Global Evidence Research Articles

Nursing strategies to address health disparities in genomics-informed care: a scoping review.

The objective of this review was to map the available global evidence on strategies that nurses can use to facilitate genomics-informed health care to address health disparities to inform the development of a research and action agenda. The integration of genomics into health care is improving patient outcomes through better prevention, diagnostics, and treatment; however, scholars have noted concerns with widening health disparities. Nurses work across the health system and can address health disparities from a clinical, research, education, policy, and leadership perspective. To do this, a comprehensive understanding of existing genomics-informed strategies is required. Published (qualitative, quantitative, mixed methods studies, systematic and literature reviews and text and opinion papers) and unpublished (gray) literature that focuses on genomics-informed nursing strategies to address health disparities over the last 10 years were included. No limitations were placed on language. The review was conducted in accordance with the JBI methodology for scoping reviews. A search was undertaken on May 25, 2023, across 5 databases: MEDLINE (Ovid), Embase, Cochrane Library (Ovid), APA PsycINFO (EBSCOhost), and CINAHL (EBSCOhost). Gray literature was searched through websites, including the International Society of Nurses in Genetics and the Global Genomics Nursing Alliance. Abstracts, titles, and full texts were screened by 2 or more independent reviewers. Data were extracted using a data extraction tool. The coded data were analyzed by 2 or more independent reviewers using conventional content analysis and the summarized results are presented using descriptive statistics and evidence tables. In total, we screened 818 records and 31 were included in the review. The majority of papers were published in either 2019 (n=5, 16%), 2020 (n=5, 16%), or 2021 (n=5, 16%). Most papers came from the United States (n=25, 81%) followed by the Netherlands (n=3, 10%), United Kingdom (n=1, 3%), Tanzania (n=1, 3%) and written from a global perspective (n=1, 3%). Nearly half the papers discussed cancer-related conditions (n=14, 45%) and most of the others did not specify a disease or condition (n=12, 30%). In terms of population, nurse clinicians were mentioned the most frequently (n=16, 52%) followed by nurse researchers, scholars, or scientists (n=8, 26%). The patient population varied, with African American patients or communities (n=7, 23%) and racial or ethnic minorities (n=6, 19%) discussed most frequently. The majority of equity issues focused on inequitable access to genetic and genomics health services amongst ethnic and racial groups (n=14, 45%), individuals with lower educational attainment or health literacy (n=6, 19%), individuals with lower socioeconomic status (n=3, 10%), migrants (n=3, 10%), individuals with lack of insurance coverage (n=2, 6%), individuals living in rural or remote areas (n=1, 3%) individuals of older age (n=1, 3%). Root causes contributing to health disparity issues varied at the patient, provider, and system levels. Strategies were grouped into 2 categories: those to prepare the nursing workforce and those nurses can implement in practice. We further categorized the strategies by domains of practice, including clinical practice, education, research, policy advocacy, and leadership. Papers that mentioned strategies focused on preparing the nursing workforce were largely related to the education domain (n=16, 52%), while papers that mentioned strategies that nurses can implement were mostly related to clinical practice (n=19, 61%). Nurses in all domains of practice can draw on the identified strategies to address health disparities related to genomics in health care. We found a notable lack of intervention and evaluation studies exploring the impact on health and equity outcomes. Additional research informed by implementation science and that measures health outcomes is needed to identify best practices. A French-language version of the abstract of this review is available as Supplemental Digital Content [ http://links.lww.com/SRX/A65 ].

Variation in worldwide incidence of Guillain-Barré syndrome: a population-based study in urban China and existing global evidence.

