High Human Development Index Countries Research Articles

Association of sex with the global burden of vision impairment caused by neonatal preterm birth: An analysis from the global burden of disease study 2019.

AimsTo investigate the sex-specific global burden of neonatal preterm birth (NPB) vision impairment by year, age, and socioeconomic status using years lived with disability (YLDs).MethodsThe global, regional, and national sex-specific YLD numbers, crude YLD rates, and age-standardized YLD rates of NPB-related moderate and severe vision loss and blindness were obtained from the Global Burden of Disease Study 2019. The Wilcoxon test and linear regression were used to investigate the relationship between sex difference in age-standardized YLD rates and the Human Development Index (HDI).ResultsBetween 1990 and 2019, the gender disparity in age-standardized YLD rates for NPB-related vision impairment remained stable, increasing from 10.2 [95% uncertainty interval (UI) 6.7–14.6] to 10.4 (95% UI 6.9–15.0) for men and 10.3 (95% UI 6.8–14.7) to 10.7 (95% UI 7.2–15.1) for women, with women consistently having higher age-standardized YLD rates. Between the ages of 25 and 75, women had higher YLD rates than males, with the biggest disparity in the 60–64 age group. In 2019, sex difference in age-standardized YLD rates across 195 nations was statistically significant. Women had higher age-standardized YLD rates than men in both low (Z = −3.53, p < 0.001) and very high HDI countries (Z = −4.75, p < 0.001). Additionally, age-standardized YLD rates were found to be adversely associated with HDI (male: Standardized β = −0.435, female: Standardized β = −0.440; p < 0.001).ConclusionDespite advancements in worldwide NPB health care, sexual differences in NPB-related vision impairment burden showed little change. Female had higher burden than male, particularly in low and very high socioeconomic status countries.

The Triple Bottom Line of Sustainable Entrepreneurship and Economic Policy Uncertainty: An Empirical Evidence from 22 Countries.

Based on the data of 22 different countries from 2005 to 2018, this paper mainly studies the influence of entrepreneurship on sustainability, and further explores the influence of Economic Policy Uncertainty (EPU) and the interaction effect between EPU and entrepreneurship on sustainability. The results show that EPU can promote economic, environmental, and social development, the interaction between EPU and green entrepreneurship is beneficial to social development, and the interaction between EPU and non-green entrepreneurship inhibits social development. For the heterogeneity analysis, 22 countries are grouped by high and low Human Development Index (HDI). The empirical results find that EPU has a better performance in low HDI countries than that in high HDI countries. In high HDI countries, the interaction between EPU and green entrepreneurship will weaken the positive effects of green entrepreneurship on the environment.

Teleophthalmology research: Where do we stand?

To identify global research trends in teleophthalmology, as well as productivity and its association with Human development index (HDI). A cross-sectional study. The main outcome measures were publication count, citation count, and publications count per million populations. Bibliographic data were derived from the Web of Science website. HDI data were derived from Human Development Report [2020]. One-way ANOVA test was used to examine the association between HDI and the outcome measures. We studied the correlation between continuous variables using Spearman's. Bibliometric analysis software's VOSviewer and Citspace were used to analyse results and creating visualizing maps. The results retrieved 355 publications, one-third of them have been published in the year of the COVID-19 pandemic; (2020). The USA has contributed to one-half of all publications, and just five countries have contributed to about 90% of all records. Very high HDI countries had significantly more publications count per million populations, than high (p-value = 0.0047), medium (p-value = 0.0081) or low HDI countries (p-value = 0.002). The main themes are screening programmes, reliability, photography, COVID-19, access, artificial intelligence, and cost-effectiveness. The leading countries in terms of both publications and citation count are the USA and India. In terms of publications count per million populations, the leading countries are Singapore and Australia. Most of the contribution in teleophthalmology research was confined to a small number of countries. More effort is needed to expand the global contribution. The hotspots in this field are artificial intelligence applications and COVID-19 impact.

