found large variation in 5-year net survival, with a nearly 15-times difference in cancer survival by country income group within the Commonwealth. Efforts to improve the availability of treatment and imaging modalities and quality of care will be crucial to reduce these disparities, with specific priorities of scale-up policies varying by setting. The Commonwealth could leverage a broad range of knowledge and resources and have an important role in supporting member countries with setting-specific priorities to improve cancer outcomes. Harvard T H Chan School of Public Health. [ABSTRACT FROM AUTHOR]

Aim: This study classified 99 countries into four income groups and then analysed the impact of secondhand smoke (SHS) exposure at home, in public places and at school, on current cigarette smoking prevalence. Methods: We utilised data from the WHO Global Youth Tobacco Survey and a meta‐analysis was conducted to evaluate the prevalence and weighted odds ratios (wORs) of adolescent smoking behaviour and SHS exposure locations. Results: Both smoking behaviours increased with higher national income levels. Smoking behaviours in high and upper‐middle‐income countries (HICs and UMICs) exhibited an association with SHS exposure in public places (HIC: wOR, 3.50 [95% CI, 2.85–4.31]; UMIC: wOR, 2.90 [2.60–3.23]) compared to home. Low‐ and lower‐middle‐income countries (LICs and LMICs) showed an association with SHS exposure in the home (LIC: wOR, 5.33 [3.59–7.93]; LMIC: wOR, 2.71 [2.33–3.17]) than public places. The association between current cigarette smoking and SHS exposure at home increased with lower income levels, while anticipated future use of any form of tobacco with SHS exposure in public places rose in lower income countries. Conclusions: Targeted interventions based on income levels are essential, emphasising home strategies in lower income countries and public place efforts in higher income countries. [ABSTRACT FROM AUTHOR]

This study considers a hypothetical global pediatric vaccine market where multiple coordinating entities make optimal procurement decisions on behalf of countries with different purchasing power. Each entity aims to improve affordability for its countries while maintaining a profitable market for vaccine producers. This study analyzes the effect of several factors on affordability and profitability, including the number of non-cooperative coordinating entities making procuring decisions, the number of market segments in which countries are grouped for tiered pricing purposes, how producers recover fixed production costs, and the procuring order of the coordinating entities. The study relies on a framework where entities negotiate sequentially with vaccine producers using a three-stage optimization process that solves a MIP and two LP problems to determine the optimal procurement plans and prices per dose that maximize savings for the entities' countries and profit for the vaccine producers. The study's results challenge current vaccine market dynamics and contribute novel alternative strategies to orchestrate the interaction of buyers, producers, and coordinating entities for enhancing affordability in a non-cooperative market. Key results show that the order in which the coordinating entities negotiate with vaccine producers and how the latter recuperate their fixed cost investments can significantly affect profitability and affordability. Furthermore, low-income countries can meet their demands more affordably by procuring vaccines through tiered pricing via entities coordinating many market segments. In contrast, upper-middle and high-income countries increase their affordability by procuring through entities with fewer and more extensive market segments. A procurement order that prioritizes entities based on the descending income level of their countries offers higher opportunities to increase affordability and profit when producers offer volume discounts. [ABSTRACT FROM AUTHOR]

The disparity in the distribution of COVID-19 vaccine has been recorded with more than 70% vaccination rate for high-income countries as compared to less than 40% for low-income countries. The low affordability of vaccines for the majority of low-income group invites the need for redistribution of vaccines. The disproportionate donation of vaccines across the globe motivates us to explore the incentive for the high-income group to redistribute. An exploratory analysis of cross-country COVID-19 vaccination distribution data shows that the countries which have received vaccines as donation has also contributed to vaccine wastage. This paper intends to provide a theoretical background for this counterintuitive observation using welfare analysis. We find that the market mechanism leads to a negative impact on global welfare due to redistribution. Only an invention with a defined redistribution mechanism may ensure an increase in global welfare. It is found that a critical value of redistribution mechanism reinforced by a minimum threshold level of income is essential to enhance welfare. The reduced form from the theoretical predictions is empirically validated with cross-country data on COVID-19 vaccination for all countries. As identified in theory, the internal support variables like political stability, government effectiveness, and health expenditure at the country level will impact global welfare. Therefore, when global cooperation is essential during a health crisis like COVID-19, improved internal coordination and intentions cannot be ignored. [ABSTRACT FROM AUTHOR]

This study examines the relationship between country-level corruption (proxied by the Corruption Perception Index, CPI) and firm performance (measured by Return on Assets, ROA) across 18,286 firms in the East Asia, South Asia, and Southeast Asia regions. Additionally, the moderating effects of audit quality (proxied by auditors' reputation) on the relationship are examined. The findings of the study indicate a positive association between corruption and ROA in high-income nations, thus providing evidence in favor of the "greasing the wheel" theory. On the other hand, a negative association is documented in the upper middle- and low-income nations, which is consistent with the "sanding the wheel" notion. Notably, audit quality has a positive moderating influence on the relationship between corruption and ROA, especially in nations with low corruption levels, reaffirming the pivotal role of reputable auditors in enhancing firm performance within these economic contexts. The results of this study have important ramifications for forming policy suggestions and enhancing governance. The findings highlight the opportunity to improve governance practices and regulations to reduce corruption and increase transparency. Policymakers can develop ways to strengthen institutional frameworks by recognizing the complex link between corruption, corporate profitability, and the function of respected auditors. [ABSTRACT FROM AUTHOR]

