Middle-income Latin American Countries Research Articles

Energy efficiency in middle-income countries with DEA: An approach for Latin America

Latin America and Caribbean countries are focused on meeting their 2030 sustainable development goals, with the promotion of actions that increase energy efficiency being a key pillar. Recent studies have applied various data envelopment analysis (DEA) models to this end, but few include Latin American countries. This study assesses energy efficiency in 18 middle-income Latin American countries from 2008 to 2019 using two super-efficient DEA radial models that are particularly adept at distinguishing between highly efficient units. The analysis incorporates a broader set of countries through clustering techniques to ensure homogeneity. From this analysis, the production function, the technical efficiency, the total energy efficiency factor and their respective correlation coefficients versus the per capita income variable are obtained for each country. Costa Rica and Argentina stand out among the Latin American middle-income countries with the highest energy efficiency within quintile Q1 and Q2, whereas Paraguay and Chile obtain the lowest efficiency within quintile Q5 and Q3. For the 18 countries studied, a higher level of income is not significantly related to a higher level of energy efficiency. This study provides policymakers an alternative indicator for effective monitoring of energy efficiency.

Marshallian and Jacobian externalities in creative industries: Evidence from Chile

Most papers on creative industries ask whether they are a source of Marshallian or Jacobian effects, inasmuch as a stronger creative sector is a direction of diversification that could have positive spillovers onto the rest of the economy. While most works have focused on developed economies, I contribute evidence from a middle-income Latin American country and study both creative occupations and creative sectors. I find that specialisation in creative sectors is associated with higher sales and a larger number of firms in those sectors, albeit at a decreasing rate. A similar relationship is found between specialisation in creative occupations and the income of those workers. I find no evidence of effects of creative specialisation on other sectors.

Clinical predictors for mechanical ventilation assistance in Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) frequently leads to respiratory failure and autonomic dysfunction, resulting in approximately one-third of patients requiring mechanical ventilation. This study aimed to identify clinical predictors for mechanical ventilation in patients with GBS. This research was conducted from 2010 to 2021 using registries from a tertiary hospital in an upper middle-income Latin American country. Participants were categorized into two groups based on their ventilation status. Demographic data were collected, and independent predictors of the need for mechanical ventilation were determined through multivariate logistic regression analysis. Dysautonomic events occurred in 36% of the patients, with 17% requiring mechanical ventilation; the average duration of intubation was 1.16 ± 3.18 days. The multivariate analysis indicated that bulbar dysfunction significantly increased the likelihood of requiring mechanical ventilation by 19-fold (OR 18.67, 95% CI 5.85-59.42), followed by ophthalmoplegia, which increased the likelihood by sixfold (OR 5.68, 95% CI 1.28-25.19). Bulbar dysfunction, dysautonomia, and lower Medical Research Council (MRC) scores were significant predictors of the need for mechanical ventilation in hospitalized GBS patients. These findings support the need for close monitoring and early admission to the intensive care unit (ICU) admission for at-risk patients.

Risk factors for COVID-19 in-hospital mortality in Argentina: A competing risk survival analysis.

COVID-19 poses dire threats for low and middle-income countries (LMICs). Yet, there remains limited rigorous evidence describing the characteristics and outcomes of hospitalized patients for LMICs, and often the evidence was based on small samples and/or unicentric. The objective of this study was to examine risk factors of COVID-19 mortality in Argentina, a hard-hit middle-income Latin American country. We analyze data on 5,146 COVID-19 patients from 11 centers across 10 cities in Argentina, making this one of the largest multi-centric retrospective observational descriptive studies in the LMICs. Information on demographics and co-morbidities was extracted from medical records. Outcomes of relevance consisted of whether the patient was discharged or deceased (as established in medical records), along with date of each event. We use survival models that account for competing risks. Median age was 60 years (IQR: 48-72), there were fewer women (40.8%) hospitalized than men (59.2%), and the most prevalent comorbidities were hypertension (40.9%), diabetes (20.0%) and obesity (19.1%). Patients were hospitalized for a median duration of 8 days (IQR: 5-13), and in-hospital mortality was 18.1%, though it varied substantially across health centers (95%CI: 17.1%-19.2%). Baseline characteristics most associated with in-hospital mortality were respiratory rate (adjusted HR = 3.6, 95%CI: 2.5-5.4 for ≥ 26 breathes/min), older age (adjusted HR = 2.5, 95%CI: 2.0-3.3 for the 80+ age group), and chronic kidney disease (adjusted HR = 2.2, 95%CI: 1.8-2.8). Associations were attenuated when survival models did not account for the competing risk of being discharged. We document lower mortality rates than those in prior studies, likely due to a lower prevalence of comorbidities amongst patients in our sample. Compared with standard Cox models, we find that, when using competing risk models, risk factors have a larger role in explaining COVID-19 mortality. Overall, we provide rigorous evidence describing the characteristics and outcomes of hospitalized patients for LMICs. Thus, our findings are useful to conduct a more accurate in-hospital monitoring of patient subgroups who may be at greater risk. They also provide valuable guidance for public health and policy efforts in Argentina and other developing countries.

