High-income Countries Research Articles

Unit Costs of Opioid Agonist Therapy (OAT): A Global Systematic review and cost Extrapolation.

People who inject drugs (PWID) face elevated risks of HIV and viral hepatitis transmission. Opioid agonist therapy (OAT) like methadone and buprenorphine reduce drug-related harms and improve health outcomes among PWID. Despite effectiveness, global OAT coverage remains suboptimal. This study estimated the global unit cost of OAT provision to inform resource allocation and scale-up of harm reduction services. We conducted a systematic review to identify cost estimates of OAT provision and cost drivers. Data were extracted from peer-reviewed and grey literature sources. Mixed-effects multivariable regression models, incorporating country-level and program-level covariates, were developed to predict OAT unit costs. The best performing model was used to extrapolate the monthly per person costs of providing OAT in 210 countries. We identified 175 cost estimates across 32 countries. Most estimates were from high-income countries. Higher unit costs were associated with higher country log GDP per capita, more program components, and inclusion of ancillary services in the cost estimations. The best-performing model predicted cost within 95% prediction intervals for 27 out of 32 countries when using the full dataset. The study highlights the scarcity of OAT cost data, particularly in low-income countries, and underscores the need for more research in diverse settings to improve the accuracy and generalizability of cost estimates. This study provides estimates of OAT unit costs, offering insights for policymakers to optimize resource allocation and expand harm reduction efforts.

Economic and geographical disparities in global contribution to open access publishing in anaesthesiology: A bibliometric analysis

Background and Aims: Open access (OA) publishing improved the reach of scientific discoveries, particularly among researchers in lower-income countries. However, OA publishing still has a global imbalance. This bibliometric analysis evaluates anaesthesia OA journals to explore geographical and economic disparities in publication volume. Methods: We queried the Directory of Open Access Journals for OA anaesthesia-related journals between 2014 and 2024. Data from the included journals were analysed using Scopus, from which we extracted the year of publication and the corresponding author’s affiliation. Additional metrics were obtained from each journal website. Countries were then categorised by income level and geographical region. Results: Thirty-four anaesthesiology OA journals were analysed, encompassing 27,634 publications from 120 countries. The leading contributors were India (23.96%), the USA (14.98%) and China (6.54%). Low-income countries accounted for 0.37% of total publications, followed by upper-middle-income (17.97%), lower-middle-income (29.07%), and high-income (52.54%) countries. The geographical distribution of publication volume was as follows: Southeast Asia (25.38%), Europe (23.18%), Western Pacific (18.92%), Americas (23.91%), Eastern Mediterranean (8.03%) and Africa (0.59%). Nineteen journals required a mean article processing charge (APC) of US $2,164.89, accounting for 51.89% of the total publications. India ranked first in non-APC journals, while the USA led in APC journals . Conclusion: While OA publishing enhances accessibility for readers, it still presents challenges for authors, particularly in economically disadvantaged countries. Significant geographical and economic disparities exist in OA publication volume, likely due to limited investment and structural barriers in lower-income countries.

Dissolving contradictory demands: A systematic review of alcohol use of working mothers.

Working mothers perform 'double shifts' of paid and domestic labour. Increased rates of employment among mothers in high income countries, and the impact of the alcohol industry actively promoting alcohol to working mothers, makes it crucial for preventative efforts to understand the factors driving alcohol use among this population. This systematic review of qualitative and quantitative studies provides an overview of the drinking patterns of working mothers and their predictors. Four databases were systematically searched in August 2024. The population of interest were adult women in high income countries, who were both mothers of at least one dependent child and employed in any capacity. The methodological quality was assessed using the Mixed Methods Appraisal Tool. Following a convergent integrated approach, narrative synthesis was conducted for all studies. Of the 4623 records maintained for screening, 22 articles (15 quantitative and 7 qualitative) were included. Working mothers were more often drinkers and consumed a higher quantity per occasion (including binge and risky drinking) in comparison to mid-life women and non-working mothers. Alcohol use was also linked to managing emotional states, as a commodity to 'cope' with gendered norms. Living in a society with increased gender equity and being partnered or married had a protective effect on heavy drinking and consumed quantity. Working mother's drinking is governed by gender norms and expectations, and countries who advance policies to improve the acceptability and compatibility of motherhood and employment may reduce working mother's alcohol use.