This study explores the impact of intellectual capital on innovation using a cross-sectional sample of 132 countries: 50 high-income and 82 low-income countries, during the period 2015–2020. Our research provides empirical evidence of the significant impact of intellectual capital on innovation. Analysis of the entire sample revealed that higher levels of knowledge enable the creation of new products and services to meet clients' diversified requirements. However, different results were obtained when we analyzed the two subgroups of high- and low-income countries. We found that the impact in which the level of intellectual capital spurs the increase of innovation is 2.8 times higher in low-income countries than in high-income ones. However, the development process in low-income countries is based on technology transfer rather than on technological development. Additionally, our results for the high-income countries suggest a shallow impact of intellectual capital on innovation. The robustness checks performed consolidate our results. This study could have significant implications for policy-makers, who must acknowledge the vital role of intellectual capital in innovation. [ABSTRACT FROM AUTHOR]

Abstract The obsolete efficiencies in conventional centralized wastewater treatment systems call for implementation of source separation and treatment of wastewater. Approximately 60–75% of domestic wastewater is attributed to greywater, which could be reused to combat freshwater crisis. The present study investigates qualitative and quantitative attributes of greywater from different sources in High-Income Countries (HICs) and Low-Income Countries (LICs). The quantity of greywater generation is positively correlated with country’s per capita income, but feebly negatively correlated with temperature. Kitchen source is the highest contributor of total suspended solids (134–1300 mg/l), whereas in case of turbidity, laundry is the major contributor (39–444 NTU). Also, kitchen greywater is characterized by comparatively high biochemical oxygen demand (BOD) of 100–1850 mg/l, low pH of 5.6–8, and elevated total nitrogen (TN) of about 1.5–48 mg/l. The high pH (7.3–10) and chemical oxygen demand (COD) levels (58–2497 mg/l) in laundry greywater are due to usage of sodium hydroxide-based soaps, while usage of wash detergents containing phosphates like sodium tripolyphosphate contribute to high total phosphorus (TP) (0.062–57 mg/l). The qualitative characteristics of greywater in HICs are perceived to be superior compared to LICs. Furthermore, the most widely used physicochemical, biological, and advanced oxidation treatment technologies for greywater are outlined briefly. It can be observed that economical treatment systems like phytoremediation or biological technologies combined with sand filtration systems can be implemented to treat greywater with high organic content in LICs, whereas in HICs where greywater is generated in large quantities, electro-coagulation combined with advanced oxidation technologies can be used to treat its higher COD levels. Graphical Abstract

The focus of most epidemiological studies has been mortality or clinical events, with less information on activity limitations related to basic daily functions and their consequences. Standardised data from multiple countries at different economic levels in different regions of the world on activity limitations and their associations with clinical outcomes are sparse. We aimed to quantify the prevalence of activity limitations and use of assistive devices and the association of limitations with adverse outcomes in 25 countries grouped by different economic levels. In this analysis, we obtained data from individuals in 25 high-income, middle-income, and low-income countries from the Prospective Urban Rural Epidemiological (PURE) study (175 660 participants). In the PURE study, individuals aged 35–70 years who intended to continue living in their current home for a further 4 years were invited to complete a questionnaire on activity limitations. Participant follow-up was planned once every 3 years either by telephone or in person. The activity limitation screen consisted of questions on self-reported difficulty with walking, grasping, bending, seeing close, seeing far, speaking, hearing, and use of assistive devices (gait, vision, and hearing aids). We estimated crude prevalence of self-reported activity limitations and use of assistive devices, and prevalence standardised by age and sex. We used logistic regression to additionally adjust prevalence for education and socioeconomic factors and to estimate the probability of activity limitations and assistive devices by age, sex, and country income. We used Cox frailty models to evaluate the association between each activity limitation with mortality and clinical events (cardiovascular disease, heart failure, pneumonia, falls, and cancer). The PURE study is registered with ClinicalTrials.gov , NCT03225586. Between Jan 12, 2001, and May 6, 2019, 175 584 individuals completed at least one question on the activity limitation questionnaire (mean age 50·6 years [SD 9·8]; 103 625 [59%] women). Of the individuals who completed all questions, mean follow-up was 10·7 years (SD 4·4). The most common self-reported activity limitations were difficulty with bending (23 921 [13·6%] of 175 515 participants), seeing close (22 532 [13·4%] of 167 801 participants), and walking (22 805 [13·0%] of 175 554 participants); prevalence of limitations was higher with older age and among women. The prevalence of all limitations standardised by age and sex, with the exception of hearing, was highest in low-income countries and middle-income countries, and this remained consistent after adjustment for socioeconomic factors. The use of gait, visual, and hearing aids was lowest in low-income countries and middle-income countries, particularly among women. The prevalence of seeing close limitation was four times higher (6257 [16·5%] of 37 926 participants vs 717 [4·0%] of 18 039 participants) and the prevalence of seeing far limitation was five times higher (4003 [10·6%] of 37 923 participants vs 391 [2·2%] of 18 038 participants) in low-income countries than in high-income countries, but the prevalence of glasses use in low-income countries was half that in high-income countries. Walking limitation was most strongly associated with mortality (adjusted hazard ratio 1·32 [95% CI 1·25–1·39]) and most consistently associated with other clinical events, with other notable associations observed between seeing far limitation and mortality, grasping limitation and cardiovascular disease, bending limitation and falls, and between speaking limitation and stroke. The global prevalence of activity limitations is substantially higher in women than men and in low-income countries and middle-income countries compared with high-income countries, coupled with a much lower use of gait, visual, and hearing aids. Strategies are needed to prevent and mitigate activity limitations globally, with particular emphasis on low-income countries and women. Funding sources are listed at the end of the Article. [ABSTRACT FROM AUTHOR]