Fear of COVID-19, risk perception and preventive behavior in health workers: a cross-sectional analysis in middle-income Latin American countries.

The aim of this study was to examine the association between fear of COVID-19 and risk perception with preventive behavior in health professionals from four Latin American countries. An analytical cross-sectional study was conducted. Health professionals with on-site care in Colombia, Ecuador, Guatemala, and Peru were surveyed. Information was collected through an online self-report questionnaire. The main variables were preventive behavior as the dependent variable and fear of COVID-19 and risk perception as independent variables. Linear regression was used, and unstandardized beta coefficient and value of ps were calculated. Four hundred and thirty-five health professionals were included, the majority were aged 42 years or older (45.29, 95%CI: 40.65-50.01) and female (67.82, 95%CI: 63.27-72.05). It was shown that the greater the fear of COVID-19, the greater the preventive behavior of COVID-19 infection (B = 2.21, p = 0.002 for total behavior; B = 1.12, p = 0.037 for additional protection at work; B = 1.11, p < 0.010 for hand washing). The risk perception of COVID-19 infection had a slight direct relationship with preventive behaviours (B = 0.28, p = 0.021 for total behavior; B = 0.13, p = 0.015 for hand washing), with the exception of the preventive behavior of using additional protection at work (p = 0.339). We found that fear and risk perception are associated with increased practice of hand washing and use of additional protection at work. Further studies are required on the influence of working conditions, job performance and the occurrence of mental health problems in frontline personnel with regard to COVID-19.

Policy evaluations of microenterprise business support services in Latin America: A systematic review

Microenterprises represent 88.4 % of Latin American enterprises, and many countries in the region have developed microenterprise promotion policies in recent years; however, rigorous evaluation remains a pending issue. To shed light on the research done on this topic over the last 20 years and propose a roadmap for the policy evaluation of microenterprise business support services and the development of microenterprise indicators, this work conducts a systematic review, following the PRISMA guidelines, of peer-reviewed journal articles examining the impact of business support services on microenterprise performance in low- and middle-income Latin American countries. We identified 679 studies, and 17 studies met the inclusion criteria. We found that the literature is surprisingly scarce; most studies focus on credits and impacts on financial performance and concentrate on Mexico; and only three articles involve randomised controlled trials. Our results have important implications for policymakers and future research.

Systemic amyloidosis journey from diagnosis to outcomes: a twelve-year real-world experience of a single center in a middle-income country