Narrative review of clinical prediction models for paediatric community acquired pneumonia.

Narrative review of clinical prediction models for paediatric community acquired pneumonia.

Forecasting incidence and mortality rates of bladder cancer in older adults using autoregressive integrated moving average (ARIMA).

e16615 Background: Bladder cancer remains a significant global health burden, particularly in older adults, with its incidence and mortality varying widely across regions. The median age at diagnosis of bladder is 73 years with 80% over the age of 65 in United States. Age of patients can impact management often requiring a multidisciplinary approach. Methods: Incidence rates for individuals aged 70+ across seven superregions (Central, Eastern Europe and Central Asia, High-income countries, North Africa and Middle East, Latin America and Carribean, South Asia, Sub-Saharan Africa, Southeast, East Asia and Oceania) were extracted from the 2021 Global Burden of Disease (GBD) database and analyzed using ARIMA in Stata 18.0 to forecast rates from 2022–2050. Mortality rates were forecasted using the GBD foresight visualization tool. Percentage changes in incidence and mortality compared to 2021 were calculated and analyzed. Results: Bladder cancer incidence rates are projected to increase in North Africa and the Middle East (+6.8% by 2030, +23.0% by 2050), Southeast Asia, East Asia, and Oceania (+5.2% by 2030, +17.0% by 2050), South Asia (+2.0% by 2030, +7.3% by 2050), Latin America and the Caribbean (+1.6% by 2030, +5.2% by 2050), and Sub-Saharan Africa (+1.8% by 2030, +6.5% by 2050). In contrast, High-Income Regions and Central Europe, Eastern Europe, and Central Asia are expected to decline, with High-Income Regions showing the steepest decrease (-10.6% by 2030, -52.0% by 2050). Mortality rates are projected to rise in High-Income Regions (+3.6% by 2030, +18.8% by 2050) andCentral Europe, Eastern Europe, and Central Asia (+3.6% by 2050, despite a -0.9% drop by 2030). Declines by 2030 are anticipated in Latin America and the Caribbean (-2.9%), North Africa and the Middle East (-4.5%), Southeast Asia, East Asia, and Oceania (-3.0%), and Sub-Saharan Africa (-2.9%), though many regions show stabilization or modest increases by 2050, such as South Asia (+7.0%) and Southeast Asia, East Asia, and Oceania (+12.4%). Conclusions: The study underscores the need for greater emphasis on regions in Asia and Africa expected to see an increase in incidence rates. The increase in mortality in many regions call for greater research in geriatric oncology and targeted interventions in older adults. Incidence rate (per 100,000 population) Mortality rates (per 100,000 population) Region 2021 2030 2050 2021 2030 2050 Central Europe, Eastern Europe, and Central Asia 64.99 61.28 57.28 39.78 39.41 41.22 High-income countries 110.38 98.67 53.03 48.40 50.13 57.49 Latin America and Caribbean 29.84 30.31 31.38 22.34 21.69 22.31 North Africa and Middle East 68.04 72.69 83.69 34.90 33.33 35.24 South Asia 18.75 19.14 20.13 15.39 15.26 16.47 Southeast Asia, East Asia and Oceania 40.60 42.71 47.49 24.02 23.30 27.01 Sub-Saharan Africa 26.57 27.06 28.31 23.64 22.96 22.90

Global trends in soft tissue and extraosseous sarcomas (1980–2021): Regional and economic disparities.