Cancer is a leading cause of mortality worldwide. By 2040, over 30 million new cancers are predicted, with the greatest cancer burden in low-income countries. In 2015, the UN passed the Sustainable Development Goal 3.4 (SDG 3.4) to tackle the rising burden of non-communicable diseases, which calls for a reduction by a third in premature mortality from non-communicable diseases, including cancer, by 2030. However, there is a paucity of data on premature mortality rates by cancer type. In this study, we examine annual rates of change for cancer-specific premature mortality and classify whether countries are on track to reach SDG 3.4 targets. This is a retrospective, cross-sectional, population-based study investigating premature mortality trends from 2000–19 using the WHO Global Health Estimates data. All cancers combined and thirteen individual cancers in 183 countries were examined by WHO region, World Bank income level, and sex. The risk of premature mortality was calculated for ages 30–69 years, independent of other competing causes of death, using standard life table methods. The primary objective was to compute average annual rate of change in premature mortality from 2000 to 2019. Secondary objectives assessed whether this annual rate of change would be sufficient to reach SDG 3.4. targets for premature mortality by 2030. This study was conducted using data retrieved for the years 2000–19. Premature mortality rates decreased in 138 (75%) of 183 countries across all World Bank income levels and WHO regions, however only eight (4%) countries are likely to meet the SDG 3.4 targets for all cancers combined. Cancers where early detection strategies exist, such as breast and colorectal cancer, have higher declining premature mortality rates in high-income countries (breast cancer 48 [89%] of 54 and colorectal cancer 45 [83%]) than in low-income countries (seven [24%] of 29 and four [14%]). Cancers with primary prevention programmes, such as cervical cancer, have more countries with declining premature mortality rates (high-income countries 50 [93%] of 54 and low-income countries 26 [90%] of 29). Sex-related disparities in premature mortality rates vary across WHO regions, World Bank income groups, and by cancer type. There is a greater reduction in premature mortality for all cancers combined and for individual cancer types in high-income countries compared with lower-middle-income and low-income countries. However, most countries will not reach the SDG 3.4 target. Cancers with early detection strategies in place, such as breast and colorectal cancers, are performing poorly in premature mortality compared with cancers with primary prevention measures, such as cervical cancer. Investments toward prevention, early detection, and treatment can potentially accelerate declines in premature mortality. WHO. [ABSTRACT FROM AUTHOR]

This study delves into the global evolution of 43 Sustainable Development Goals (SDG) indicators, spanning 7 major health themes across 185 countries to evaluate the potential progress loss due to the COVID-19 pandemic. Both the cross-country and temporal variability of the dataset are employed to estimate an empirical model based on an extended version of the Preston curve, which links well-being to income levels and other key socioeconomic health determinants. The approach reveals significant global evolution trends operating in each SDG indicator assessed. We extrapolate the model yearly between 2020 and 2030 using the IMF's pre-COVID-19 economic growth projections to show how each country in the dataset are expected to evolve in these health topics throughout the decade, assuming no other external shocks. The results of this baseline scenario are contrasted with a post-COVID-19 scenario, where most of the pandemic costs were already known. The study reveals that economic growth losses are, on average, estimated as 42% and 28% for low- and lower middle-income countries, and of 15% and 7% in high- and upper middle-income countries, respectively, according to the IMF's projections. These disproportional figures are shown to exacerbate global health inequalities revealed by the curves. The expected progress loss in infectious diseases in low-income countries, for instance, is an average of 34%, against a mean of 6% in high-income countries. The theme of Infectious diseases is followed by injuries and violence; maternal and reproductive health; health systems coverage; and neonatal and infant health as those with worse performance. Low-income countries can expect an average progress loss of 16% across all health indicators assessed, whereas in high-income countries the estimated loss is as low as 3%. The disparity across countries is even more pronounced, with cases where the estimated progress loss is as high as nine times worse than the average loss of 8%. Conversely, countries with greater fiscal capacity are likely to fare much better under the circumstances, despite their worse death count, in many cases. Overall, these findings support the critical importance of integrating the fight against inequalities into the global development agendas. [ABSTRACT FROM AUTHOR]