BackgroundSystemic amyloidosis is caused by the deposition of misfolded protein aggregates in tissues, leading to progressive organ dysfunction and death. Epidemiological studies originate predominantly from high-income countries, with few data from Latin America. Due to the non-specific clinical manifestations, diagnosing amyloidosis is often challenging and patients experience a long journey and delay in diagnosis. This study aimed to assess clinical and laboratory characteristics, the diagnostic journey, and outcomes of patients with biopsy-proven systemic amyloidosis diagnosed between 2009 and 2020 at a university referral center in a middle-income Latin American country. Patients´ medical records were retrospectively reviewed.ResultsOne hundred and forty-three patients were included. The median age at diagnosis was 60 years and 54% were male. Until the diagnosis, most of the patients (52%) were seen by at least 3 specialists, the main ones being: general practitioners (57%), nephrologists (45%), and cardiologists (38%). The most common manifestations were renal (54%) and cardiac (41%) disorders, and cachexia was seen in 36% of patients. In 72% of the cases, ≥ 2 biopsies were required until the final diagnosis. The median time from symptoms onset to diagnosis was 10.9 months, and most patients (75%) had ≥ 2 organs involved. The following subtypes were identified: AL (68%), ATTR (13%), AA (8%), AFib (4%), and inconclusive (7%). Median OS was 74.3 months in the non-AL subgroup and 18.5 months in AL. Among AL patients, those with advanced cardiac stage had the worst outcome [median OS 8.6 months versus 52.3 for stage III versus I–II, respectively (p < 0.001)]. AL subtype, cardiac involvement, and ECOG ≥ 2 were identified as independent risk factors for reduced survival.ConclusionsSystemic amyloidosis is still an underdiagnosed condition and the delay in its recognition leads to poor outcomes. Medical education, better diagnostic tools, improvement in access to therapies, and establishment of referral centers may improve patient outcomes in middle-income countries.

Burden of skin cancer in Colombia

Levels of incidence and mortality of skin cancer in Colombia and Latin America are largely unknown. Present the available information from official and gray literature and governmental databases to grasp the magnitude and characteristics of skin cancer in Colombia (middle-income Latin American country). Narrative review based on a literature search (2005-2020), gray literature and cancer registry and governmental warehouse data, calculation of proportions and age-standardized incidence (ASIR) and mortality rates (ASMR), expressed per 100,000 person-years. ASIR of cutaneous melanoma in Colombia is around 3, corresponding ASMR between 0.7 and 0.8. Distinctive features are the high proportion and rates for acral melanomas, and the advanced stage at diagnosis in the general population but not in private clinics. For non-melanoma skin cancer, ASIR is at least around 35-40, ASMR 0.8. Among the wealthy Colombians, melanoma features are similar to those of high incidence countries (but of lower magnitude), whereas the majority of the population present distinct features with a much higher proportion of acral melanomas, very late stages at diagnosis, and poor prognosis. More advanced melanomas seem to have a relation with lower socioeconomic status. Non-melanoma skin cancer is common, with very high mortality rates at levels even above those of predominantly fair-skinned populations, implying high fatality rates for non-melanoma skin cancers. This could indicate a late diagnosis or difficulties in access to treatment, illustrating the need for primary and secondary prevention to reduce the burden of disease and improve the prognosis of this common cancer.

CALMA, a Mobile Health Application, as an Accessory to Therapy for Reduction of Suicidal and Non-Suicidal Self-Injured Behaviors: A Pilot Cluster Randomized Controlled Trial

The present study was aim to evaluate the acceptability and preliminary effectiveness of a mobile-health application, CALMA, based on dialectical behavioral therapy skills. CALMA was proposed as an adjunct to therapy for the reduction of non-suicidal and suicidal self-injury behaviors. A parallel design was used to compare the intervention group (DBT + CALMA) and the comparison group (DBT). Patients were randomized based on their groups following a randomized cluster design. After treatment, patients completed a follow-up assessment four weeks later. Each cluster was represented by a different DBT Skills Training Group offered weekly at FORO Foundation for Mental Health. Six DBT Skills Training groups were randomized to the intervention or comparison group. Twenty-one individuals met inclusion criteria and eighteen were included in the analysis. Acceptability was measured with the User Experience Questionnaire short version (UEQ-s) and preliminary efficacy with the Self-injurious thoughts and behaviors interview (SITBI). CALMA shows good acceptability to be used as an adjunct to therapy specific to the reduction of suicidal and non-suicidal self-directed violence. Evidence for preliminary efficacy included a high probability of decreased in more behaviors evaluated with the SITBI pre- and post-intervention for the group that received CALMA as compared to the comparison group. Our study provides initial evidence for the effectiveness and acceptability of CALMA. Future studies scaling up this intervention in a larger number of participants are necessary. CALMA may be especially useful in low and middle-income Latin American countries to improve access to evidence-based interventions openly available in Spanish and free to download. Highlights CALMA is a DBT-based app aimed to reduce non-suicidal and suicidal self-directed violence. The app showed good acceptability by users A high probability of decrease in suicidal ideation, suicidal plan, suicidal gesture, thoughts about NSSI and NSSI pre- and post-intervention was observed