The current and future incidence and mortality of gastric cancer in 185 countries, 2020–40: A population-based modelling study

SummaryBackgroundTo examine global patterns of gastric cancer in 2020 and the projected burden in 2040.MethodsData on primary gastric cancer were extracted from the GLOBOCAN database for the year 2020. Age-standardized incidence and mortality rates were calculated by sex, country, world region and level of human development index (HDI) for 185 countries. The predicted burden of incidence and mortality in 2040 was calculated based on demographic projections.FindingsIn total, ∼1.1 million new cases and 770,000 deaths of gastric cancer were estimated in 2020. Incidence rates were on average 2-fold higher in males than females (15.8 and 7.0 per 100,000, respectively) with variation across countries. Highest incidence rates were observed in Eastern Asia for both males and females (32.5 and 13.2, respectively); males residing in Japan (48.1), Mongolia (47.2) and Korea (39.7) had the highest rates in the world. Incidence was lowest in Africa with incidence rates < 5 per 100,000. Highest mortality rates were observed in Eastern Asia for both males (21.1) and females (8.8). A lower share of deaths was observed in very high HDI countries compared to medium and low HDI countries. The annual burden of gastric cancer is predicted to increase to ∼1.8 million new cases and ∼1.3 million deaths by 2040.InterpretationThese estimates of the global burden of gastric cancer pinpoint countries and regions of high incidence and mortality in need of cancer control initiatives. Primary prevention through eradication of H. pylori and behavioural changes such as reducing salt intake, smoking, obesity, and alcohol, remains key in stomach cancer control.FundingNo direct funding was received. All authors had access to the included study data and all authors agreed with the final decision to submit for publication.

Relationship between socio-demographic correlates and human development index with physical activity and sedentary time in a cross-sectional multicenter study

BackgroundSocio-demographic correlates and human development index (HDI) are associated with self-reported physical activity, but only a few studies have focused on device-measured physical activity and sedentary time in Latin America. We examined the relationship between socio-demographic correlates and HDI with physical activity and sedentary time in a cross-sectional study.MethodsWe based our analyses on 2522 (53.1% women; 18–65 years [mean age 38.3 years]) adults drawn from the eight Latin America countries. Physical activity (light, moderate, vigorous, and moderate-to-vigorous intensity and steps) and sedentary time were assessed using Actigraph GT3X + accelerometers. Sex, age, and race/ethnicity were self-reported. The HDI country information was obtained from the United Nations Development Program.ResultsFor the age, ethnicity, vigorous physical activity and steps/day, there were significant differences between high and very high HDI countries. Women and younger age presented lower sedentary time than men and older. In moderate-to-vigorous physical activity, we found lower duration in women (-13.4 min/week), younger age (-0.1 min/week), and white/caucasian (-2.7 min/week) than men, older ages and mixed ethnicity. Women (-1266.5 steps/week) and very high HDI (-847.3 steps/week) presented lower steps than men and high HDI. Black (2853.9 steps/week), other (1785.4 steps/week), and white/caucasian ethnicity (660.6 steps/week) showed higher steps than mixed ethnicity.ConclusionsDifferent socio-demographic correlates are associated with physical activity intensity; however, HDI is associated with vigorous physical activity and steps in the Latin American region, which can in turn guide policies to promote physical activity in the region.Trial registrationClinicalTrials.GovNCT02226627. Retrospectively registered on August 27, 2014.

Ovarian cancer today and tomorrow: A global assessment by world region and Human Development Index using GLOBOCAN 2020.

Ovarian cancer remains to have relatively poor prognosis particularly in low-resourced settings. It is therefore important to continually examine the burden of ovarian cancer to identify areas of disparities. Our study aims to provide an overview of the global burden of ovarian cancer using the GLOBOCAN 2020 estimates by country, world region, and Human Development Index (HDI) levels, as well as the predicted future burden by the year 2040 by HDI. Age-standardized incidence and mortality rates for ovarian cancer in 185 countries were calculated by country, world region, and for the four-tier HDI. The number of new cases and deaths were projected for the year 2040 based on demographic projections by HDI category. Approximately 314 000 new ovarian cancer cases and 207 000 deaths occurred in 2020. There were marked geographic variations in incidence rates, with the highest rates observed in European countries with very high HDI and low rates were found in African countries within the lowest HDI group. Comparable mortality rates were observed across the four-tier HDI. Relative to 2020 estimates, our projection for 2040 indicates approximately 96% and 100% increase in new ovarian cancer cases and deaths, respectively, among low HDI countries compared to 19% and 28% in very high HDI countries. Our study highlights the disproportionate current and future burden of ovarian cancer in countries with lower HDI levels, calling for global action to reduce the burden and inequality of ovarian cancer in access to quality cancer care and treatment.