e23509 Background: Sarcoma is one of the rare malignancies arising from bone or soft tissues, shares a incidence of 1% of all cancers across the world. This study analyzes data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to examine trends and provide a detailed outlook on its global trajectory. Methods: Data was extracted from the GBD 2021 database, focusing on age-standardized death rates (ASDR), Disability Adjusted Life Years (DALYs) and incidence of sarcoma. Analytics conducted using join point regression to determine average annual percentage changes (AAPC). Results: Globally, ASDR for soft tissue and extraosseous sarcomas have continuously declined from 1980-2021. In 1980, the ASDR was 0.77(95% UI: 0.65-0.91) and it declined to 0.60 (AAPC: -0.602; 95% UI: -0.67, -0.53, P<0.001) in 2021. Globally, DALYs rate was 27.4(95% UI: 22.61-33.29) per 100,000 people in 1990 and it decreased to 20.54 (AAPC: -0.0936; 95% CI: -1.02, -0.085, P<0.001) in 2021. The Incidence rate was 27.4(95% UI: 22.61-33.29) in 1990 that decreased to 20.54 (AAPC: -0.131; 95% CI: -0.25 to -0.003, P=0.04) in 2021. Globally, DALYs rate was 27.4(95% UI: 22.61,33.29) per 100,000 people in 1990 and it decreased to 20.54 (AAPC: -.0936; 95% CI: -1.02-to -0.085, P<0.001) in 2021. In geographical analysis, America, Africa and Asia had uniformly declining ASDRs while Europe had a steady rise in ASDR. From 1980 to 2021, America had decreasing death rates with an AAPC of -0.243 (95% CI: -0.48, -0.0050; P=0.04) and nonsignificant decreasing incidence rates with an AAPC of -0.022(95% CI: -0.21, 0.16). Africa and Asia also had declining death rates with AAPC of -0.734 (95% CI: -0.81, -0.65; P<0.001) and AAPC of -1.13 (95%CI: -1.21, -1.06; P<0.01) respectively. Conversely Europe had an increasing trend both in death and incidence rate, with death rate AAPC of 0.33 (95%CI: 0.12,0.55; P<0.001). Per World Bank income levels, high-income countries saw a slight increase in death rates, while others declined. Conclusions: The results show a steady decline in ASDR, DALY and incidence rates from 1980 to 2021. However, regional disparities show declining ASDR in America, Asia, and Africa, while Europe saw a steady rise. Similarly, death rates slightly increased in high-income countries, while lower-income groups saw declines. Sarcoma death rates compared between 1980 and 2021. Location Year Rate Upper Lower Global 1980 0.77 0.90 0.65 2021 0.60 0.73 0.51 America 1980 0.96 1.00 0.93 2021 0.87 0.91 0.81 Europe 1980 0.70 0.74 0.67 2021 0.80 0.85 0.74 Asia 1980 0.67 0.83 0.46 2021 0.42 0.57 0.32 Africa 1980 1.12 1.64 0.89 2021 0.83 1.24 0.64

Telehealth use in the well-child health setting. A systematic review of acceptability and effectiveness for families and practitioners.

Telehealth use in the well-child health setting. A systematic review of acceptability and effectiveness for families and practitioners.

Comparative trends in brain and CNS cancer across high-income countries: A benchmarking study (1990-2021).

e22504 Background: Brain and central nervous system (CNS) cancer poses a significant public health challenge, particularly in high-income countries (HIC) where aging populations and advanced diagnostic capabilities contribute to rising incidence rates. Despite improvements in treatment, the disease remains associated with high morbidity and mortality, necessitating ongoing research into its epidemiological trends, risk factors, and healthcare disparities to inform targeted interventions. Methods: We estimated incidence, prevalence, deaths, and disability adjusted life years (DALYs) due to brain and CNS cancer by age, sex, year and location across the HIC from 1990-2021 using global burden of disease study 2021 standardized tool. Results: The total prevalence count of brain and CNS cancer increased from 189,483 (185,084-193,201) in 1990 to 371,604 (351,197-387,196) in 2021. The number of deaths rose from 40,918 (39,726-41,750) in 1990 to 66,574 (62,329-69,082) in 2021, while the total DALYs increased from 1.3 (1.3-1.4) million to 1.8 (1.7-1.9) million over the same period. The highest annual percentage change (APC) in total prevalence count was observed in High-income Asia Pacific (4.34%), Southern Latin America (3.26%), and Australasia (2.04%). In terms of mortality, the highest APC was recorded in Southern Latin America (2.56%), High-income Asia Pacific (2.48%), and Australasia (1.84%) between 1990 and 2021. At the national level, the highest APC in age-standardized incidence rate (ASIR) was observed in Chile (2.4%), followed by Singapore (2.03%) and Japan (1.92%). Regarding the age-standardized mortality rate (ASMR), the highest APC was recorded in Chile (1.9%), Japan (1.42%), Switzerland (0.97%), and Monaco (0.92%) from 1990 to 2021. Age-wise, the highest incidence count in 2021 was observed in individuals aged 70-74 years, with 13,052 cases (12,088-13,748). The highest number of deaths occurred in the same age group, with 9,749 deaths (9,091-10,165). The greatest burden of DALYs was recorded in individuals aged 60-64 years, reaching 228,721 (220,464-235,397) in 2021. Conclusions: The global burden of brain and CNS cancer has significantly increased from 1990 to 2021, with a notable rise in prevalence, deaths, and DALYs. The highest growth rates were observed in High-income Asia Pacific, Southern Latin America, and Australasia, with Chile, Singapore, and Japan experiencing the steepest national increases in incidence. The disease burden was most pronounced in older age groups, highlighting the need for targeted interventions and improved healthcare strategies to mitigate its impact.