The Latin American and Nigerian Conditional Cash Transfer Experience: A Comparative Analysis

Despite the recent economic growth in Nigeria, poverty remains a social problem. One of the strategies employed by the Nigerian government and some development partners towards solving this problem is the deployment of social protection instruments, such as Conditional Cash Transfers (CCTs), which aim at stemming the tide of poverty and vulnerability. This study uses the secondary research method to examine the extent to which the Latin American CCT model influenced the design and operation of the Nigerian CCT programme. The policy diffusion model adopted for the study posits that the success of CCT programmes in Latin America has stimulated its extension to many developing countries outside the region. The findings from the review of selected literature explain the rationale for CCTs as short-term poverty reduction and long-term human capital development. Admittedly, a nexus exists between the Latin American and Nigerian strategies. Yet the study concludes that the Latin American model cannot adequately serve as a blueprint for the Nigeria strategy, given that underlying conditions in upper middle-income Latin American countries are clearly different from those present in low income or lower middle-income African countries like Nigeria. The study recommends urgent implementation of the National Social Protection Policy; a review of the current CCT programme in Nigeria every two years and extensive research into social protection strategies.

The biohabitus of scarcity: bio-social dispositions and the "obesity epidemic" in Mexico.

In this article, we explore the potential of Warin etal.'s concept of biohabitus (a set of embodied biological and social dispositions) as a conceptual tool for the understanding of mechanisms behind the "obesity epidemic." Elaborating on this concept, we argue that a context of food scarcity gives rise to a biohabitus geared to energy-saving, expressed in both biological (the thrifty genotype/phenotype hypotheses) and symbolic dispositions (Bourdieu's "taste of necessity"), and the interaction between this type of biohabitus and changes in the food-related environment results in increased body mass index. We exemplify the use of this framework by applying it to the case of Mexico, a middle-income Latin American country with one of the highest prevalences of obesity worldwide. The example shows how the concept of biohabitus can help researchers move beyond disciplinary explanations, towards a more complex understanding of the conjunction of social and biological processes that result in differential patterns of health and disease.

Alcohol marketing policy and advertising exposure in low and middle income Latin American countries

While it is presumed that alcohol marketing policies decrease adolescent exposure to alcohol advertising, scientific literature on the topic is sparse. The current study sought to determine if alcohol marketing policy strength in the World Health Organization’s (WHO) region of the Americas was associated with adolescent alcohol ad exposure. A secondary analysis was conducted using data from the Global School-based Health Survey and the WHO’s Global Information System on Alcohol and Health . Linear regression was used, and the analysis included country-level (i.e. other alcohol policies, human development index (HDI), pattern of drinking score (PDS)) and individual-level (i.e. participant age, sex, socioeconomic status (SES), lifetime drinking status) covariates. Among 47,195 adolescents, 11–16 years old, from 13 countries, marketing policy strength was inversely associated with alcohol ad exposure (β (95% confidence interval (CI)) = −0.82 (−0.96, −0.68), p < .001). Other alcohol control measures, HDI, PDS, and participant SES were also inversely associated with exposure (p’s < .001). As presumed, alcohol marketing policies may reduce adolescent exposure to alcohol advertising, and countries should consider including strong marketing restrictions, or complete marketing bans, when implementing alcohol control policies in their effort to meet the sustainable development goals.

