Rates In High-income Countries Research Articles

Severe maternal morbidity in high income countries

IntroductionWith declining maternal mortality rates in high income countries (HICs), severe maternal morbidity (SMM) is becoming an important quality measure of maternal care. However, there is no international consensus on the definition and types of SMM. This study aims to critically analyze published literature on SMM in HICs. ObjectivesTo compare definitions and criteria used to identify SMM, and to identify the main types and risk factors contributing to SMM in eight HICs. MethodsThree databases were searched, results were filtered, and ten studies were critically appraised. ResultsSix of the articles discussed SMM identification criteria and proposed definition modifications. Longer hospital stay and admission to intensive care unit were suggested as additional criteria. Disease-based criteria was shown to be superior to organ dysfunction criteria. Seven articles detailed common types of SMM as severe haemorrhage, hypertensive disorders, and pre-eclampsia/eclampsia. Six articles described SMM risk factors, of which advanced maternal age and caesarean delivery were most common. DiscussionThis literature review identified disease-based criteria and Canadian study criteria as promising measures of SMM. It also identified several types and risk factors of SMM common between HICs. These findings can help physicians identify women at risk of SMM. The study is however limited to eight HICs and ten studies. Further research should aim to investigate how the measures compare with previous sources of criteria, and to discern the association of weight and race risk factors with SMM.

Premature mortality trends in 183 countries by cancer type, sex, WHO region, and World Bank income level in 2000-19: a retrospective, cross-sectional, population-based study.

Cancer is a leading cause of mortality worldwide. By 2040, over 30 million new cancers are predicted, with the greatest cancer burden in low-income countries. In 2015, the UN passed the Sustainable Development Goal 3.4 (SDG 3.4) to tackle the rising burden of non-communicable diseases, which calls for a reduction by a third in premature mortality from non-communicable diseases, including cancer, by 2030. However, there is a paucity of data on premature mortality rates by cancer type. In this study, we examine annual rates of change for cancer-specific premature mortality and classify whether countries are on track to reach SDG 3.4 targets. This is a retrospective, cross-sectional, population-based study investigating premature mortality trends from 2000-19 using the WHO Global Health Estimates data. All cancers combined and thirteen individual cancers in 183 countries were examined by WHO region, World Bank income level, and sex. The risk of premature mortality was calculated for ages 30-69 years, independent of other competing causes of death, using standard life table methods. The primary objective was to compute average annual rate of change in premature mortality from 2000 to 2019. Secondary objectives assessed whether this annual rate of change would be sufficient to reach SDG 3.4. targets for premature mortality by 2030. This study was conducted using data retrieved for the years 2000-19. Premature mortality rates decreased in 138 (75%) of 183 countries across all World Bank income levels and WHO regions, however only eight (4%) countries are likely to meet the SDG 3.4 targets for all cancers combined. Cancers where early detection strategies exist, such as breast and colorectal cancer, have higher declining premature mortality rates in high-income countries (breast cancer 48 [89%] of 54 and colorectal cancer 45 [83%]) than in low-income countries (seven [24%] of 29 and four [14%]). Cancers with primary prevention programmes, such as cervical cancer, have more countries with declining premature mortality rates (high-income countries 50 [93%] of 54 and low-income countries 26 [90%] of 29). Sex-related disparities in premature mortality rates vary across WHO regions, World Bank income groups, and by cancer type. There is a greater reduction in premature mortality for all cancers combined and for individual cancer types in high-income countries compared with lower-middle-income and low-income countries. However, most countries will not reach the SDG 3.4 target. Cancers with early detection strategies in place, such as breast and colorectal cancers, are performing poorly in premature mortality compared with cancers with primary prevention measures, such as cervical cancer. Investments toward prevention, early detection, and treatment can potentially accelerate declines in premature mortality. WHO.

Factors Associated with Outcomes at 1 Year in Paediatric Post-nephrectomy Patients for Nephroblastoma at the University Teaching Hospital and Cancer Diseases Hospital in Lusaka, Zambia.

