Upper-middle Income Countries Research Articles

Modeling the global impact of reducing out-of-pocket costs for children's surgical care.

Over 1.7 billion children lack access to surgical care, mostly in low- and middle-income countries (LMICs), with substantial risks of catastrophic health expenditures (CHE) and impoverishment. Increasing interest in reducing out-of-pocket (OOP) expenditures as a tool to reduce the rate of poverty is growing. However, the impact of reducing OOP expenditures on CHE remains poorly understood. The purpose of this study was to estimate the global impact of reducing OOP expenditures for pediatric surgical care on the risk of CHE within and between countries. Our goal was to estimate the impact of reducing OOP expenditures for surgical care in children for 149 countries by modeling the risk of CHE under various scale-up scenarios using publicly available World Bank data. Scenarios included reducing OOP expenditures from baseline levels to paying 70%, 50%, 30%, and 10% of OOP expenditures. We also compared the impact of these reductions across income quintiles (poorest, poor, middle, rich, richest) and differences by country income level (low-income, lower-middle-income, upper-middle-income, and high-income countries).Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal. The risk of CHE due to a surgical procedure for children was highest in low-income countries. An unexpected observation was that upper-middle income countries were at higher risk for CHE than LMICs. The most vulnerable regions were Africa and Latin America. Across all countries, the poorest quintile had the greatest risk for CHE. Increasing interest in financial protection programs to reduce OOP expenditures is growing in many areas of global health. Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal across countries, wealth groups, or even by wealth groups within countries. Understanding these complexities is critical to develop appropriate policies to minimize the risks of poverty.

Availability of substance use screening and treatment within HIV clinical sites across seven geographic regions within the IeDEA consortium

BackgroundOverwhelming evidence highlights the negative impact of substance use on HIV care and treatment outcomes. Yet, the extent to which alcohol use disorder (AUD) and other substance use disorders (SUD) services have been integrated within HIV clinical settings is limited. We describe AUD/SUD screening and treatment availability in HIV clinical sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. MethodsIn 2020, 223 IeDEA HIV clinical sites from 41 countries across seven geographic regions completed a survey on capacity and practices related to management of AUD/ SUD. Sites provided information on AUD and other SUD screening and treatment practices. ResultsSites were from low-income countries (23%), lower-middle-income countries (38%), upper-middle income countries (17%) and high-income counties (23%). AUD and SUD screening using validated instruments were reported at 32% (n=71 located in 12 countries) and 12% (n=27 located in 6 countries) of the 223 sites from 41 countries, respectively. The North American region had the highest proportion of clinics that reported AUD screening (76%), followed by East Africa (46%); none of the sites in West or Central Africa reported AUD screening. 31% (n=69) reported both AUD screening and counseling, brief intervention, psychotherapy, or Screening, Brief Intervention, and Referral to Treatment; 8% (n=18) reported AUD screening and detox hospitalization; and 10% (n=24) reported both AUD screening and medication. While the proportion of clinics providing treatment for SUD was lower than those treating AUD, the prevalence estimates of treatment availability were similar. ConclusionsAvailability of screening and treatment for AUD/SUD in HIV care settings is limited, leaving a substantial gap for integration into ongoing HIV care. A critical understanding is needed of the multilevel implementation factors or feasible implementation strategies for integrating screening and treatment of AUD/SUD into HIV care settings, particularly for resource-constrained regions.

Classifying disaster risk reduction strategies: conceptualizing and testing a novel integrated approach