Geographical variation existed in the incidences of Guillain-Barré syndrome (GBS), but no national population-based study has evaluated the incidences of GBS in China. This study aimed to estimate the incidence of GBS in urban China and evaluate the worldwide variation in the incidence of GBS. Firstly, we did a population-based study to calculate the incidence of GBS in urban China based on the National Urban Medical Insurance database from 2013 to 2017. To identify GBS cases, natural language processing was used first for handling the lengthy and unstructured diagnostic information and then checked by prestigious neurologists. Secondly, a systematic review and meta-analysis were performed to analyze the incidence of GBS worldwide. Up to July 4, 2022, Medline, Embase, and Web of Science were retrieved to identify the population-based studies regarding the incidence of GBS. The basic information and the statistics regarding incidence were extracted. Quality assessment considered sample representativeness, condition assessment, and statistical methods. A total of 1.44 billion person-years in insurance data was covered, with 3,534 GBS cases identified. The annual incidences of GBS in urban China between 2013 and 2017 ranged from 0.41 (95% CI: 0.27 to 0.58) to 0.58 (95% CI: 0.38 to 0.82) per 100,000 person-years. The incidence was the highest in Northwest China and the lowest in Northeast China. The meta-analysis included 122 articles. The quality assessment showed that the quality scores of 43.3% of studies were ≥ 0.75 (the total score is 1). The global incidence of GBS was 1.12 (95% CI: 0.98 to 1.27) per 100,000 person-years. The incidences in West Europe, South Asia, and North Europe were higher, while the incidences in Australia and New Zealand, Southeast Asia, and North Africa were lower. The incidence of enteric infections was positively associated with the incidence of GBS (coefficient=0.0000185, P=0.007). The incidence in Europe, Australia, and America rose significantly from 1960 to 2020 (coefficient=0.01, t=2.52, P=0.015). There is a clear regional variation of the GBS incidence at both national and global levels. Careful control of enteric infections should be conducted to reduce the disease burden.

Global evidence on the energy–environment dilemma: the role of energy-related uncertainty across diverse environmental indicators

ABSTRACT Several existing studies show that macroeconomic uncertainties intensify global environmental and climate challenges, putting the globe at risk of not being able to achieve the United Nations’ Sustainable Development Goals by 2030. In this study, we provide global evidence on the role of energy-related uncertainty in the energy – environment dilemma between 1996 and 2021. We employ three distinct environmental indicators – load capacity factor (LCF), carbon dioxide emissions (CO2), and ecological footprint (EFP) – alongside a comprehensive global energy-related uncertainty index and time-frequency-quantile methods based on the Wavelet Quantile Correlation, Cross-Quantilogram, and Wavelet Local Multiple Correlation with Dominance. The empirical results suggest negative and strong nonlinear dependencies between energy-related uncertainty and the LCF across periods and quantiles. The results further suggest that the energy-related uncertainty has positive and strong nonlinear dependences not only with CO2 emissions but also EFP across various periods and quantiles. The results further suggest that the dependences between energy-related uncertainty and environmental indicators vary across periods and quantiles, with evidence of stronger dependency structures in the long run. These findings underscore the substantial influence of energy-related uncertainties on contemporary environmental challenges. We suggest that governments and policymakers need to reshape policy directives toward mitigating the environmental effects of energy-related uncertainties.

Climate policies that achieved major emission reductions: Global evidence from two decades.

Meeting the Paris Agreement's climate targets necessitates better knowledge about which climate policies work in reducing emissions at the necessary scale. We provide a global, systematic ex post evaluation to identify policy combinations that have led to large emission reductions out of 1500 climate policies implemented between 1998 and 2022 across 41 countries from six continents. Our approach integrates a comprehensive climate policy database with a machine learning-based extension of the common difference-in-differences approach. We identified 63 successful policy interventions with total emission reductions between 0.6 billion and 1.8 billion metric tonnes CO2. Our insights on effective but rarely studied policy combinations highlight the important role of price-based instruments in well-designed policy mixes and the policy efforts necessary for closing the emissions gap.

The impact of economic uncertainty on corporate ESG performance: Global evidence

This paper examines the impact of economic uncertainty on firms' overall environmental and social governance (ESG) performance in 3448 companies in 40 economies from 2006 to 2022. It is found that the overall ESG performance of corporations improves with increasing economic uncertainty for both, but more so in developed countries than developing countries. Higher competition further strengthens this relationship indirectly in developed countries but directly weakens it in developing countries. The results are also robust to run different model specifications, samples, and time selections. The findings are consistent with the Stakeholder Theory in developing country firms and a larger group of developed country firms. The results also highlight the substantial influence of economic uncertainty on corporate ESG policies, shedding light on the uncertainty-mitigating aspects of corporate ESG performance.