The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020

Thyroid cancer incidence rates have increased in many countries and settings; however, mortality rates have remained stable at lower rates. This epidemiological pattern has been largely attributed to an overdiagnosis effect. Timely evidence for the global epidemiological status is necessary to identify the magnitude of this problem and the areas mostly affected by it. We therefore aimed to provide an up-to-date assessment on the global distribution of thyroid cancer incidence and mortality rates in 2020. We extracted age-standardised incidence and mortality rates per 100 000 person-years of thyroid cancer as defined by the International Classification of Diseases for Oncology 10th Revision (code C73), for 185 countries or territories by sex and 18 age groups (ie, 0-4, 5-9, …, 80-84, and ≥85 years) from the GLOBOCAN database. Both incidence and mortality estimates were presented by country and aggregated across the 20 UN-defined world regions and according to the UN's four-tier Human Development Index (ie, low, medium, high, and very high) in 2020. Globally, in 2020, the age-standardised incidence rates of thyroid cancer were 10·1 per 100 000 women and 3·1 per 100 000 men, and age-standardised mortality rates were 0·5 per 100 000 women and 0·3 per 100 000 men. In both sexes, incidence rates were five times higher in high and very high Human Development Index countries than in low and medium Human Development Index countries, whereas mortality rates were relatively similar across different settings. Incidence rates in women differed by more than 15 times across world regions, with the highest incidence rates being in the Federated States of Micronesia and French Polynesia (18·5 per 100 000 women), North America (18·4 per 100 000), and east Asia (17·8 per 100 000, with South Korea reaching 45 per 100 000). Mortality rates were less than one per 100 000 in most countries and in both sexes. South Korea had the highest incidence-to-mortality rate ratio in both sexes, followed by Cyprus and Canada. The current thyroid cancer epidemiological landscape is strongly suggestive of a large effect of overdiagnosis in many countries and settings worldwide, confirming the relevance of thyroid cancer overdiagnosis as a global public health problem. None.

How do digital capabilities affect firm performance? The mediating role of technological capabilities in the “new normal”

This study proposes a model to explain the effect of digital capabilities on firm performance in the “new normal” context from a firm-level perspective. Moreover, it analyzes the mediating role of technological capabilities and the Human Development Index (HDI) in explaining firm performance. Our study used data from the World Bank's Enterprise Surveys 2020, which included 999 firms from 27 countries. We applied the methodological approach, partial least square structural equation modeling (PLS-SEM), to test the hypothetical model. The results show that digital capabilities positively influence firm performance only through technological capabilities. We also empirically demonstrate that digital skills in low HDI economies have a more significant indirect effect on firm performance than in high HDI countries. Finally, some promising avenues for future research and implications for managers and policymakers are suggested based on these findings.

Predicting completion of clinical trials in pregnant women: Cox proportional hazard and neural network models.