Nephroblastoma is the most common primary malignant renal tumour of childhood. The survival rates in high-income countries are approximately 90%. However, low-income countries have low survival rates of 20%-50%. This study assessed factors associated with treatment outcomes of children post-nephrectomy for nephroblastoma at the University Teaching Hospital and Cancer Diseases Hospital in Lusaka, Zambia. A retrospective observational cohort study was conducted, where all children diagnosed with unilateral Wilms tumour below the age of 16 years who had nephrectomy from July 2016 to June 2019 were enrolled. Sociodemographic, clinical characteristics and treatment outcomes were noted. All data were coded and stored in a tabular format using Microsoft Excel. Statistical software STATA version 13 was used for analysis. Thirty patients were enrolled. The male-to-female ratio was 1:1. The 1-year event-free survival was 46.7%. Treatment abandonment accounted for 36.6% of the participants. 16.7% of the patients had disease progression. No patient had a relapse or died during the 1-year follow-up period. 66.7% had advanced disease stages III and IV. Advancement in age (above 4.3 years), living in a rural environment more than 100 km away from Lusaka and advanced disease stage were all associated with a poor outcome. Factors associated with a poor outcome in this study were advanced age and late presentation.

Mortality of Young Women due to Breast Cancer in Low, Middle and High-Income Countries: Systematic Literature Review and Meta-Analysis.

To identify the difference in breast cancer mortality rates among young women according to countries' economic classification. A systematic literature review included retrospective studies on breast cancer mortality rates in women aged 20 to 49 years. Databases used were PubMed, Web of Science, Scopus, and Virtual Health Library, with articles selected in English, Portuguese, and Spanish. The study selection and analysis were conducted by two pairs of researchers. Data from 54 countries were extracted, including 39 high-income, 12 upper-middle-income, and 3 lower-middle-income countries. A meta-analysis was performed with the quantitative data from two studies. Six articles met the inclusion criteria. Four were analyzed descriptively due to data diversity, and two were included in the meta-analysis. The pooled mortality rate for high-income countries was 10.2 per 100,000 women (95% CI: 9.8-10.6), while for upper-middle-income countries, it was 15.5 per 100,000 women (95% CI: 14.9-16.1). Lower-middle-income countries had a pooled mortality rate of 20.3 per 100,000 women (95% CI: 19.5-21.1). The decrease in mortality rates in high-income countries was statistically significant (p<0.05). Mortality rates for breast cancer among young women have decreased significantly in high-income countries but have increased in lower-income countries. This disparity underscores the impact of insufficient investment in preventive measures, health promotion, early diagnosis, and treatment on young women's mortality in lower-income countries.

Epidemiology of carbapenem-resistant Acinetobacter baumannii colonization in neonatal intensive care units: A systematic review and meta-analysis

BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB) in neonatal intensive care units (NICUs) represents an escalating challenge in healthcare settings, particularly in managing hospital-acquired infections (HAIs). Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs, with rates as high as 41.7 cases per 1000 patients in ICUs, accounting for 13.6% of all HAIs. These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii . A particularly concerning aspect of CRAB colonization is its asymptomatic nature, enabling its transmission through healthcare workers (HCWs) or the NICU environment to vulnerable neonates with developing immune systems. AIM To explore the prevalence of CRAB colonization in NICUs, focusing on neonates, healthcare workers, and the environmental samples, to enhance epidemiological understanding and inform targeted interventions. METHODS We conducted according to PRISMA 2020 checklist guidelines, a comprehensive literature search across multiple databases including MEDLINE (Ovid), EMBASE (Ovid), Global Health (Ovid), Web of Science, and Global Index Medicus. Studies were selected based on predetermined criteria, primarily involving neonates, HCWs, and environmental swabs, using culture or molecular methods to detect CRAB colonization. We excluded studies that did not specifically focus on NICUs, were duplicates, or lacked necessary data. The study selection and quality assessment were conducted independently by two reviewers. Data extraction involved collecting comprehensive details about each study. Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals, stratifying results by regional location. We assessed study heterogeneity using Cochran's Q statistic and I ² statistic, with regression tests employed to evaluate potential publication bias. RESULTS We analyzed 737 records from five databases, ultimately including 13 studies from ten countries. For neonates, the pooled prevalence was 4.8% (95%CI: 1.1% to 10.5%) with the highest rates observed in South-East Asia (10.5%; 95%CI: 2.4% to 23.3%). Among HCWs, a single Indian study reported a 3.3% prevalence. Environmental samples showed a prevalence of 2.3% (95%CI: 0% to 9.3%), with the highest rates in South-East Asia (10%; 95%CI: 4.2% to 17.7%). Significant heterogeneity was found across studies, and no publication bias was detected. CONCLUSION This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions, particularly in South-East Asia, contrasting with lower rates in high-income countries. The study reveals a gap in research on HCWs colonization, with only a single study from India reporting moderate prevalence. Environmental samples indicate moderate levels of CRAB contamination, again higher in South-East Asia. These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs, including exploring the roles of HCWs and the environment in transmission, understanding antimicrobial resistance patterns, and developing effective prevention measures.