Regional variations in cleft lip and palate repair techniques: A mixed-methods study of international volunteer surgeons.

Regional variations in cleft lip and palate repair techniques: A mixed-methods study of international volunteer surgeons.

Residential indoor temperatures and health: A scoping review of observational studies.

Residential indoor temperatures and health: A scoping review of observational studies.

What are the policy options for regulating private equity involvement in health care? A review of policies implemented or considered in seven high-income countries.

What are the policy options for regulating private equity involvement in health care? A review of policies implemented or considered in seven high-income countries.

Social determinants of where people die: A study of moderators and mediators using linked UK Census and mortality data.

Social determinants of where people die: A study of moderators and mediators using linked UK Census and mortality data.

An overview of reviews of breastfeeding barriers and facilitators: Analyzing global research trends and hotspots.

Breastfeeding is the most cost-effective intervention for reducing infant morbidity and mortality, offering benefits for infants and mothers. Despite extensive promotion, global adherence remains below 50%, resulting in significant clinical, economic, and environmental impacts. Thus, this overview of reviews aims to synthesize barriers and facilitators of breastfeeding, analyze research trends, and identify gaps to guide future research. A comprehensive literature search was conducted, including systematic reviews that examine these factors. The search covered seven electronic data repositories. The methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Bibliometric analysis focused on identifying top journals, authors, and countries, assessing their impact, and exploring trends over time. Findings were classified and analyzed thematically through line-by-line coding, theme description, and analytical formulation. A total of 123 reviews were included, mostly of high quality and published in top journals. Key trends comprised a growing focus on psychosocial and cultural factors, increased representation from low- and middle-income countries, and improved methodological rigor. However, geographical representation remains biased towards high-income countries, and some breastfeeding outcomes need further exploration. Thematic analysis revealed four categories: Therapeutic and care interventions; Support networks and education; Maternal-infant health issues; and Societal and environmental context. In conclusion, this overview of reviews identifies barriers and facilitators of breastfeeding and emphasizes the need for more inclusive research and tailored support. Addressing gaps in evidence for enhancing healthcare systems and policies can improve breastfeeding practices and outcomes worldwide.

Genomic epidemiology of third-generation cephalosporin-resistant Escherichia coli from companion animals and human infections in Europe.

In high-income countries, dogs and cats are often considered members of the family. Because of this proximity, it has been suggested that pets and humans might exchange bacterial species from their gut microbiota, with multidrug resistant bacteria being of particular concern. The aim of this study was to compare the genomes of third-generation cephalosporin-resistant (3GC-R) Escherichia coli responsible for human and pet infections in Europe. Whole-genome sequencing data from 3GC-R E. coli isolated from clinical samples of humans, dogs and cats, and published in eight European studies were re-analyzed using bioinformatics tools. The acquired genes responsible for 3GC-R were identified. The sequence type (ST) of all genomes were assessed by multilocus sequence typing. Alpha and beta diversities were measured within and between the two populations. We included genomes of 1327 3GC-R E. coli isolated from humans and animals with 109 (8.2%) being responsible for infections in dogs and cat, and 1218 (91.8%) responsible for human infections. Alpha diversity analysis suggested greater diversity within ST and 3GC-R genes in the animal population. Beta diversity analysis by principal coordinate analysis separated animal and human strains. ST131 was more abundant in human strains (43.4%) than in animal strains (14.7%) (p<0.001). Six STs, including ST372, were identified almost exclusively in 3GC-R E. coli from animal origin. The bla CTX-M-15 gene was more frequent in humans (49.24%) than in companion animals (17.9%) (p<0.001). The resistance genes bla CMY-2 (30.8%) and bla CTX-M-1 (15.4%) were more frequent in E. coli isolated from pets (p<0.001). We found that populations of 3GC-R E. coli responsible for human and pet infections in Europe do not overlap. Although it cannot rule out occasional transmission of bacteria between pets and humans within a household, it suggests that dogs and cats are not a major source of human infection with this antibiotic-resistant pathogen.

