Global disparities in scientific publications: A 5-year analysis of 10 critical care journals

Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data

BackgroundSepsis causes death and morbidity in young infants. Globally, an estimated 1.3 – 3.9 million young infants experience sepsis and 400,000 – 700,000 die from sepsis-related conditions annually. Even though...

Dynamics between financial development, tourism, sanitation, renewable energy, trade and total reserves in 19 Asia cooperation dialogue members

Many randomized clinical trials (RCTs) led by high-income countries (HICs) now enroll patients from lower middle-income countries (LMICs) and upper middle-income countries (UMICs). Although enrolling diverse populations promotes research collaborations, there are issues regarding which countries participate in RCTs and how this participation may contribute to global research. To describe which UMICs and LMICs participate in RCTs led by HICs. A cross-sectional study of all oncology RCTs published globally during January 1, 2014, to December 31, 2017, was conducted. The study cohort was restricted to RCTs led by HICs that enrolled participants from LMICs and UMICs. Study analyses were conducted in November 1, 2021, to May 31, 2022. A bibliometric approach (Web of Science 2007-2017) was used to explore whether RCT participation was proportional to other measures of cancer research activity. Participation in RCTs (ie, percentage of RCTs in the cohort in which each LMIC and UMIC participated) was compared with country-level cancer research bibliometric output (ie, percentage of total cancer research bibliometric output from the same group of countries that came from a specific LMIC and UMIC). Among the 636 HIC-led RCTs, 186 trials (29%) enrolled patients in LMICs (n = 84 trials involving 11 LMICs) and/or UMICs (n = 181 trials involving 26 UMICs). The most common participating LMICs were India (42 [50%]), Ukraine (39 [46%]), Philippines (23 [27%]), and Egypt (12 [14%]). The most common participating UMICs were Russia (115 [64%]), Brazil (94 [52%]), Romania (62 [34%]), China (56 [31%]), Mexico (56 [31%]), and South Africa (54 [30%]). Several LMICs are overrepresented in the cohort of RCTs based on proportional cancer research bibliometric output: Ukraine (46% of RCTs but 2% of cancer research bibliometric output), Philippines (27% RCTs, 1% output), and Georgia (8% RCTs, 0.2% output). Overrepresented UMICs include Russia (64% RCTs, 2% output), Romania (34% RCTs, 2% output), Mexico (31% RCTs, 2% output), and South Africa (30% RCTs, 1% output). In this cross-sectional study, a substantial proportion of RCTs led by HICs enrolled patients in LMICs and UMICs. The LMICs and UMICs that participated in these trials did not match overall cancer bibliometric output as a surrogate for research ecosystem maturity. Reasons for this apparent discordance and how these data may inform future capacity-strengthening activities require further study.

PurposeThe Sustainable Development Goal (SDG) 16 outlines sustainability as associated with peace, good governance and justice. The perception of international tourists about security measures and risks is a key factor affecting destination choices, tourist flow and overall satisfaction. Thus, we investigate the impact of armed forces personnel, prices, economic stability, financial development and infrastructure on tourism.Design/methodology/approachThis research used data from 130 countries from 1995 to 2019, which were divided into four income groups. This study employs a two-step generalized method of moments (GMM) technique and a novel tourism index comprising five relevant indicators of tourism.FindingsA 1% increase in armed forces personnel expands tourism in all income groups – 0.369% High Income Countries (HICs), 0.348% Upper Middle Income Countries (UMICs), 0.247% Lower Middle Income Countries (LMICs) and 0.139% Low Income Countries (LICs). The size of the tourism-safety coefficient decreases from high to low-income groups. The impact of inflation is significantly negative in all panels, excluding LICs. The reduction in tourism was 0.033% in HICs, 0.049% in UMICs and 0.029% in LMICs for a 1% increase in prices. The increase in the global tourism index is more in LICs (0.055%), followed by LMICs (0.024%), UMICs (0.009%) and HICs (0.004%) for a 1% expansion in the gross domestic product (GDP)/capita growth. However, the magnitude of the growth-led tourism impact is greater in developing countries. A positive impact of foreign direct investment (FDI) inflow was found in all panels like 0.016% in HICs, 0.050% in UMICs and 0.119% in LMICs for a 1% increase in FDI inflow. The rise in the global tourism index is 0.097% (HICs), 0.124% (UMICs) and 0.310% (LMICs) for a 1% rise in the financial development index. The increase in the global tourism index is 0.487% (HICs), 0.420% (UMICs) and 0.136% (LICs) for a 1% rise in the infrastructure index.Research limitations/implicationsEmpirical analysis infers important policy implications such as (a) establishment of a peaceful environment via recruitment of security personnel, use of safe city cameras, modern technology and law enforcement; (b) provision of basic facilities to tourists like sanitation, drinking water, electricity, accommodation, quality food, fuel and communication network and (c) price stability through different tools of monetary and fiscal policy.Originality/valueFirst, it explains the effect of security personnel on a comprehensive index of tourism instead of a single variable of tourism. Second, it captures the importance of economic stability (i.e., economic growth, financial development and FDI inflow) in the tourism–peace nexus.