Global trends in COVID-19 incidence and case fatality rates (2019-2023): a retrospective analysis.

Analyzing and comparing COVID-19 infection and case-fatality rates across different regions can help improve our response to future pandemics. We used public data from the WHO to calculate and compare the COVID-19 infection and case-fatality rates in different continents and income levels from 2019 to 2023. The Global prevalence of COVID-19 increased from 0.011 to 0.098, while case fatality rates declined from 0.024 to 0.009. Europe reported the highest cumulative infection rate (0.326), with Africa showing the lowest (0.011). Conversely, Africa experienced the highest cumulative case fatality rates (0.020), with Oceania the lowest (0.002). Infection rates in Asia showed a steady increase in contrast to other continents which observed initial rises followed by decreases. A correlation between economic status and infection rates was identified; high-income countries had the highest cumulative infection rate (0.353) and lowest case fatality rate (0.006). Low-income countries showed low cumulative infection rates (0.006) but the highest case fatality rate (0.016). Initially, high and upper-middle-income countries experienced elevated initial infection and case fatality rates, which subsequently underwent significant reductions. COVID-19 rates varied significantly by continent and income level. Europe and the Americas faced surges in infections and low case fatality rates. In contrast, Africa experienced low infection rates and higher case fatality rates, with lower- and middle-income nations exceeding case fatality rates in high-income countries over time.

General Anesthesia for Cesarean Delivery for Thrombocytopenia in Hypertensive Disorders of Pregnancy: Findings From the Obstetric Airway Management Registry

(Anesth Analg. 2023;136:992–998) In Africa, maternal morality following cesarean delivery is 50× more likely compared to morality rates in high-income countries, and spinal anesthesia (SA) is the preferred anesthetic method during cesarean delivery. For parturient patients with hypertensive disorders (ie, preeclampsia, eclampsia, or gestational hypertension), there is an increased risk for adverse outcomes, including spinal epidural hematoma following SA, so thrombocytopenia should be excluded before neuraxial blockade. An accurate platelet count is necessary before SA in emergent situations of fetal distress, which can be complicated when laboratory services are unavailable or off-site. The primary aim of this study was to determine which patients received general anesthesia (GA) when the presence of thrombocytopenia was known versus suspected. The secondary aim was perioperative platelet counts of patients with suspected thrombocytopenia to determine how often GA may have been avoided in favor of SA if platelet count was known.

30-Day Readmission Rate of Patients with COPD and Its Associated Factors: A Retrospective Cohort Study from a Tertiary Care Hospital.

Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors. A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed. The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission. The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.

PDGF, NGF, and EGF as main contributors to tumorigenesis in high-risk retinoblastoma.