Women's mental health during the perinatal period is a major public health problem in Pakistan. Many challenges and competing priorities prevent progress to address the large treatment gap. Aim To quantify the long-term impacts of untreated perinatal depression and anxiety in economic terms, thus highlighting its overall burden based on country-specific evidence. Cost estimates were generated for a hypothetical cohort of women giving birth in 2017, and their children. Women and children experiencing adverse events linked to perinatal mental health problems were modelled over 40 years. Costs assigned to adverse events included were those linked to losses in quantity and quality-of-life, productivity, and healthcare-related expenditure. Present values were derived using a discount rate of 3 %. Data were taken from published cohort studies, as well as from sources of population, economic and health indicators. The total costs were $16.5 billion for the cohort and $2680 per woman giving birth. The by far largest proportion referred to quality-of-life losses ($15.8 billion). Productivity losses and out-of-pocket expenditure made up only a small proportion of the costs, due to low wages and market prices. When the costs of maternal suicide were included, total costs increased to $16.6 billion. Important evidence gaps prevented the inclusion of all cost consequences linked to perinatal mental health problems. Total national costs are much higher compared with those in other, higher middle-income countries, reflecting the excessive disease burden. This study is an important first step to inform resource allocations. • Perinatal mental health problems are a major public health problem in Pakistan. • This study is the first to quantify the costs of perinatal mental health problems in a lower-middle income country. • Costs of $6.2 billion nationally exceed those found in higher middle income countries. • Estimates highlight the urgent need to allocate resources to meet Strategic Development Goals. [ABSTRACT FROM AUTHOR]

Simple Summary: Equids, such as horses, donkeys, and mules, play vital roles in various types of work globally, with their use differing significantly across countries of different income levels. We conducted a thorough review of research literature to examine if and how terms related to working equids are used in high-, middle-, and low-income countries. Our findings indicate that studies focusing on higher-income countries tend to produce more research papers on equids, except for when using the terms "working equid" and "draft equid", which are more common in studies focusing on lower-income countries, and these terms often refer to animals in low-resource rural settings and marginalised communities. We suggest that "working equid" should be defined as "any equid engaged in physical labour that provides a significant or direct contribution to the economic livelihood, sustenance or support of the owner/user's family, typically within a low resource setting". The lack of a standard definition complicates policy making and welfare legislation, especially in lower-income countries where equids are crucial for livelihoods but are often overlooked by policy. This study highlights the need for more inclusive and culturally aware terminology to improve welfare standards and policies for working equids worldwide. Equids are engaged in myriad types of work across the world, with contexts and industries varying widely between high-, middle- and low-income countries as classified by the World Bank. Through a comprehensive abstract search and literature review, we examined the usage and context of terms associated with working equids in high-income countries (HICs), upper-middle-income countries (UMICs), lower-middle-income countries (LMICs), and low-income countries (LICs). Analysis showed that the search term used was significantly associated with World Bank country income classification. All search terms except two returned a significantly higher number of papers for higher-income countries compared to lower-income countries. The two exceptions were "working equid" and "draft equid", which returned significantly more papers for lower-income countries than higher-income countries. Both terms also returned papers from high-income and upper-middle-income countries, but these were always in the context of low-resource settings and rural or marginalised communities, of which we provide examples in the discussion. We propose that the term "working equid" should be used to describe "any equid engaged in physical labour that provides a significant or direct contribution to the economic livelihood, sustenance or support of the owner/user's family, typically within a low resource setting". Our review highlights the intricate interplay between socioeconomic factors and examines how equids are described in the literature. The lack of a universally accepted definition leads to challenges in policy formulation, resource allocation, and welfare standards development, particularly in LMICs and LICs where working equids are crucial to livelihoods. This study underscores the need for a more inclusive and comprehensive approach to terminology, advocating for future research to bridge linguistic and cultural gaps in understanding working equids globally. Such efforts are vital for equitable and effective welfare standards and policy development for these animals. [ABSTRACT FROM AUTHOR]

The Nam Theun 2 dam is an influential case of applying safeguards to mitigate social and environmental impacts from hydropower, being used as a model for large dams globally. However, these safeguards have produced mixed results. We examine the role of safeguards in hydropower, and how stakeholders have discussed its use. Based on a literature review and stakeholder interviews, we conduct a discourse analysis of narratives used to frame hydropower. We find four discourses being used for different purposes: Green Neoliberalism to legitimize, Ecological Modernization to operationalize, Green Radicalism to criticize, and Radical Incrementalism to repurpose hydropower. Whereas green radicalism in high-income countries challenges over-consumption, we find that green radicalism in low-income countries highlights environmental justice and shortcomings of conventional development models. We argue for a broader understanding of discourses to include Radical Incrementalism as one strategy for change of careful and considered actions over time. [ABSTRACT FROM AUTHOR]