10526 Background: While several studies have highlighted the global shortages of oncologists and their workload, few have studied the characteristics of current oncology training. Methods: An online survey was distributed through a snowball method via national oncology societies and a pre-existing network of contacts to cancer care providing physicians in 57 countries. Countries were classified into low- or lower-middle-income countries (LMICs), upper-middle-income countries (UMICs), and high-income countries (HICs) based on World Bank criteria. Results: 273 physicians who trained in 57 different countries responded to the survey; 33% (90/273), 32% (87/273), and 35% (96/273) in LMICs, UMICs and HICs respectively. 60% of respondents were practicing physicians and 40% were in training. The proportion of trainees was higher in LMICs (51%; 45/89) and UMICs (42%; 37/84), than HICs (19%; 28/96; P = 0.013). A higher proportion of respondents from LMICs (37%; 27/73) self-fund their core oncology training compared to UMICs (13%; 10/77) and HICs (11%; 10/89; P < 0.001). Respondents from HICs were more likely to complete an accepted abstract, poster and publication from their research activities compared to respondents from UMICs and LMICs (abstract: 37/72 (51%) from HICs, 18/66 (27%) from UMICs, 24/65 (37%) from LMICs, P = 0.014; poster: (42/72 (58%) from HICs, 28/66 (42%) from UMICs, 13/65 (20%) from LMICs, P < 0.001; publication: 43/72 (60%) from HICs, 32/66 (49%) from UMICs, 24/65 (37%) from LMICs, P = 0.029). Respondents identified several barriers to effective training including skewed service to education ratio and burnout. With regards to preparedness for practice, mean scores on a 5-point Likert scale were low for professional tasks like supervision and mentoring of trainees, leadership and effective management of an oncology practice, and understanding of healthcare systems irrespective of country grouping. Conclusions: Investment in training by the public sector would be vital to decreasing the prevalence of self-funding in LMIC. Gaps in research training and enhancement of competencies in research dissemination in LMIC require attention. Instruction on cancer care systems and leadership need to be incorporated in training curricula in both LMICs and HICs.

Background: The World Health Organisation Framework Convention on Tobacco Control Article 14 guidelines stress that health care workers (HCW) should set an example by not using tobacco, however the overall prevalence among HCW worldwide is unknown. We present prevalence estimates of tobacco use among HCW by country income level, gender and occupation. Methods: We searched five electronic databases; Medline, EMBASE, CINHAL Plus, CAB Abstracts, and LILACS for original studies published between 1 January 2000 and 14 March 2016 that included HCW and tobacco use data from 2000 onward. We performed random effect meta-analyses to obtain estimates by World Bank income level, occupation, and gender (Prospero number CRD42016041231) Findings 282 studies met our inclusion criteria, including 157 studies from high-income countries (HIC), 92 from upper- middle- income countries (UMIC), and 33 from Lower Middle and low Income countries (LMLIC). The overall prevalence of tobacco use was 22% (95% CI 21-23). Smoking prevalence was highest in the UMIC 25% (95% CI 22-28%), higher in males compared to females (31% vs 17%) and highest in nurses, 25% (22-27%). Heterogeneity was high (I2 > 90%) in all sub-group analyses. There was borderline significant reduction in the overall tobacco use prevalence between 2000 and 2014 (p=0·06). Interpretation: HCW continue to use tobacco at high rates. Tackling tobacco use in these groups requires urgent action as they are at the front line for tackling tobacco use in their patients. Funding: UK Centre for Tobacco and Alcohol Studies. Declaration of interests: We declare no competing interests.