Retinoblastoma (RB) is the most common form of eye cancer experienced in childhood. Its aggressive malignancy is associated with excellent survival rates in high-income countries; however, the prognosis in third-world countries is less favorable. Early diagnosis can maximize the patient's visual outcomes and their survival rate. Therapy should be conducted in highly specialized treatment centers. Intravenous chemotherapy (IVC) in bilaterally affected children currently forms the majority of therapy. Local destructive procedures and local chemotherapies such as intra-arterial chemotherapy (IAC) or intravitreal chemotherapy can be taken into consideration depending on the extent and size of the tumor. Nonetheless, children and parents remain under constant stress, revisiting doctors for medical treatment and fearing vision loss and even enucleation of the eye. Adequate molecular patient stratification to improve targeted therapy is still lacking. This retrospective study analyzed formalin-fixed paraffin-embedded specimens from a cohort of 21 RB samples. A total of 11 of those samples showed undifferentiated retinoblastoma (URB) histopathological risk features, and the other 10 showed differentiated retinoblastoma (DRB) histopathological grading. RNA from all samples was isolated and analyzed via digital gene expression patterns. Conductors of cell survival and DNA repair were dominant in the DRB samples. In contrast, the agents responsible for cell-cycle progression and apoptosis were overexpressed in URB samples. Our work reveals the importance of molecular mechanisms within the immune system subjected to histologic subtypes of RB, providing more detailed background on their genetic behavior. This is of great interest for therapeutic strategies, such as targeted immune- and gene-based therapies, for retinoblastoma.

Analyzing the impact of natural capital on socio- economic objectives under the framework of sustainable development goals

Natural capital plays an essential role in achieving socio-economic objectives and is connected to the basic conditions for human survival. Here, we discuss the role played by natural capital in sustainable socio-economic objectives (SDG1, 3, 5, and 8) in 131 countries and territories during the period 2000–2018. In the long term, the increased dependence on natural capital can contribute to decent work and economic growth, but it has negative impacts on poverty reduction as well as the promotion of good health, well-being, and gender equality. The relationship between natural capital and each socio-economic objectives changes with different levels of socio-economic. In addition, the regression results of countries at different stages of development show heterogeneity. Unlike low-income countries, the dependence on natural capital reduces poverty rates in high-income countries, and is conducive to gender equality in middle-income countries. Governments should create incentives to protect and enhance natural wealth to prevent the depletion of natural capital or its unsustainable conversion into other forms of capital.

Trends in childhood cancers at Tygerberg Hospital from 1994 to 2014

Background. There is a paucity of data regarding childhood cancer incidence in low- and middle-income countries owing to a lack ofdisease-specific, hospital- and population-based registries.Objective. To describe the disease profile and outcome of children with cancer, treated at a single institution in South Africa between1994 and 2014.Methods. Data collected included demographic data (age at diagnosis, sex, stage or risk group, race) and 5-year overall survival (OS) of children aged ≤15 years diagnosed with cancer. Time to event and factors associated with 5-year outcomes were analysed, using Kaplan-Meier curves and Cox regression analysis.Results. The most common malignancies were leukaemia (27.7%), brain tumours (18.4%), lymphomas (14.1%), nephroblastoma (8.0%)and soft-tissue sarcomas (7.4%) for 935 patient records. Limited-disease solid tumours and standard-risk haematological malignancieshad good OS rates of 77.7% and 85.9%, respectively, although OS for the whole group was 60.2%. Nephroblastoma (89.3%), retinoblastoma (86.7%), Hodgkin’s lymphoma (89.7%) and Burkitt lymphoma (75.5%) had the best OS. Type of cancer (p&lt;0.01), solid-tumour stage (p&lt;0.001) and risk classification for haematological malignancies (p&lt;0.001) were significantly associated with mortality.Conclusions. Underlying cancer diagnosis, stage and risk group remained significant factors influencing survival with good OS for limited disease in solid tumours and standard-risk haematological malignancies, which was comparable with survival rates in high-income countries.

Does Artificial Intelligence Threaten Working Places?