Multimodal strategies for the implementation of infection prevention and control interventions-update of a systematic review for the WHO guidelines on core components of infection prevention and control programmes at the facility level.

Health care-associated infections (HAIs) remain a significant challenge worldwide, and the use of multimodal strategies is recommended by the WHO to enhance infection prevention. To update the systematic review on facility level infection prevention and control interventions on the WHO core component of using multimodal strategies. Data sources: Medline (by PubMed), EMBASE, CINAHL, and the Cochrane library. Randomized controlled studies, interrupted time series, and before-after studies in acute care settings, from November 24, 2015 to June 30, 2023. Both paediatric and adult populations. Infection prevention and control interventions implemented with at least three WHO multimodality elements. Assessment of risk of bias: Effective practice and organisation of care and integrated quality criteria for review of multiple study designs tools. Methods of data synthesis: Descriptive data synthesis. Of 5678 identified titles and abstracts, 32 publications were eligible for data extraction and analysis. Five non-controlled before-after studies were excluded due to an insufficient integrated quality criteria for review of multiple study designs score. Of the remaining 27 studies, nine reported on the effect of multimodal strategies to reduce device-associated HAIs, four on surgical site infections, eight on infections due to antimicrobial resistance and six on hand hygiene (HH) compliance. Eleven were controlled studies (randomized controlled studies or controlled before-after studies), nine interrupted time series and seven non-controlled before-after studies. Twenty-two of the studies originated from high-income countries, and the overall quality was medium to low. Twenty studies showed either significant HAI reductions or HH improvement. Most studies demonstrate a significant effect on HAI prevention and HH improvement after applying a multimodal strategy. However, the quality of evidence remains low to moderate, with few studies from low-income or middle-income countries. Future research should focus on higher quality studies in resource limited settings.

Do Indonesian midwifery-led birth units provide safe, accessible care? A secondary analysis of demographic health survey cross-sectional data.

Do Indonesian midwifery-led birth units provide safe, accessible care? A secondary analysis of demographic health survey cross-sectional data.

Loneliness and cognitive function in older adults living in Latin America: A systematic review.

Loneliness and cognitive function in older adults living in Latin America: A systematic review.

Migration and Women's Health Research (2000-2023): A bibliometric analysis of trends and gaps.

This bibliometric study examines the scholarly landscape of migration and women's health, analyzing 1314 Scopus-indexed articles from 462 journals published between 2000 and 2023. Findings indicate a consistent increase in research output, reflecting growing global interest in this interdisciplinary field. Geographically, high-income countries (HICs), including the United States, Canada, the United Kingdom, and Australia, dominate contributions, while low- and middle-income countries (LMICs) remain underrepresented despite hosting significant migrant populations. International collaborations play a crucial role, with key institutions such as the University of California and the London School of Hygiene and Tropical Medicine shaping research efforts. The keyword co-occurrence analysis highlights migration, gender dynamics, mental health, and reproductive health as dominant themes. Persistent gaps in mental and reproductive healthcare access for migrant women emphasize the need for trauma-informed care (TIC), mobile bilingual healthcare services, and inclusive health policies. Disparities in research funding further exacerbate global health inequities, underscoring the necessity of equitable redistribution of resources, including redirecting at least 10% of HIC research grants to LMIC-led studies. The COVID-19 pandemic magnified pre-existing vulnerabilities, stressing the importance of multilateral collaborations and sustainable policy interventions to enhance migrant healthcare access. This study provides valuable insights into research trends, collaboration networks, and thematic focus areas, offering a foundation for future interdisciplinary research and evidence-based policymaking aimed at promoting health equity for migrant women globally.

Updates in Treatment of Hypoxic-Ischemic Encephalopathy.

Updates in Treatment of Hypoxic-Ischemic Encephalopathy.

Is this time different? Impact of AI in output, employment and inequality across low, middle and high-income countries

Is this time different? Impact of AI in output, employment and inequality across low, middle and high-income countries