The COVID-19 Pandemic Identifies Significant Global Inequities in Hemodialysis Care in Low and Lower-Middle Income Countries—An ISN/DOPPS Survey

Background: Palliative care improves outcomes for people with cancer, but in many countries access remains poor. Understanding future needs is essential for effective health system planning in response to global policy. Aim: To project the burden of serious health-related suffering associated with death from cancer to 2060 by age, gender, cancer type and World Bank income region. Design: Population-based projections study. Global projections of palliative care need were derived by combining World Health Organization cancer mortality projections (2016–2060) with estimates of serious health-related suffering among cancer decedents. Results: By 2060, serious health-related suffering will be experienced by 16.3 million people dying with cancer each year (compared to 7.8 million in 2016). Serious health-related suffering among cancer decedents will increase more quickly in low income countries (407% increase 2016–2060) compared to lower-middle, upper-middle and high income countries (168%, 96% and 39% increase 2016-2060, respectively). By 2060, 67% of people who die with cancer and experience serious health-related suffering will be over 70 years old, compared to 47% in 2016. In high and upper-middle income countries, lung cancer will be the single greatest contributor to the burden of serious health-related suffering among cancer decedents. In low and lower-middle income countries, breast cancer will be the single greatest contributor. Conclusions: Many people with cancer will die with unnecessary suffering unless there is expansion of palliative care integration into cancer programmes. Failure to do this will be damaging for the individuals affected and the health systems within which they are treated.

Most of the developing countries in the world are facing a well-known challenging factor-like income inequality that affects the issue of balanced growth and welfare. The core goal of this paper is to investigate whether the Human Capital Index (HCI) joined with Good Governance (GG) variables have a significant impact on reducing income inequality in upper middle income (UMI) and lower middle income (LMI) countries or not. The first point is to investigate the relationship between HCI and income inequality and the second one is to find out the joint effect (HCI and GG) on income inequality (Gini Coefficient). The author divides all the countries based on income levels like UMI and LMI countries according to WB. For the UMI, HCI has no significant positive impact on reducing income inequality. However, if HCI works combined with good governance indicators like (HCI*RL), (HCI*RQ), and (HCI*GE), these interacted variables do not have significant power to reduce income inequality in UMI countries. Contrarily, for LMI countries, HCI helps to diminish income inequality significantly. When citizens achieve technical and educational qualifications, it helps them earn more money and shrinks income inequality significantly. Moreover, when HCI joints with good governing variables like PS, RQ, and RL that help to reduce income inequality significantly in LMI countries. There are some significant differences between UMI and LMI in foreign investment, job opportunities, foreign investment, and macroeconomic conditions that generate income-gap. This analysis finds that LMI countries grab influential effect in reducing income inequality in their economy compared to UMI countries.

The study aims to compare the trauma care systems in Asian countries. Asian countries were categorised into three groups; 'lower middle-income country', 'upper middle-income country' and 'high-income country'. The Medline/PubMed database was searched for articles published from January 2005 to December 2014 using relevant key words. Articles were excluded if they examined a specific injury mechanism, referred to a specific age group, and/or did not have full text available. We extracted information and variables on pre-hospital and hospital care factors, and regionalised system factors and compared them across countries. A total of 46 articles were identified from 13 countries, including Pakistan, India, Vietnam and Indonesia from lower middle-income countries; the Islamic Republic of Iran, Thailand, China, Malaysia from upper middle-income countries; and Saudi Arabia, the Republic of Korea, Japan, Hong Kong and Singapore from high-income countries. Trauma patients were transported via various methods. In six of the 13 countries, less than 20% of trauma patients were transported by ambulance. Pre-hospital trauma teams primarily comprised emergency medical technicians and paramedics, except in Thailand and China, where they included mainly physicians. In Iran, Pakistan and Vietnam, the proportion of patients who died before reaching hospital exceeded 50%. In only three of the 13 countries was it reported that trauma surgeons were available. In only five of the 13 countries was there a nationwide trauma registry. Trauma care systems were poorly developed and unorganised in most of the selected 13 Asian countries, with the exception of a few highly developed countries.