Unravelling the Digital Thread: How Access, Protection, and Adoption Drive Technological Entrepreneurship

This study explores the relationship between digital access, protection, and adoption in supporting technological entrepreneurship within national digital ecosystems. The study utilised PROCESS regression analysis on the Global Entrepreneurship Development Institute (GEDI)’s Digital Development Economy (DPE) Index 2020 dataset to examine selected digital factors’ direct and indirect effects on entrepreneurial activity across 116 countries. While the relationship between digital access, adoption, protection, and technological entrepreneurship has been established in previous research, this study provides global evidence to reinforce this connection. However, digital protection did not significantly moderate the effect of digital access. Notably, digital adoption emerged as a significant mediator, influencing the impacts of both access and protection on entrepreneurial outcomes. This study emphasises the importance of understanding the complex relationships between digital factors in cultivating a thriving entrepreneurial ecosystem, offering valuable insights for policymakers and practitioners seeking to stimulate technological innovation and economic growth.

Evaluating the impact of the global evidence, local adaptation (GELA) project for enhancing evidence-informed guideline recommendations for newborn and young child health in three African countries: a mixed-methods protocol

BackgroundPoverty-related diseases (PRD) remain amongst the leading causes of death in children under-5 years in sub-Saharan Africa (SSA). Clinical practice guidelines (CPGs) based on the best available evidence are key to strengthening health systems and helping to enhance equitable health access for children under five. However, the CPG development process is complex and resource-intensive, with substantial scope for improving the process in SSA, which is the goal of the Global Evidence, Local Adaptation (GELA) project. The impact of research on PRD will be maximized through enhancing researchers and decision makers’ capacity to use global research to develop locally relevant CPGs in the field of newborn and child health. The project will be implemented in three SSA countries, Malawi, South Africa and Nigeria, over a 3-year period. This research protocol is for the monitoring and evaluation work package of the project. The aim of this work package is to monitor the various GELA project activities and evaluate the influence these may have on evidence-informed decision-making and guideline adaptation capacities and processes. The specific project activities we will monitor include (1) our ongoing engagement with local stakeholders, (2) their capacity needs and development, (3) their understanding and use of evidence from reviews of qualitative research and, (4) their overall views and experiences of the project.MethodsWe will use a longitudinal, mixed-methods study design, informed by an overarching project Theory of Change. A series of interconnected qualitative and quantitative data collections methods will be used, including knowledge translation tracking sheets and case studies, capacity assessment online surveys, user testing and in-depth interviews, and non-participant observations of project activities. Participants will comprise of project staff, members of the CPG panels and steering committees in Malawi, South Africa and Nigeria, as well as other local stakeholders in these three African countries.DiscussionOngoing monitoring and evaluation will help ensure the relationship between researchers and stakeholders is supported from the project start. This can facilitate achievement of common goals and enable researchers in South Africa, Malawi and Nigeria to make adjustments to project activities to maximize stakeholder engagement and research utilization. Ethical approval has been provided by South African Medical Research Council Human Research Ethics Committee (EC015-7/2022); The College of Medicine Research and Ethics Committee, Malawi (P.07/22/3687); National Health Research Ethics Committee of Nigeria (01/01/2007).

Postglacial ocean methane release from the northern South China Sea

Methane release into seawater and the atmosphere as a result of cold seepage activity is a sensitive indicator of global environmental change during the last glacial period. However, the link between postglacial ocean methane escape and possible increases in atmospheric methane concentration remains unclear, which hinders the evaluation of methane impact on climatic variability. In this study, lipid biomarkers were analyzed on samples from the Shenhu area in the South China Sea to reconstruct the marine gas hydrate variability since the last glacial time. The reconstructed methane release during the cool Last Glacial Maximum and Younger Dryas agreed well with previous findings. Interestingly, our results identified a pronounced methane outgassing at the end of Heinrich 1, which was likely triggered by the abrupt increase in intermediate water temperature. The occurrence of this gas hydrate dissociation before the drastic rise in atmospheric methane during Bølling-Allerød implied that the change in the gas hydrate reservoir could likely indirectly contribute to the initiation of the warming event, though more global evidence needs to be provided in the future.