BackgroundAlthough disaster risk reduction (DRR) addresses underlying causes and has been shown to be more cost-effective than other emergency management efforts, there is lack of systematized DRR categorization, leading to insufficient coherence in the terminology, planning, and implementation of DRR. The aim of this study was to conceptualize and test a novel integrated DRR framework that highlights the intersection between two existing classification systems.MethodsGrounded theory was used to conceptualize a novel DRR framework. Next, deductive conceptual content analysis was used to categorize interventions from the 2019 Cities100 Report into the proposed DRR framework. The term “connection” indicates that an intervention can be categorized into a particular section of the novel integrated approach. A “connection” was determined to be present when the intervention description stated an explicit connection to health and to the concept within one of the categories from the novel approach. Further descriptive statistics were used to give insight into the distribution of DRR interventions across categories and into the application of the proposed framework.ResultsThe resulting framework contains nine intersecting categories: “hazard, prospective”, “hazard, corrective”, “hazard, compensatory”, “exposure, prospective”, “exposure, corrective”, “exposure, compensatory”, “vulnerability, prospective”, “vulnerability, corrective”, and “vulnerability, compensatory”. The thematic analysis elucidated trends and gaps in the types of interventions used within the 2019 Cities100 Report. For instance, exposure-prospective, exposure-compensatory, and vulnerability-compensatory were the most under-utilized strategies, accounting for only 3% of the total interventions. Further descriptive statistics showed that upper middle-income countries favored “hazard, corrective” strategies over other DRR categories while lower middle-income countries favored “exposure, corrective” over other DRR strategies. Finally, European cities had the highest percentage of DRR connections (51.39%) compared to the maximum possible DRR connections, while African cities had the lowest percentage of DRR connections (22.22%).ConclusionsThe study suggests that the proposed DRR framework could potentially be used to systematically evaluate DRR interventions for missing elements, aiding in the design of more equitable and comprehensive DRR strategies.

Physical late effects of treatment among survivors of childhood cancer in low- and middle-income countries: a systematic review.

Physical late effects of treatment are well-documented among childhood cancer survivors in high-income countries, but whether prevalence and risk factors are comparable in low- and middle-income countries (LMICs) is unclear. We conducted a systematic review to assess physical late effect outcomes among childhood cancer survivors in LMICs. Five health sciences databases were searched from inception to November 2022 in all languages. We included observational studies conducted in LMICs that evaluated physical late effects of treatment in childhood cancer survivors. Mean or median cohort follow-up must have been ≥ 5 years from original cancer diagnosis. Sixteen full articles and five conference abstracts were included. Studies were conducted in lower-middle (n = 12, 57%) or upper-middle income (n = 9, 43%) countries; nearly half (n = 9, 43%) were conducted in India. Five cohorts (24%) were comprised entirely of 5-year survivors. Subsequent malignant neoplasms were reported in 0-11% of survivors (n = 10 studies). Hypothyroidism and metabolic syndrome prevalence ranged from 2-49% (n = 4 studies) and 4-17% (n = 5 studies), respectively. Gonadal dysfunction ranged from 3-47% (n = 4 studies). Cardiac dysfunction ranged from 1-16% (n = 3 studies). Late effects of the musculoskeletal and urinary systems were least investigated. Substantial knowledge gaps exist in LMIC childhood cancer survivorship. No low-income country data were found. In middle-income countries, late effects were defined and assessed variably and limited by selection bias and small sample sizes. Survivors in LMICs can experience physical late effects of treatment, though additionally systematically collected data from survivor cohorts are needed to fill knowledge gaps.

Mapping the Common Barriers to Optimal COPD Care in High and Middle-Income Countries: Qualitative Perspectives from Clinicians.

Chronic obstructive pulmonary disease (COPD) poses a significant global health burden despite being largely preventable and treatable. Despite the availability of guidelines, COPD care remains suboptimal in many settings, including high-income countries (HICs) and upper-middle-income countries (UMICs), with varied approaches to diagnosis and management. This study aimed to identify common and unique barriers to COPD care across six countries (Australia, Spain, Taiwan, Argentina, Mexico, and Russia) to inform global policy initiatives for improved care. COPD care pathways were mapped for each country and supplemented with epidemiological, health-economic, and clinical data from a targeted literature review. Semi-structured interviews with 17 respiratory care clinicians were used to further validate the pathways and identify key barriers. Thematic content analysis was used to generate the themes. Six themes were common in most HICs and UMICs: "Challenges in COPD diagnosis", "Strengthening the role of primary care", "Fragmented healthcare systems and coordination challenges", "Inadequate management of COPD exacerbations", "Limited access to specialized care" and, "Impact of underfinanced and overloaded healthcare systems". One theme, "Insurance coverage and reimbursement challenges", was more relevant for UMICs. HICs and UMICs differ in patient and healthcare provider awareness, primary care involvement, spirometry access, and availability of specialized care. Both face issues with healthcare fragmentation, guideline adherence, and COPD exacerbation management. In addition, UMICs also grapple with resource limitations and healthcare infrastructure challenges. Many challenges to COPD care are the same in both HICs and UMICs, underscoring the pervasive nature of these issues. While country-specific issues require customized solutions, there are untapped possibilities for implementing global respiratory strategies that support countries to manage COPD effectively. In addition to healthcare system-level initiatives, there is a crucial need for political prioritization of COPD to allocate the essential resources it requires.