Aim: Paediatric eosinophilia is a common clinical dilemma, often leading to resource‐ and time‐consuming assessments. We aim to evaluate the main aetiologies of eosinophilia in children from different socioeconomic settings and propose a diagnostic algorithm. Methods: A systematic literature review was conducted through PubMed, Embase and the Cochrane Library. Studies published from January 2012 to June 2023 reporting the incidence and aetiology of peripheral eosinophilia in children were included. Evidence from studies on children originating from low‐ or high‐income countries was compared. Results: A total of 15 observational studies, encompassing 3409 children, were included. The causes of eosinophilia varied based on the children's origin and the eosinophilia severity. In children from high‐income countries, allergic diseases were the leading cause, with a prevalence of 7.7%–78.2%, while parasitosis ranged from 1.0% to 9.1%. In children from low‐income countries, parasitosis was predominant, ranging from 17.7% to 88.3%, although allergic diseases were found in 2.5%–4.8% of cases. Concerning severity, allergic diseases were the leading cause of mild‐to‐moderate eosinophilia; parasitosis was associated with moderate‐to‐severe eosinophilia, while immunological disorders were mostly found in severe cases. Conclusion: We developed a step‐up diagnostic algorithm that considers the child's origin and eosinophilia severity and could optimise resource allocation. [ABSTRACT FROM AUTHOR]

Although biotherapeutic drugs have the potential of transforming the management of many life‐threatening diseases, their affordability and accessibility remain an issue. This study offers an overview of the global affordability of biotherapeutic products. For this, prices for 10 representative biotherapeutic products were examined in 40 countries, including high‐income countries (HICs), upper middle‐income countries (UMICs), lower middle‐income countries (LMICs), and low‐income countries (LICs). The affordability of these biotherapeutics was calculated based on the World Health Organization/Health Action International (WHO/HAI) method. As expected, affordability was found to be better in HICs, followed by UMICs, LMICs, and finally, LICs. Furthermore, based on the trend of per capita income, we predict that in UMICs and LMICs, the affordability of high molecular weight biologics will worsen by 1.5× and 2× by 2030, respectively, and further by 4× and 6× by 2040. On the other hand, affordability will stay nearly the same for people living in HICs in the coming decades. Our analysis suggests that it is imperative that measures be taken to make this class of products more affordable and accessible. Governments can contribute by creating conducive policies. Global institutions like the WHO can play a significant role as well. Finally, manufacturers need to invest in and implement manufacturing innovations. [ABSTRACT FROM AUTHOR]

Despite its role in treating the most dominant non-communicable diseases worldwide, the global workforce of oral and maxillofacial (OM) surgeons is not well-characterized. To address the current deficit in understanding of the global OM surgeon workforce and to elevate oral and maxillofacial surgery (OMS) in the global health discourse, we join other surgical specialties in evaluating global surgical capacity with a descriptive analysis of the distribution of OM surgeons worldwide. A mixed-methods study was implemented using a combination of literature review, in-country contacts, internet searches, and survey data. The survey was distributed globally from January to June 2022. Data regarding OM surgeon workforce estimates were obtained for 104 of 195 United Nations-recognized countries (53.3%). Among countries with available estimates, the median global workforce density was 0.518 OM surgeons per 100,000 population. Twenty-eight countries (26.9%) were reported to have two or fewer OM surgeons. The median OM surgeon workforce density for low-income countries was 0.015 surgeons per 100,000 population, compared to 1.087 surgeons per 100,000 population in high-income countries. low and middle-income countries countries have the least workforce density as well as the least data coverage. More work is needed to better understand the capacity of the global OM surgeon workforce and access to OMS care. [ABSTRACT FROM AUTHOR]

We argue that importing stimulates firms' learning‐based R&D activities in the present and future periods. Our theory predicts that the strength of the learning effect depends on the type of imported materials, the industries, and the import destination. Using a dataset on Chinese manufacturing firms covering the episode of China's WTO accession, we employ the multiple‐treatment propensity matching difference‐in‐differences method and find evidence supporting our hypotheses: (1) importing capital goods stimulates more R&D expenditures than importing intermediates; (2) R&D intensity increases more for capital goods importers in capital‐intensive industries than those in labor‐intensive industries; and (3) importers increase R&D intensity more by importing from high‐income countries than low‐income countries. [ABSTRACT FROM AUTHOR]