In recent years, Artificial Intelligence (AI) has made significant progress in non-routine, cognitive tasks. The May 2023 CfM-CEPR survey asked the members of its European panel to predict the impact of AI on global economic growth and unemployment rates in high-income countries over the upcoming decade. Most respondents believe that AI is likely to boost global growth to 4-6% per annum. It is also stated that AI is unlikely to affect employment rates in high-income countries, with the remainder split between predicting an increase and a decrease in unemployment rates. From farming and education to healthcare and the military, AI is poised to make sweeping changes to the workplace. This paper makes an attempt to answer the question: can it have a positive impact, or are we in for a darker future? This study presents AI implementation into the labor progress model and predicts its possible influence. The suggested model is highly adaptive and will be useful both for practical and academic purposes.

Global Variations in Heart Failure Etiology, Management, and Outcomes

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

Overview of thermal ablation devices for treating precancerous cervical lesions in low-resource settings

In 2020, there were an estimated 604 000 cases and 341 000 deaths from cervical cancer [1], with 91% of these deaths occurring in low- and middle-income countries (LMICs) [2]. While screening programs have led to a dramatic reduction in cervical cancer rates in high-income countries, their implementation in LMICs has faced many challenges [3]. Screen-and-treat programs, […]

A community-based participatory approach to engaging Congolese migrants in intervention co-design

Abstract Issue The World Health Organization has called for tailored, community-based interventions to address disparities in vaccination uptake affecting migrant and minoritised populations, however few exist. This study directly responds to global calls for community-centred and participatory approaches to engaging migrants in routine and COVID-19 vaccination. Problem description Black and African migrants are known to be at risk of under-immunisation and have lower COVID-19 vaccine uptake rates in high-income countries. This UK study will use community-based participatory approaches to engage Congolese migrants in co-developing a tailored intervention to increase vaccine uptake. A community-academic coalition will lead the study. Community members will be trained as peer researchers and financially compensated. The final output will be an intervention strategy tailored to and embedded within the Congolese migrant community. Preliminary results The coalition held 20 hours of planning meetings and peer researcher training in 2021 and co-developed a phased study involving 1) community days with poster walls and qualitative in-depth interviews with Congolese migrants, 2) interviews and workshops with local stakeholders, and 3) co-design workshops with Congolese migrants. Following outreach and pre-engagement, approximately 80 migrants attended the community days, with more than 50 interviews and 100% left positive feedback (including: felt valued, welcomed, Congolese language recognised). Lessons Community-academic partnerships are resource-intensive but can be an effective means to build and maintain trust required to deliver a community-based research study. Academic partners should support community partners in understanding the research process to help manage expectations and provide financial compensation for their time and effort. This study offers an innovative engagement model and study design that can be adapted to other underserved populations. Key messages • Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities. • This study uses a novel, theory-driven, participatory approach to engage with and identify barriers to vaccination in Congolese migrants and co-design a tailored strategy to increase uptake.

A Systematic Review of Severe Maternal Morbidity in High-Income Countries.

With declining maternal mortality rates in high-income countries (HICs), severe maternal morbidity (SMM) is becoming an important quality measure of maternal care. However, there is no international consensus on the definition and types of SMM. This study aims to critically analyze published literature on SMM in HICs. The objectives are to compare definitions and criteria used to identify SMMand identify the main causes and risk factors contributing to SMM in HICs. PubMed, Cumulative IndextoNursing and Allied Health Literature(CINAHL), and Scopus databases were searched for articles published between 2010 and 2022, results were filtered, and 10 studieswere critically appraised. Six of the articles discussed SMM identification criteria and proposed definition modifications. Longer hospital stays and admission to the intensive care unit (ICU) were suggested as additional criteria. Disease-based criteria were shown to be superior to organ dysfunction criteria. Seven articles detailed common types of SMM as severe hemorrhage, hypertensive disorders, and preeclampsia/eclampsia. Six articles described SMM risk factors, of which advanced maternal age and cesarean delivery were the most common. This literature review identified disease-based criteria and Canadian study criteria as promising measures of SMM. It also identified several causes and risk factors of SMM common between HICs. These findings can help physicians identify women at risk of SMM. The study is however limited to eight HICs and 10 studies. Further research should aim to investigate how these criteria compare with previous sources of criteria and discern the association of weight and race risk factors with SMM.