Rapid increase in carbon dioxide emission triggers climate change, while climate change poses a threat to food security. On the other hand, emission increase as a result of agricultural production continues. Considering this cycle, it is thought that examining the relationship between agricultural production and carbon dioxide emissions can help countries take emission-reducing measures and develop policies to ensure food safety. With this thought, a common correlated effect estimator was used in this study to explain the relationship between crop and livestock production index and carbon dioxide emission of 184 countries with the use of data for the period of 1998-2014. Countries were classified under four categories: low-income countries, lower middle-income countries, upper middle-income countries and high-income countries. According to DCCE test results, it was reported that a 1% increase in crop production index had effect on CO2 emission only in lower middle-income countries. A 1% increase in livestock production index, on the other hand, was reported to increase CO2 emission rates by 0.28, 0.49, and 0.39 in lower middle-income, upper middle-income, and high-income countries, respectively. When evaluated in general, it could be stated that livestock breeding has a higher effect on CO2 emission in agricultural production. The findings of the present study revealed that countries need to improve agricultural production methods in ways to minimize the positive association between vegetative and livestock production in accordance with their level of development, to adopt more environment-friendly agricultural technologies and to endorse international environmental policies.

The contemporary world has become increasingly interdependent in terms of economic, social and political development. These various forms of interdependence, usually termed globalization, help disseminate ideas, information, products, and services around the world. Increase in globalization has also increased path-dependence, affecting economic, social, and institutional development and completing some industries, products and technologies to grow in line with the global demand and changing standards. While the role of globalization in economic growth, technology transfer and institutional development is established in literature, the role of globalization in reversing environmental deterioration is not explored yet. The current study looks at how globalization has affected renewable energy use in high, upper middle and lower middle income countries. The empirical results based on a fixed effects model show that countries differ in terms of taking advantage of different types of globalization, i.e., economic, social and political, while transitioning towards renewable energy (RE) projects. Economic globalization has a positive influence on RE usage in the case of high and lower middle income countries, Social globalization in case of high and upper middle income countries. Contrary to the positive impacts of economic and social globalization, political globalization has a negative impact on RE usage in the case of high income countries. In addition to globalization, the effect of government effectiveness, GDP per capita and CO2 vary across the groups of countries.

Prior researchers have explored the role of FDI and economic growth or financial development and economic growth in a particular sample of countries or region while no collective studies on the effect of FDI, banks and stock market on economic growth in region or income-based groups have been conducted yet. Using a balanced panel data set of the globe of 193 upper middle income (UMI), lower middle income (LMI) and high income (HMI) countries for the period of 1998 to 2018, the study ever the first time explore the role of FDI, banks and stock markets financial development on economic growth by employing static methods and Dynamic approaches which contributes to the scarce literature on the collective and across income-based groups of countries. All model findings for the global panel indicates that FDI affect economic growth significantly and positively in the global panel, lower middle income (LMI) and upper middle income (UMI) countries where it’s not true for high income (HI) countries. Banking sector development also affect economic growth significantly but negatively in the global panel, high income and upper middle-income countries while not significant for the lower middle income (LMI) countries. Stock market development also affects economic growth significantly but negatively in the global panel. Furthermore, the result concludes that FDI have a larger effect on economic growth than does banks or stock market financial development. This study suggest high income countries regards improving FDI attraction, lower middle income (LMI) countries in regards improve banking sector and collectively suggest to improve major driver and functioning of banking sector and stock markets to spur economic growth. This study is beneficial for the government channels and financial sector of the study countries to make further decision.

Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Multinational HF registry of 23 341 participants in 40 high-income, upper-middle-income, lower-middle-income, and low-income countries, followed up for a median period of 2.0 years. HF cause, HF medication use, hospitalization, and death. Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper-middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower-middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper-middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower-middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper-middle-income countries (ratio = 2.4), similar in lower-middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper-middle-income countries (9.7%), then lower-middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower-middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.