Future socioeconomic climate pathways have regional water-quality consequences whose severity and equity have not yet been fully understood across geographic and economic spectra. We use a process-based, terrestrial-freshwater ecosystem model to project 21st-century river nitrogen loads under these pathways. We find that fertilizer usage is the primary determinant of future river nitrogen loads, changing precipitation and warming have limited impacts, and CO2 fertilization-induced vegetation growth enhancement leads to modest load reductions. Fertilizer applications to produce bioenergy in climate mitigation scenarios cause larger load increases than in the highest emission scenario. Loads generally increase in low-income regions, yet remain stable or decrease in high-income regions where agricultural advances, low food and feed production and waste, and/or well-enforced air pollution policies balance biofuel-associated fertilizer burdens. Consideration of biofuel production options with low fertilizer demand and rapid transfer of agricultural advances from high- to low-income regions may help avoid inequitable water-quality outcomes from climate mitigation. This study suggests consideration of biofuel production options with low fertilizer demand and rapid transfer of agricultural advances from high- to low-income regions that may help avoid inequitable water-quality outcomes from climate mitigation. [ABSTRACT FROM AUTHOR]

None of the global targets for protecting nature are currently met, although humanity is critically dependent on biodiversity. A significant issue is the lack of data for most biodiverse regions of the planet where the use of frugal methods for biomonitoring would be particularly important because the available funding for monitoring is insufficient, especially in low-income countries. We here discuss how three approaches to insect biomonitoring (computer vision, lidar, DNA sequences) could be made more frugal and urge that all biomonitoring techniques should be evaluated for global suitability before becoming the default in high-income countries. This requires that techniques popular in high-income countries should undergo a phase of 'innovation through simplification' before they are implemented more broadly. We predict that techniques that acquire raw data at low cost and are suitable for analysis with AI (e.g. images, lidar-signals) will be particularly suitable for global biomonitoring, while techniques that rely heavily on patented technologies may be less promising (e.g. DNA sequences). We conclude the opinion piece by pointing out that the widespread use of AI for data analysis will require a global strategy for providing the necessary computational resources and training. This article is part of the theme issue 'Towards a toolkit for global insect biodiversity monitoring'. [ABSTRACT FROM AUTHOR]

Introduction: Low-income countries in East Africa have a lower incidence of colorectal cancer (CRC) than high-income countries; however, the incidence has steadily increased in the last few decades. In Uganda, the extent to which genetic and environmental factors, particularly dietary factors, contribute to the aetiology of CRC is unclear. Therefore, the objective of our study was to determine the relationship between dietary factors and CRC in Uganda. Methods: We conducted a case-control study and recruited 128 cases and 256 controls, matched for age (± 5 years) and sex. Data regarding the frequency of consumption of the dietary factors were obtained from all the participants using an interview-based questionnaire. The potential dietary risk factors and protective factors evaluated included the type and frequency of meat consumed and the type and frequency of high-fibre foods consumed. The frequency was either 4 or more times/week, 2–3 times/week, once/week or never. Conditional logistic regression analyses were used to determine the odds ratios associated with the different risk and protective factors. Results: The median age (IQR) for the case participants was 55.5 (43-67.5) years, and that of the control participants was 54 (42–65) years. The male-to-female ratio was 1:1 for all the participants. Factors significantly associated with CRC cases included:- the consumption of boiled beef 2–3 times/week (aOR:3.24; 95% CI: 1.08–9.69; p < 0.035). Consumption of high-fibre foods, including:- millet for ≥ 4 times/week (aOR: 0.23; 95% CI: 0.09–0.62; p = 0.003)), spinach for ≥ 4 times/week (aOR:0.32; 95% CI: 0.11–0.97; p = 0.043), and potatoes 2–3 times/week (aOR: 0.30; 95% CI: 0.09–0.97; p = 0.044), were protective against CRC. Boiled cassava showed a tendency to reduce the likelihood of CRC when consumed ≥ 4 times/week (aOR:0.38; 95% CI: 0.12–1.18) however this did not reach statistical significance (p = 0.093). Conclusions: The consumption of boiled beef increases the risk of CRC, while the intake of high-fibre foods may reduce the risk of CRC among Ugandans. We recommend nutritional educational programmes to increase public awareness regarding the protective role of a high-fibre diet and to limit the intake of cooked meat in our Ugandan population. [ABSTRACT FROM AUTHOR]

The obsolete efficiencies in conventional centralized wastewater treatment systems call for implementation of source separation and treatment of wastewater. Approximately 60–75% of domestic wastewater is attributed to greywater, which could be reused to combat freshwater crisis. The present study investigates qualitative and quantitative attributes of greywater from different sources in High-Income Countries (HICs) and Low-Income Countries (LICs). The quantity of greywater generation is positively correlated with country's per capita income, but feebly negatively correlated with temperature. Kitchen source is the highest contributor of total suspended solids (134–1300 mg/l), whereas in case of turbidity, laundry is the major contributor (39–444 NTU). Also, kitchen greywater is characterized by comparatively high biochemical oxygen demand (BOD) of 100–1850 mg/l, low pH of 5.6–8, and elevated total nitrogen (TN) of about 1.5–48 mg/l. The high pH (7.3–10) and chemical oxygen demand (COD) levels (58–2497 mg/l) in laundry greywater are due to usage of sodium hydroxide-based soaps, while usage of wash detergents containing phosphates like sodium tripolyphosphate contribute to high total phosphorus (TP) (0.062–57 mg/l). The qualitative characteristics of greywater in HICs are perceived to be superior compared to LICs. Furthermore, the most widely used physicochemical, biological, and advanced oxidation treatment technologies for greywater are outlined briefly. It can be observed that economical treatment systems like phytoremediation or biological technologies combined with sand filtration systems can be implemented to treat greywater with high organic content in LICs, whereas in HICs where greywater is generated in large quantities, electro-coagulation combined with advanced oxidation technologies can be used to treat its higher COD levels. Highlights: Assessment of variations in qualitative and quantitative characteristics of greywater from various sources and in HICs and LICs. The quantity of greywater generation is positively correlated with the per capita income, but feebly negatively correlated with the temperature aspect of the country. Kitchen is the major source of BOD5 and TN, while laundry is the major contributor of COD and TP in the greywater. [ABSTRACT FROM AUTHOR]