This study aimed to develop a model for predicting the completion of clinical trials involving pregnant women using the Cox proportional hazard model and neural network model (DeepSurv) and to compare the predictive performance of both methods. We collected data on 819 clinical trials performed on pregnant women and intervention studies using at least one drug as intervention from 2009 to 2018 from ClinicalTrials.gov. The Cox proportional hazard model and DeepSurv were used to develop models that predict clinical trial completion. The concordance index (C‐index) was used to evaluate the predictive performance. The Cox proportional hazard model revealed that a sample size of n ≥ 329 (hazard ratio [HR] = 0.53), very high human development index (HDI) country (HR = 0.28), abortion (HR = 3.30), labor (HR = 2.16), and iron deficiency anemia (HR = 2.29) were significantly related to the probability of clinical trial completion (all p value < 0.01). The C‐index of the model development dataset and test dataset were 0.72 and 0.73, respectively. DeepSurv model consisted of one hidden layer with 16 nodes. DeepSurv showed the C‐index comparable to the Cox proportional hazard model. The C‐index of the training dataset and test dataset were 0.76 and 0.72, respectively. Further a nomogram that calculate a probability of clinical trial completion at 1 year, 3 years, and 5 years was developed. Both the Cox proportional hazard model and DeepSurv yielded sufficient predicting performance. We hope that this study will contribute to the execution of future clinical trials in pregnant women.

Impact of the COVID-19 pandemic on population-based cancer registry.

The COVID‐19 pandemic has caused disruptions to national health systems and impacted health outcomes worldwide. However, the extent to which surveillance systems, such as population‐based cancer registration, have been affected was not reported. Here we sought to evaluate the effect of the pandemic on registry operations across different areas and development levels worldwide. We investigated the impact of COVID‐19 on three main areas of cancer registry operations: staffing, financing and data collection. An online survey was administered to 750 member registries of the International Association for Cancer Registries. Among 212 responding registries from 90 countries, 65.6% reported a disruption in operations, ranging between 45% in south‐eastern Asia and 87% in the Latin America and Caribbean. Active data collection was disrupted more than case notifications or hybrid methods. In countries categorized with low Human Development Index (HDI), a greater number of registries reported a negative impact (81.3%) than in very high HDI countries (57.8%). This contrast was highest in term of impact on financing: 9/16 (56%) registries in low HDI countries reported a current or an expected decline in funding, compared to 7/108 (7%) in very high HDI countries. With many cancer registries worldwide reporting disruption to their operations during the early COVID‐19 pandemic, urgent actions are needed to ensure their continuity. Governmental commitment to support future registry operations as an asset to disease control, alongside a move toward electronic reporting systems will help to ensure the sustainability of cancer surveillance worldwide.

Thyroid Cancer: Global Burden and Trends.

The incidence of thyroid cancer continues to increase, representing the 5th most common cancer type in the USA today (Sherman, Lancet 361(9356):501-11, 2003). The current study sought to analyze the global burden of thyroid cancer utilizing the publicly accessible GLOBOCAN database. An estimated 586,202 cases of thyroid cancer were reported in 2020, making thyroid cancer the 10th most common cancer worldwide. The majority of thyroid cancer cases occurred in countries with a high or very high Human Development Index (HDI), accounting for 91% of new cases. With respect to the World Health Organization (WHO) regions, the Western Pacific had the highest incidence of thyroid cancer accounting for 47.6% of cases despite representing only 25.4% of the world's population. Thyroid cancer incidence and mortality are expected to increase by 29.9% and 67%, respectively, by the year 2040. The African region is projected to experience the highest increase in both incidence (84.3%) and mortality (100.3%) over this time period. The results of our study demonstrate that the incidence and mortality of thyroid cancer vary by the geographic location and socio-economic status. Although the incidence was noted to be the highest in very high HDI countries and the Western Pacific region, mortality was noted to be disproportionately higher in the low HDI countries and African region. This may be due to discrepancies in access to care and/or environmental exposures such as ionizing radiation and iodine deficiency. Further measures are required to improve the outcomes from thyroid cancer regardless of the geographic location or socio-economic status.

Modeling global transfusion medicine education.

Modeling global transfusion medicine education.