Exploring the road to public healthcare accessibility: a qualitative study to understand healthcare utilization among hard-to-reach groups in Kerala, India

BackgroundKerala, a southern state in India, is known to be atypical due to its high literacy rate and advanced social development indicators. Facing competition from a dominant private healthcare system, recent government health system reforms have focused on providing free, high-quality universal healthcare in the public sector. We carried out an analysis to ascertain the initial impacts of these measures among ‘hard to reach groups’ as part of a larger health policy and systems research study, with a focus on public sector health service utilisation.MethodsWe conducted Focus Group Discussions (FGDs) among identified vulnerable groups across four districts of Kerala between March and August of 2022. The FGDs explored community perspectives on the use of public healthcare facilities including enablers and barriers to healthcare access. Transliterated English transcripts were coded using ATLAS.ti software and thematically analyzed using the AAAQ framework, supplemented with inductive code generation.ResultsA total of 34 FGDs were conducted. Availability and cost-effectiveness were major reasons for choosing public healthcare, with the availability of public insurance in inpatient facilities influencing this preference. However, accessibility of public sector facilities posed challenges due to long journeys and queues. Uneven roads and the non-availability of public transport further restricted access. Gaps in acceptability were also observed: participants noted the need for the availability of special treatments available, reduced waiting times for special groups like those from tribal communities or the elderly mindful of their relatively greater travel and need for prompt care. Although quality improvements resulting from health reform measures were acknowledged, participants articulated the need for further enhancements in the availability and accessibility of services so as to make public healthcare systems truly acceptable.ConclusionThe ‘Kerala Model of Development’ has been applauded internationally for its success in recent years. However, this has not inured the state from the typical barriers to public sector health care use articulated by participants in the study, which match global evidence. In order to deepen the impact of public sector reforms, the state must try to meet service user expectations– especially among those left behind. This requires attention to quality, timeliness, outreach and physical access. Longer term impacts of these reforms – as we move to a post-COVID scenario - should also be evaluated.

Network structure, dynamic evolution and block characteristics of sovereign debt risk: The global evidence

Global sovereign debt risks are escalating with the tightening of global liquidity. We apply the LASSO-VAR spillover model, network approach and block model to analyze the overall situation and time-varying characteristics of sovereign risk volatility spillover effects among 50 countries. The results show that there is a discernible cyclical pattern in the spillover effect of global sovereign risk volatility, with the spillover intensity progressively rising in each cycle, and more countries have emerged as "net risk exporters" recently. Countries and regions exhibit diverse risk spillover traits, and assume varying roles in the transmission of sovereign debt risks. The originator of a sovereign risk shock isn't necessarily its primary disseminator, underscoring the need to account for systemic significance and risk infectivity. The interlinkages among sovereign debt risk spillover blocks vary over time, given that the composition and attributes of these blocks change. Our findings provide implications for related regulators and investors.

Convergence in economic complexity: global evidence

ABSTRACT This study explores the convergence pattern of economic complexity across a global sample of 129 countries from 1995 to 2020. The panel convergence method is employed, which endogenously identifies the membership of convergence clubs. The findings suggest that countries flock together in six distinct clubs. Upon further inspection, it becomes evident that factors such as population density, human capital, trade openness, foreign direct investment, and real GDP significantly influence the clubs’ membership of economic complexity. Therefore, government policies must be specifically tailored to each club’s determinants’ unique characteristics to enhance a country’s economic complexity.