Psychiatric disorders in children and adolescents in a middle-income Latin American country

BackgroundChild and adolescent mental health has scarcely been studied in developing countries, though it is an important aspect of health. Mental health problems in youth often continue into adulthood if not diagnosed or treated in time.MethodsThe Sistema de Evaluación de Niños y Adolescentes (SENA) [Child and Adolescent Evaluation System] was used to evaluate mental health indicators in a sample of students in Northern Chile. Two age-appropriate versions of the assessment were applied to a total sample of 5043 students, which included an elementary education sample of 1953 schoolchildren from fourth grade through sixth grade (ages 8 to 13 years), and a Secondary School sample of 3090 schoolchildren from seventh grade (the last year of elementary school) through the last year of Secondary school (senior high school) (ages 12 to 19 years). For each group, the version of the assessment used was determined by the students’ grade level. Both samples included municipal, government-subsidized, and private schools.ResultsIn this student population, depression, anxiety, and behavioral disorders were the main mental health problems identified, and indicators revealed a progressive increase in cases over the years, coinciding with the global epidemiological scenario. Males showed a greater presence of externalizing behaviors related to mental health problems associated with aggression and defiant behavior. However, females showed the highest number of mental health issues overall, especially regarding problems related to internalization. There are significant differences between school types.ConclusionsOur sample population analysis indicates that early intervention is necessary for the diagnosis and treatment of youth, with the goal of reducing the probability that psychiatric disorders will be prolonged, evolving, and worsening in adulthood.

Cancer pain management in Mexico

BackgroundPain control is an essential component of high-quality palliative care. Unfortunately, many low-income and middle-income countries lack an appropriate infrastructure to provide palliative care and suffer from a severe lack...

Social and Cultural Barriers to Women's Participation in Pap Smear Screening Programs in Low- and Middle-Income Latin American and Caribbean Countries: An Integrative Review.

Pap smear screening programs have been ineffective in reducing cervical cancer mortality in most Latin American and Caribbean countries, in part due to low screening rates. The purpose of this review was to analyze recent studies to identify demographic, social, and cultural factors influencing women's participation in Pap screening programs in Latin America and the Caribbean. For this integrative review, cervical cancer screening in Latin America and the Caribbean was searched using PubMed, CINAHL, EMBASE, and PsycINFO databases. Findings/Results: Demographic barriers to screening were socioeconomic status, education, race/ethnicity, and geography. Social barriers included lack of uniformity in screening guidelines, lack of knowledge regarding cervical cancer, and lack of preventive culture. Cultural barriers were fear/embarrassment and gender roles. There are multilevel barriers to Pap smear utilization among women in Latin America and the Caribbean. Findings highlight a need for health system engagement, promotion of preventive care, and community-generated educational programs and solutions.

Obstacles to Takeup: Ecuador's Conditional Cash Transfer Program, The Bono de Desarrollo Humano

Summary Social assistance programs cannot help the poor if the poor do not enroll in them. Obstacles to the takeup of social assistance in industrialized countries include information costs, compliance costs, and psychological costs. Using qualitative field research and quantitative analysis of data from a nationwide survey in 2013–14, we explore the impact of these costs on the takeup of the Bono de Desarrollo Humano (BDH), a US $50 monthly cash transfer in Ecuador. Drawing on interviews with Ecuadorians whose households are eligible for the BDH, as well as on findings about social assistance takeup in industrialized countries, we hypothesize that particular information costs, compliance costs, and psychological costs, along with program design and household poverty, will influence the probability of BDH takeup. We then use probit regression to estimate the statistical effect of these factors on the probability of takeup, using data on 11,449 BDH-eligible households sampled by Ecuador's 2013–14 Encuesta Condiciones de Vida (Living Standards Measurement Survey). Controlling for program design and household poverty, we find that compliance costs and psychological costs each have a significant deterrent effect on BDH takeup. The purpose of social assistance is to help the poor, but if social assistance is to achieve this goal, the poor must actually receive it. This study helps to identify the forces and circumstances that influence the takeup of an important social assistance program in a middle-income Latin American country.