Catastrophe squared: COVID-19 vaccine inequity in humanitarian crises

The COVID-19 pandemic has caused physical, social, and economic devastation all around the world. While more manageable case numbers and immunisation efforts seem to indicate that the world has come a long way in controlling the virus, there is great inequity in vaccination numbers around the world. Low-income countries have only received 14 doses per 100 people—13-fold lower than the 182 doses per 100 people in upper-middle income and high-income countries. This paper highlights the disparity of COVID-19 vaccination rates in high-income countries versus those afflicted with crises and raises the need for linking pandemic response with humanitarian assistance.

Epidemiology of inflammatory bowel diseases in the state of Rio Grande do Sul, Brazil.

BACKGROUNDThis is the first study on the epidemiology of inflammatory bowel diseases (IBDs) in Rio Grande do Sul (RS), the southernmost state of Brazil with the country’s fifth largest population. Crohn’s disease (CD) and ulcerative colitis (UC) are collectively termed IBDs. They have high incidence and prevalence rates in high-income countries, although in recent years there has been a change in the classic geographical distribution of IBDs, with growing rates in traditionally low-incidence regions.AIMTo estimate the incidence and prevalence of IBDs in the RS state, Brazil, between 2014 and 2019.METHODSThis is a cross-sectional descriptive observational study. Patients with IBD who had initiated treatment and met the inclusion criteria of the RS state free drug distribution program were included. Data were obtained from registration or renewal records of the RS state specialty pharmacy. The male, female, and total populations were estimated according to mid-year data from the Brazilian Institute of Geography and Statistics, which served as a reference for calculating the incidence and prevalence rates of IBDs during the study period. Results were described using mean, standard deviation, and range.RESULTSWe included 1082 patients with IBD, of whom 57.5% were female and 42.5% were male. Patients with CD accounted for 72.45% of the sample, and those with UC accounted for 27.54%. IBD prevalence during the study period was 9.51 per 100000 population, of which 6.89 corresponded to people with CD and 2.62, to people with UC. Incidence rates per 100000 population/year were 2.54 in 2014, 2.61 in 2015, 1.91 in 2016, 0.80 in 2017, 0.83 in 2018, and 0.96 in 2019. The mean IBD incidence rate per 100000 population was 1.61, of which 1.17 corresponded to CD and 0.44, to UC. The mean age was 41 years, and patients were mostly aged 30-40 years. Prevalence by region was higher in the state capital metropolitan area: 12.69 per 100000 population.CONCLUSIONOur results demonstrated an IBD prevalence of 9.51% and incidence of 1.61 per 100000 population. The patients were predominantly female, and CD was more prevalent than UC.

Adding to the mantra: vaccines prevent illness and death, and preserve existing antibiotics

With rising incomes and the increased availability of antibiotics globally, per-capita consumption of antibiotics in middle-income countries is fast approaching the rates in high-income countries.1 Antimicrobial resistance has emerged as a major source of morbidity and mortality worldwide, and now is estimated to cause more deaths than malaria or HIV/AIDS.2 Existing and new vaccines could help avert a substantial proportion of current antibiotic use, and there is now considerable evidence linking vaccination with decreased use of antibiotics and averted cases of antimicrobial resistance.

Longer parental time and lower fertility rate

The fertility rates in high-income countries have been lower than the replacement level for decades. We argue that the rising parental time plays an essential role in the fertility rate decline. To this end, we construct an indicator named the parental time share, which links the time use survey data and the Barro–Becker modeling framework. We modify the model of de Silva and Tenreyro (2020) by introducing endogenous parental time share. The modified model analytically shows that the parental time share increases with the accumulation of human capital and depresses the fertility rate. The quantitative results fit the dynamics of fertility rates, human capital investments, and parental time shares in the high-income countries since 1965, confirming the importance of the parental time share in shaping the demographic changes. We also extend the basic model to account for countries at all income levels and present a demography opportunity set that describes all the combinations of fertility rates, human capital investments, and parental time shares.