Conflict and Girl Child Marriage: Global Evidence

Conflict and Girl Child Marriage: Global Evidence

Impact of air pollution on human morality: A multinational perspective

This study aimed to investigate whether global air pollution harms human morals beyond physiological and psychological health. To accomplish this, we conducted an original survey involving over 80,000 individuals across 30 countries, inquiring about their recent perceived unethical behaviors. Through regression analyses, we identified global evidence of a positive correlation between local monthly average concentrations of nitrogen dioxide (NO2) and perceptions of unethical behavior. This finding suggests that air pollution may potentially elicit unethical behavior through a complex response mechanism. It is noteworthy that the impact of air pollution on the inclination to perceive unethical behavior is heterogeneous across categories of unethical behavior and countries. For example, the effects of increasing air pollution concentrations vary even within the same European country: an increase in NO2 concentration in Greece and the Netherlands augments the inclination to perceive fatal unethical behaviors such as murder, terrorism, and suicide, while in Germany, NO2 concentration diminishes the inclination to perceive the same types of unethical behaviors. Overall, the societal costs of air pollution may be even more far-reaching than previously acknowledged, and further research is necessary to unveil the intricate response mechanisms underlying this issue.

Migration across the urban hierarchy: Has China’s urbanisation transitioned from the primate city stage to the secondary city stage?

The population density in megacities in China gives rise to challenges, such as traffic congestion and soaring housing prices. A trend of leaving primate cities can be observed as well as a population increase in secondary cities. These trends might point to an urbanisation transition from the primate city stage to the secondary city stage. Research is needed to determine at which stage of urbanisation China currently resides, and who are migrating across the different levels of cities in this stage. In order to answer these questions, the current study combines the theory of differential urbanisation and migrant selectivity, and analyses city-level migration patterns and demographic characteristics of migrants across the urban hierarchy. The findings indicate that China is currently in the intermediate primate city stage, where the upward migration across the urban hierarchy is driven by younger adults with higher education and income, and a lower likelihood of marriage or parenthood. Building upon global evidence, this research further extends the theory of differential urbanisation by incorporating migrant selectivity into the interpretation of urbanisation stages. It reveals that educated migrants tend to concentrate and move up the urban hierarchy in the primate city stage but might deconcentrate during the secondary and small city stages. This study offers practical insights for policymakers at the national and city levels to develop population growth plans, adjust targeted migration policies and respond to future urbanisation processes.

Collaboration between traditional health practitioners and biomedical health practitioners: Scoping review.

Collaboration between traditional health practitioners (THPs) and biomedical health practitioners (BHPs) is highly recommended in catering for pluralistic healthcare users. Little is known about bidirectional collaborations at healthcare service provision level. To map global evidence on collaboration attempts between THPs and BHPs between January 1978 and August 2023. We followed the Arksey and O'Malley framework in conducting this scoping review. Two reviewers independently screened articles for eligibility. A descriptive numerical and content analysis was performed on ATLAS.ti 22. A narrative summary of the findings was reported using the PRISMAScR guideline. Of the 8404 screened studies, 10 studies from 12 articles were included in the final review. Studies came from America (n= 5), Africa (n= 2), China (n= 2) and New Zealand (n= 1). Eight studies reported case studies of bidirectional collaboration programmes, while two studies reported on experimental research. All collaborations occurred within biomedical healthcare facilities. Collaboration often entailed activities such as relationship building, training of all practitioners, coordinated meetings, cross-referrals, treatment plan discussions and joint health promotion activities. This study confirmed that practitioner-level collaborations within healthcare are few and sparse. More work is needed to move policy on integration of the two systems into implementation. There is a need to conduct more research and document emerging collaborations.Contribution:This research illuminates the contextual challenges associated with sustaining collaborations. The data would be important in informing areas that need strengthening in the work towards integration of THPs and BHPs.

Severe acute hepatitis of unknown origin in children: Is it still amystery? What role does adenovirus play?