Composite Index of health Inequity for a Middle Income Country

To develop and validate a composite index of health inequity based on mortality by grouped causes. An ecological study in a middle-income Latin American country, with aggregate indicators available from municipalities and departments, which were selected from health observatories, research groups and health authorities. They were divided into intolerable and "not completely avoidable" according to current scientific progress, and were added in categories: traffic accident, aggression, kidney disease, HIV infection, intestinal parasitic diseases, syphilis, fecal / oral transmission disease, tuberculosis, disease Vector-borne diseases, respiratory disease, cerebral hemorrhagic / ischemic events, maternal mortality, lower mortality 5 years, meningitis. After analysis of main components, a composite index of health inequity (IIS) is obtained for men and women. Internal consistency was evaluated using Cronbach's Alpha coefficient. Concurrent validation was done with proportion of people in Unsatisfied Basic Needs (UBN), Human Development Index (HDI), Life Expectancy at Birth (LEB), among others. IIS is built showing higher values for women in most municipalities and departments; And for sites with high HDI, high LEB and low UBN. Cronbach's alpha was 0.6688, IIS-men and 0.725, IIS-women. An IIS was obtained, is valid and reproducible. The role of big cities in inequities in health is highlighted, probably due to the effect of intolerable health.

Structural Problems of Faltering Economic Development in Middle Income Latin American Countries

Structural Problems of Faltering Economic Development in Middle Income Latin American Countries

Factors related to inter-observer reproducibility of conventional Pap smear cytology: a multilevel analysis of smear and laboratory characteristics.

To identify factors that influence the inter-observer reproducibility of the routine, conventional Pap smear cytology (Pap smear test) in a network of certificated laboratories in a middle-income Latin American country. Twenty-six laboratories provided each an average of 26 negative for malignancy (NILM) and high-grade squamous intraepithelial lesion (HSIL) Pap smears. An external panel reviewed the slides. The kappa index and multilevel logistic regression were used to estimate the reproducibility and odds ratios (OR) of a false result with 95% confidence intervals (95% CI), respectively. Results are presented for laboratories that collect (collector laboratories) and do not collect (non-collector laboratories) samples. The agreements ranged widely (median kappa 0.51, range 0.16-0.70). The overall false-positive (FP) and false-negative (FN) rates were 31% (95% CI 27-35) and 11% (95% CI 7-17). Among collector laboratories (N = 14), a bigger sample collection volume decreased the probability of a FP (OR-adjusted 0.05, 95% CI 0.02-0.1) whereas the number of quality defects (OR-adjusted 1.67, 95% CI 1.25-2.24), high workload (OR-adjusted 5.52, 95% CI 3.85-7.92) and collection by cytotechnologists (OR-adjusted 1.28, 95% CI 1.15-1.42) or health professionals (OR-adjusted 2.26, 95% CI 2.04-2.49) instead of nursing assistants increased it. Among non-collector laboratories (N = 9), the FP rate increased with the number of quality defects (OR-adjusted 1.86, 95% CI 1.06-3.26) but decreased if the samples were collected by health professionals instead of nursing assistants (OR-adjusted 0.37, 95%CI 0.17-0.80). No significant associations were observed for FN. Staff in charge of cervical sampling significantly determined the reproducibility of the Pap smear test, but this depended on whether the laboratory collects samples or read samples collected elsewhere.

How Large are Earnings Penalties for Self-Employed and Informal Wage Workers?

This paper examines the earnings penalties and premiums associated with different types of employment in 73 countries. Workers are divided into four categories: non-professional own-account workers, employers and own-account professionals, informal wage employees, and formal wage employees. Approximately half of the workers in low income countries are non-professional own-account workers, and the majority of the rest are informal employees. Fewer than 10 percent are formal employees, and only 2 percent of workers in low income countries are employers or own-account professionals. As per capita gross domestic product increases across countries, there are large net shifts from non-professional own-account work into formal wage employment. Across all regions and income levels, non-professional own-account workers and informal wage employees face an earnings penalty compared with formal wage employees. But in low income countries, this earnings penalty is small, and non-professional own-account workers earn a positive premium relative to all wage employees. Earnings penalties for non-professional own-account workers tend to increase with gross domestic product and are largest for female workers in high income countries. On average, employers and own-account professionals earn a premium compared to employees, although there are important differences across countries and between men and women. In terms of regional differences, earnings premiums for employers and professionals are largest for men in middle income Latin American countries. On the other hand, women employers and professionals do not earn a statistically significant premium compared to employees in any region of the world. These results are consistent with compensating wage differentials and firm quasi-rents playing important roles in explaining cross-country variation in earnings penalties, and raise questions about the extent to which the unskilled self-employed are rationed out of formal wage work in low income countries.