Global, Regional, and National Lifetime Probabilities of Developing Cancer in 2020

Background: The lifetime risk of cancer is a measure of the cumulative impact of cancer across a defined age span, and has obvious intuitive appeal. There are however few examples of its systematic use in comparative assessments of cancer-specific risk across populations. We therefore sought to estimate and interpret the lifetime and age-conditional probabilities of developing cancer at the country, world region and global level in 2020. Methods: We obtained estimates of sex- and age-specific cancer incidence rates from GLOBOCAN for 185 countries for the year 2020, alongside all-cause mortality and population data from the United Nations. Countries were categorized into quartiles of the Human Development Index (HDI) as developed by the United Nations Development Programme. The lifetime risk of cancer was estimated using the adjusted for multiple primaries (AMP) method, taking into account competing risks of death from causes other than cancer as well as average life expectancy. Findings: In 2020, the estimated global lifetime risk of cancer from birth to death was 25.1% (26.3% in men and 24.0% in women) . There were marked differences in risks between countries within world regions and by level of human development. In very high HDI, high HDI, medium HDI and low HDI countries, the lifetime risk of cancer was 38.5%, 25.4%, 11.4%, and 10.3%, respectively, with cancer risks highest in Ireland (49.7%) and lowest in Central African Republic (6.6%). There was similar heterogeneity according to cancer type by sex. Worldwide, prostate cancer and breast cancer were associated with the greatest lifetime risks among men and women, of 4.6% and 5.9% respectively. The lifetime risk of cancer decreased by age, with a remaining risk of 12.6% from the age 70 years. Interpretation: In 2020, the global lifetime risk of cancer from birth to death translates approximately 1 in 4 persons developing cancer, with men and women having similar levels of lifetime risk. The identified age-specific variations in cancer risk at the population level can provide important information to support the targeted cancer prevention and health systems planning. Funding: National Key R&D Program of China, National Natural Science Foundation of China, and Beijing Nova Program Declaration of Interest: All authors declare no competing interests.

Trends in pediatric lymphoma incidence by global region, age and sex from 1988-2012

BackgroundGlobal variation in lymphoma incidence by type and age at diagnosis, region, sex, and Human Development Index (HDI) categories has not been reported, may shed light on potential biologic mechanisms and identify areas for targeted interventions. MethodsUsing the Cancer Incidence in Five Continents data from 1988 to 2012, we identified Hodgkin (HL), non-Hodgkin (NHL), and Burkitt lymphoma (BL) diagnosed in children aged 0–19 years. We estimated incidence rates (IRs; cases/million) and average annual percent change in incidence (AAPC; 95 % CI) by geographic region, sex, and HDI for each age group (0−9years and 10−19 years). ResultsThere were 42,440 NHL, 38,683 H L, and 7703 included. Southern European (SE) 10−19-year-olds (yo) had the highest IR of NHL (19.6 cases/million) in 2008−2012. HL IRs for 0−9yo were <6 cases/million and >25 cases/million for 10−19yo in European regions and Oceania (OC). BL IRs were generally <5cases/million. Northern Europe (NE), SE, and OC 10−19yo had significantly increased APPCs in incidence for all lymphomas with the largest increases in BL (NE AAPC: 7.69 %; 95 % CI: 5.27, 10.16; SE AAPC: 5.21 %; 95 % CI: 3.26, 7.19; OC AAPC: 3.97 %; 95 % CI: 3.26, 4.70). BL incidence increased among males of all ages by approximately 2 %. NHL and BL incidence increased significantly among 10−19yo in very high HDI countries by approximately 3 %. ConclusionsSouthern and Northern Europe and Oceania displayed increased incidence of all lymphomas studied from 1988 to 2012. BL incidence significantly increased in 8 of 15 global regions, males, and higher HDI countries over the study period. Mechanisms underlying these increases remain to be elucidated.

Societal development and the alcohol-attributable burden of disease.