Using a multilevel modelling approach to analyse a novel dataset of academic publications at all business schools in 11 European countries, this paper finds that the influence of organisational- and country-level contextual factors on researchers varies considerably based on the type of institution and the development level of the country they are located in. At the organisational-level, we find that greater spatial connectivity–operationalised through proximity to nearby business schools, rail stations, and airports–is positively related to scientific research volume and public dissemination (news mentions). While this result is significant only for high-income countries (above EU-average 2018 GDP per capita), this is likely because the low-income countries (below EU-average 2018 GDP per capita) examined here lack a 'critical mass' of well-connected universities to generate observable agglomeration effects. At the country-level, the results indicate that in high-income countries, less prestigious schools benefit from higher rates of recent international immigration from any foreign country, providing a direct policy pathway for increasing research output for universities that aren't already well-known enough to attract the most talented researchers. In low-income countries, recent immigration rates are even stronger predictors of research performance across all levels of institutional prestige; more open immigration policies would likely benefit research performance in these countries to an even greater extent. Finally, the paper's results show that, in low-income countries, a composite measure of a country's quality of life (including self-rated life satisfaction, health, working hours, and housing overcrowding) is positively related to research outcomes through its interaction with school prestige. This suggests that the lower a country's quality of life, the more researchers are incentivised to produce higher levels of research output. While this may in part reflect the greater disparities inherent in these countries' economic systems, it is noteworthy–and perhaps concerning–that we have observed a negative correlation between country-level quality of life and research performance in low-income countries, which is particularly felt by researchers at less prestigious institutions. [ABSTRACT FROM AUTHOR]

Outcomes from traumatic brain injury (TBI) including death differ significantly between high-, middle-, and low-income countries. Little is known, however, about differences in TBI research across the globe. The objective of this article was to examine randomized controlled trials (RCTs) of moderate-to-severe TBI in high-income countries (HICs) compared with low- and middle-income countries (LMICs), as defined by the World Bank income per capita cutoff of $13,205 US dollars. A systematic review was conducted for articles published in the English language to December 2022 inclusive using MEDLINE, PubMed, Scopus, CINAHL, EMBASE, and PsycINFO in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria: (1) human participants with a mean age of ≥18 years; (2) ≥50% of the sample had moderate to severe TBI; and (3) the study design was a RCT. Data extracted included author, year, country, sample size, primary focus (medical/surgical management or rehabilitation), injury etiology, time post-injury, and indicator(s) used to define TBI severity. There were 662 RCTs (published 1978–2022) that met inclusion criteria comprising 91,946 participants. There were 48 countries represented: 30 HICs accounting for 451 RCTs (68.1%) and 18 LMICs accounting for 211 RCTs (31.9%). The 62.6% of RCTs from LMICs were conducted in the acute phase post-injury (≤1 month) compared with 42.1% of RCTs from HICs. Of RCTs from LMICs, 92.4% focused on medical/surgical management compared with 52.5% from HICs. Since 2016, more RCTs have been conducted in LMICs than in HICs, indicating the importance of better understanding this pattern of research output. [ABSTRACT FROM AUTHOR]

Access to healthcare is a social right and its demand is universal. However, health resources are limited and have to be rationed justifiably which borders on societal values and the efficiency of the healthcare system. A more efficient health system will promote more equitable access to health care based on the principle of universal health coverage (UHC) advocated by the World Health Organisation. The efficiency of any health system depends on the structure of its funding or financing system. Evidence has shown that there is a strong correlation between country's income and total health expenditure. This also affects the health financing systems of countries. This discourse exposes the challenge of health inequities/inequalities and its correlation with health funding systems in low-income countries and upper-middle/high-income countries using Nigeria and the United States as reference countries. It also attempts to discuss the feasibility of attaining more equitable access to healthcare in a manner that promotes health equity and equality through economic evaluations of interventions in diseases of high socioeconomic burden and major health outcome concerns. [ABSTRACT FROM AUTHOR]