On March 31, 2022, severe acute hepatitis of unknown origin was first reported from the Royal Glasgow Children's Hospital in Scotland. According to the criteria by WHO-ECDC, a probable case of unknown acute hepatitis in children is defined as a subject under 16 years of age, who tested negative for viral hepatitis and transaminases >500 U/L, starting from the 1st of October 2021. WHO invites Member States to participate in the global effort to collect anonymized clinical data on probable cases of severe acute hepatitis of unknown aetiology. As of May 26, 2021, 650 cases were already registered on the platform worldwide, of whom at least 38 cases have required liver transplants. Several hypotheses such as previous SARS-CoV-2 infection or coinfection or infection with another virus were examined and a strong association was found between adenovirus (41F) and acute hepatitis of unknown aetiology cases. This review article summarizes the global epidemiological evidences on acute hepatitis of unknown origin in children, analysing their incidence and characteristics.

Health systems response to climate change adaptation: a scoping review of global evidence

BackgroundThe health system plays a critical role in safeguarding the well-being of communities in the face of health risks associated with climate change. This review maps evidence on health systems' adaptation to climate risk and barriers to effective adaptation.MethodsThis review followed the recommendations by Arksey and O’Malley for conducting scoping review. Search for records was conducted in PubMed, Central, Web of Science, JSTOR, Google, and Google Scholar. Only peer-reviewed papers published in English language were included in this review. All the 63 included studies were critically appraise d.ResultsWe found that efforts are being made to create resilient health systems by incorporating climate change into health policies. Investments are being made in innovative technologies, climate-resilient health infrastructure, enhancing healthcare delivery, developing the capacity of climate specialists and agencies to provide high-quality evidence for resilient health systems. We also found that several obstacles prevent health system adaptation to climate risk, including poor policy implementation and evaluation. The obstacles are further exacerbated by financial constraints, including poverty, a lack of political commitment, inadequate data, and deficient healthcare systems, especially in developing countries. There is also a lack of integration of climate change into mental health actions and the health and safety of healthcare workers.ConclusionEfforts to develop resilient health systems against climate risks are underway, but persistent obstacles, including inadequate policy implementation, resource limitations, and a lack of integration of climate change into critical health domains, hinder comprehensive adaptation measures, particularly in developing nations.

Global evaluation and outcomes of cholecystectomy: protocol for a multicentre, international, prospective cohort study (GlobalSurg 4)

IntroductionCholecystectomy is one of the most common operations performed worldwide. Although laparoscopic surgery has been the ‘gold-standard’ approach for this operation, there is a paucity of global evidence around the...

Reseeding inhibits grassland vegetation degradation – Global evidence

Global grassland faces different degradation degrees, and reseeding is commonly used to restore degraded grasslands. However, the factors affecting the results of reseeding restorations worldwide remain unclear. Here, we screened 141 independently published articles and performed a meta-analysis of the extracted 1386 data pairs. We selected five quantitative indices and four α diversity indices to analyze the effects of reseeding on the degraded grassland. Our results showed that reseeding significantly increased the quantitative indices and diversity index of degraded grasslands worldwide. Mixed reseeding has the best effect on improving the diversity of degraded grassland. A high mixed reseeding number was more conducive to restoring degraded grassland diversity. The more severe the grassland degradation, the better the restoration effect of reseeding. Short- and medium-term restorations significantly increased the diversity of degraded grassland. However, the restoration time increased the response proportion of aboveground biomass and cover. After reseeding, the proportion of aboveground biomass (AGB) response in humid areas was greater than in arid regions. This study explored the overall effect of reseeding restoration and the factors affecting reseeding restoration, providing a basis for the global restoration of degraded grassland and promoting the healthy development and sustainable use of grassland.

Revisiting the nexus between development aid, institutions, and growth: A global evidence

AbstractObjectiveThis study mainly focuses on the relationship between development aid and growth as well as examines the role of the institutional development levels of countries in this relationship and makes economic inferences.MethodsThe analysis is conducted for 64 countries receiving official development assistance in the 2000–2020 period. To provide robust estimates in these studies, the Driscoll and Kraay estimator is used after fixed and random effects models.ResultsIn almost all of the estimated models, a significant relationship between official development assistance per capita and growth is found. Moreover, the models with institutional factors and interaction terms also support the results. According to the robust estimation results, official development assistance per capita positively affects growth.ConclusionThe results for all countries do not mean that good policies and strong institutions are unnecessary. In contrast, they show that the priority is the sum of aid per capita.