This study aimed to examine if there is an interaction between alcohol use and human development in terms of their associations with alcohol-attributable health harms. Statistical modelling of global country- and region-specific data from 2016. Global. The units of the analyses were countries (n=180) and regions (n=4) based on their Human Development Index (HDI). Alcohol-attributable harms [deaths, years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALYs) lost] and risk relations were based on a recent study using World Health Organization (WHO) estimates for 2016. Human development was measured using the HDI, a summary score of life expectancy, education and gross national income from the United Nations Development Programme. Interactions between HDI and adult per-capita consumption (APC) affecting alcohol-attributable harms were assessed using likelihood ratio tests. Differences in alcohol-attributable harms per litre of APC between HDI groups were assessed using regression analyses and a reference group of low HDI. APC is associated with alcohol-attributable deaths, YLL, YLDs and DALYs lost, while HDI is associated with alcohol-attributable deaths, YLL and DALYs lost. Statistical analyses indicated there is an interaction between HDI and APC in their associations with alcohol-attributable deaths, YLL and DALYs lost per 100 000 people. The alcohol-attributable burden was highest in low HDI countries, with 11.65 [95% confidence interval (CI)=10.75, 12.40] deaths and 495.61 (95% CI=461.83, 569.23) DALYs lost per 100 000 people per litre of APC, and lowest in very high HDI countries, with 4.15 (95% CI=2.46, 5.71) deaths and 200.31 (95% CI=122.78, 265.10) DALYs lost per 100 000 people per litre of APC. However, no statistical differences between low and very high HDI groupings for these burdens were observed. There appears to be an interaction between the Human Development Index and alcohol use in their associations with alcohol-attributable deaths, years of life lost and disability-adjusted life years lost but not with alcohol-attributable years lived with disability. Alcohol appears to have a stronger harmful impact per litre of alcohol consumed in lesser developed countries than in developed countries.

Cost per DALY averted in low, middle- and high-income countries: evidence from the global burden of disease study to estimate the cost-effectiveness thresholds

BackgroundDetermining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge for policymakers, especially in low- and middle-income countries. This study aimed to estimate the cost per disability-adjusted life-year (DALY) averted for countries with different levels of Human Development Index (HDI) and Gross Domestic Product (GDP).MethodsThe data about DALYs, per capita health expenditure (HE), HDI, and GDP per capita were extracted for 176 countries during the years 2000 to 2016. Then we examined the trends on these variables. Panel regression analysis was performed to explore the correlation between DALY and HE per capita. The results of the regression models were used to calculate the cost per DALY averted for each country.ResultsAge-standardized rate (ASR) DALY (DALY per 100,000 population) had a nonlinear inverse correlation with HE per capita and a linear inverse correlation with HDI. One percent increase in HE per capita was associated with an average of 0.28, 0.24, 0.18, and 0.27% decrease on the ASR DALY in low HDI, medium HDI, high HDI, and very high HDI countries, respectively. The estimated cost per DALY averted was $998, $6522, $23,782, and $69,499 in low HDI, medium HDI, high HDI, and very high HDI countries. On average, the cost per DALY averted was 0.34 times the GDP per capita in low HDI countries. While in medium HDI, high HDI, and very high HDI countries, it was 0.67, 1.22, and 1.46 times the GDP per capita, respectively.ConclusionsThis study suggests that the cost-effectiveness thresholds might be less than a GDP per capita in low and medium HDI countries and between one and two GDP per capita in high and very high HDI countries.

The Inequitable Global Burden of Lip and Oral Cancers: Widening Disparities Across Countries

In light of continued innovation in cancer immunotherapy regimens and surgical management, no studies currently exist assessing the effect of these advances on global disparities in lip and oral cavity cancer disease burden. The purpose of this study is to characterize longitudinal trends in disease burden caused by lip and oral cavity cancers globally. This retrospective, longitudinal cohort study extracted data on lip and oral cavity cancer disease burden from The Global Health Data Exchange for 1990-2017. The primary predictor variable was country human development index (HDI). The primary outcome variable was disease burden, measured by age-standardized disability-adjusted life years (DALYs) per 100,000 population, listed for each individual country. Additional variables assessed include country-level data on alcohol consumption and tobacco smoking. Concentration indices were also calculated. Mann-Whitney U and Kruskal-Wallis one-way analysis of variance tests with Bonferroni correction were utilized with a significance threshold of 0.008. A total of 185 countries met inclusion criteria. Global age-standardized DALYs increased from 44.5±35.7 to 51.1±41.1 from 1990 to 2017. High HDI and medium HDI countries showed a+37.6% and+22.4% median increase in DALYs, respectively, which is significantly greater than very-high HDI (+3.8%) and low HDI countries (-0.5%) (P<.001). The concentration index for lip and oral cavity cancer became increasingly negative from -0.064 to -0.077 from 1990 to 2015. In 2017, disease burden was concentrated in South Asia and Eastern Europe. High and medium HDI countries experienced a disproportionate growth in lip and oral cavity cancer disease burden. These findings may have resulted from increased life expectancy among these countries. Global and public health policy initiatives should focus on understanding the mechanisms driving these disparities with the goal of reducing disease burden globally.

Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study

IntroductionSurgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and...

Risk factors associated with adverse maternal outcomes following intrapartum cesarean birth: a secondary analysis of the WHO global survey on maternal and perinatal health, 2004\u20132008

BackgroundTo identify risk factors associated with a composite adverse maternal outcomes in women undergoing intrapartum cesarean birth.MethodsWe used the facility-based, multi-country, cross-sectional WHO Global Survey of Maternal and Perinatal Health (2004–2008) to examine associations between woman-, labor/obstetric-, and facility-level characteristics and a composite adverse maternal outcome of postpartum morbidity and mortality. This analysis was performed among women who underwent intrapartum cesarean birth during the course of labor.ResultsWe analyzed outcomes of 29,516 women from low- and middle-income countries who underwent intrapartum cesarean birth between the gestational ages of 24 and 43 weeks, 3.5% (1040) of whom experienced the composite adverse maternal outcome. In adjusted analyses, factors associated with a decreased risk of the adverse maternal outcome associated with intrapartum cesarean birth included having four or more antenatal visits (AOR 0.60; 95% CI: 0.43–0.84; p = 0.003), delivering in a medium- or high-human development index country (vs. low-human development index country: AOR 0.07; 95% CI: 0.01–0.85 and AOR 0.02; 95% CI: 0.001–0.39, respectively; p = 0.03), and malpresentation (vs. cephalic: breech AOR 0.52; CI: 0.31–0.87; p = 0.04). Women who were medically high risk (vs. not medically high risk: AOR 1.81; CI: 1.30–2.51, p < 0.0004), had less education (0–6 years) (vs. 13+ years; AOR 1.64; CI: 1.03–2.63; p = 0.01), were obstetrically high risk (vs. not high risk; AOR 3.67; CI: 2.58–5.23; p < 0.0001), or had a maternal or obstetric indication (vs. elective: AOR 4.74; CI: 2.36–9.50; p < 0.0001) had increased odds of the adverse outcome.ConclusionWe found reduced adverse maternal outcomes of intrapartum cesarean birth in women with ≥ 4 antenatal visits, those who delivered in a medium or high human development index country, and those with malpresenting fetuses. Maternal adverse outcomes associated with intrapartum cesarean birth were medically and obstetrically high risk women, those with less education, and those with a maternal or obstetric indication for intrapartum cesarean birth.

Profiles of Active Transportation among Children and Adolescents in the Global Matrix 3.0 Initiative: A 49-Country Comparison.

This article aims to compare the prevalence of active transportation among children and adolescents from 49 countries at different levels of development. The data was extracted from the Report Cards on Physical Activity for Children and Youth from the 49 countries that participated in the Global Matrix 3.0 initiative. Descriptive statistics and a latent profile analysis with active transportation, Human Development Index and Gini index as latent variables were conducted. The global average grade was a “C”, indicating that countries are succeeding with about half of children and youth (47–53%). There is wide variability in the prevalence and in the definition of active transportation globally. Three different profiles of countries were identified based on active transportation grades, Human Development Index (HDI) and income inequalities. The first profile grouped very high HDI countries with low prevalence of active transport and low inequalities. The second profile grouped low and middle HDI countries with high prevalence of active transportation and higher inequalities. And the third profile was characterized by the relatively high prevalence of active transportation and more variability in the socioeconomic variables. Promising policies from countries under each profile were identified. A unified definition of active transportation and contextualized methods for its assessment are needed to advance in surveillance and practice.