This paper studies the effect of being landlocked on international trade flows in the manufacturing sector. The study overcomes the empirical challenge of using a country‐specific variable 'landlocked', within a structural gravity framework in the presence of importer and exporter fixed effects. Results show that the impact of being landlocked for manufactured goods trade is highly negative and statistically significant. Such effect is higher for low‐income landlocked countries compared to high‐income landlocked countries. The impact of being landlocked on manufactured goods trade declined in 2005 compared to 1980. A series of robustness checks further confirm the estimates. [ABSTRACT FROM AUTHOR]

Copyright of Hacettepe University Journal of Economics & Administrative Sciences / Hacettepe Üniversitesi Iktisadi ve Idari Bilimler Fakültesi Dergisi is the property of Hacettepe University, Faculty of Economic & Administrative Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Education is well-known as a determinant of oral health and dental behaviours in high-income countries, but much less is known for countries with lower incomes. This study aimed to identify the extent to which education affects oral health and dental behaviours in Indonesia. Materials and Methods: This study used data from the Indonesian Basic Health Survey 2013. From this nationally representative sample of 945,057 people 5-100 years old, a series of mixed-effects Poisson regression models that accounted for sampling weights estimated the effect of educational attainment on edentulism, dental care utilisation, and toothbrushing behaviour. Results: Consistent educational gradients were found for all outcomes and across all model specifications. People without a formal educational degree had a 1.03 (95% CI: 1.03-1.04) times higher risk of not utilising any dental care, a 3.15 (95% CI: 2.47-4.02) times higher risk of being edentulous, and a 15.6 (95% CI: 12.76-19.02) times higher risk of having low toothbrushing frequency than people having a university degree or higher. Conclusions: Stark and consistent educational gradients were observed in the dentate status, dental services utilisation, and toothbrushing in Indonesia. Educational inequalities were much larger for toothbrushing behaviours than for dental care utilisation. Intervention points for health policy should urgently prioritise public health interventions to promote overall educational attainment, preventive services, and dental care targeted at those with lower educational attainment. [ABSTRACT FROM AUTHOR]

Background: There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions. Methods: Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. Results: Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters). Conclusions: High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation. [ABSTRACT FROM AUTHOR]

To date, no systematic review or meta-analysis has comprehensively estimated the risk of mortality by surgery type on an international scale. We aim to delineate the risk of mortality in patients with COVID-19 who undergo surgery. PubMed (MEDLINE), Scopus, OVID, the World Health Organization Global Literature on Coronavirus Disease, and Corona–Central databases were searched from December 2019 through January 2022. Studies providing data on mortality in patients undergoing surgery were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for abstracting data were followed and performed independently by two reviewers. The main outcome was mortality in patients with COVID-19. Of a total of 4023 studies identified, 46 studies with 80,015 patients met our inclusion criteria. The mean age was 67 y; 57% were male. Surgery types included general (14.9%), orthopedic (23.4%), vascular (6.4%), thoracic (10.6%), and urologic (8.5%). Patients undergoing surgery with COVID-19 elicited a nine-fold increased risk of mortality (relative risk [RR] 8.99, 95% confidence interval [CI] 4.96-16.32) over those without COVID-19. In low-income and middle-income countries (RR: 16.04, 95% CI: 4.59-56.12), the mortality risk was twice as high compared to high-income countries (RR: 7.50, 95% CI: 4.30-13.09). Mortality risk in surgical patients with COVID-19 compared to those without is increased almost 10-fold. The risk was highest in low-income and middle-income countries compared to high-income countries, suggesting a disproportionate effect of the pandemic on resource-constrained regions. • Largest meta-analysis study of more than 79,000 surgical patients. • Mortality is increased almost 10-fold in surgical patients with COVID-19. • COVID-induced mortality risk is double in low-income and middle-income countries. • Type of surgery is not associated with mortality risk. [ABSTRACT FROM AUTHOR]

Background: Low admission rates at Polish medical universities led many students to study abroad. Ukraine provided an appealing option for years. The purpose of the study is to investigate the most important factors that motived Polish students enrolled at I. Horbachevsky Ternopil National Medical University in Ukraine to pursue medical and dentistry studies in lower middle-income countries, just before the outbreak of the war. It has become incredibly important to determine crucial economic and non-economic factors. Methods: The paper draws on a quantitative survey (N = 94) conducted among medical and dental students from Poland who had studied at I. Horbachevsky Ternopil National Medical University in Ukraine using a semi-structured questionnaire. To test whether there was a relationship between the importance of the motives, Pearson's chi-square independence test was employed. Results: The study found the key economic and non-economic factors for pursuing Ukrainian studies were rejection from Polish tuition-free programs, lower Ukrainian tuition and living costs compared to Poland and to other European Union countries. Determining reasons for choosing Ternopil University were recruiter and friend recommendations and its prestige among Ukrainian medical schools. Gender influenced the ranking of motives. Conclusion: The article examines the unique pre-war educational migration from Poland to Ukraine – occurring counter to typical flows from lower to higher a lower income country. The study showed that universities should strengthen recruiting efforts and highlight competitive tuition and living costs to attract international students, especially from relatively more developed nations. [ABSTRACT FROM AUTHOR]