The use of tier three therapies in acute brain injured patients

BACKGROUND In patients with acute brain injury (ABI) and refractory intracranial hypertension, the so-called ‘tier three therapies’ (TTT) (hypothermia, metabolic suppression with barbiturates, and decompressive craniectomy) may be used. OBJECTIVE We aimed to describe the incidence of use of TTT, and to assess their effect on outcome. DESIGN A secondary analysis of the ENIO observational study. SETTING Seventy-three intensive care units (ICUs) in 18 countries worldwide between June 2018 and November 2020. PATIENTS One thousand five hundred and twelve adult patients admitted to an intensive care unit (ICU) with ABI were included and categorised according to use or not of one or more TTT. RESULTS Three hundred and ninety-six patients (26.2%) received at least one TTT during the ICU stay. Five patients (0.3%) received all three TTT. TTT patients were younger (P < 0.0001), less likely to have a preinjury history of hypertension (P = 0.0008), and less frequently anisocoric within 24 h from ICU admission (P < 0.0001) than those with no tier three therapy. TTT were used less frequently in high-income countries than in upper income and lower middle-income countries (no TTT in 78% of patients in high-income countries, in 60.6% of patients in upper middle-income countries, and in 56.6% of patients in lower middle-income countries; P < 0.0001). TTT were more frequent in patients with traumatic brain injury (TBI) compared with other types of ABI and in patients with invasive intracranial pressure (ICP) monitoring (P < 0.0001). TTT use was associated with a higher incidence of ventilator-associated pneumonia (P < 0.0001), need for tracheostomy (P = 0.0194), and prolonged ICU length of stay (LOS; P < 0.0001) but not with increased ICU or hospital mortality (P = 0.999). CONCLUSION Patients with ABI are frequently managed using at least one TTT. Their use varies according to a country's economic resources, the type of ABI, and ICP monitoring and is associated with a higher risk of complications but not with ICU or hospital mortality.

Administrative management and service quality in the dental offices within the context of an upper middle-income country.

This study examined the correlation between administrative management and service quality in dental offices in an upper middle-income country. An applied research approach with an observational, cross-sectional, and exploratory design was used. The sample included 100 patients aged 18 and older from dental offices in Peru, during 2023. Convenience sampling was employed. Spearman correlation and linear regression analyses were conducted. Results showed a positive and moderately strong correlation between administrative management and service quality (Spearman's rho = 0.79, p < 0.001). Effective organizing (β = 2.11, p < 0.001) and controlling (β = 1.58, p = 0.034) in administrative management were significantly associated with improved service quality. The study concludes that better administrative management positively impacts the quality of service in dental offices.

Spatial distribution and associated factors of co-occurrence of overweight/obesity and Anemia among women in the reproductive age in sub-Saharan Africa: A multilevel analysis, DHS 2016-2021.

Overweight/obesity is one of the major public health problems that affect both developed and developing nations. The co-occurrence of overweight/obesity and anemia is thought to be largely preventable if detected early. To date, no spatial analyses have been performed to identify areas of hotspots for the co-occurrence of overweight/obesity and anemia among reproductive women in sub-Saharan Africa. Therefore, this study aimed to assess the spatial distribution and associated factors of the co-occurrence of overweight/obesity and anemia among women of reproductive age. Data for the study were drawn from the Demographic and Health Survey, a nationally representative cross-sectional survey conducted in the era of Sustainable Development Goals, in which the World Health Assembly decided and planned to cease all forms of malnutrition by 2030. Seventeen sub-Saharan African countries and a total weighted sample of 108,161 reproductive women (15-49 years) were included in our study. The data extraction, recoding and analysis were done using STATA V.17. For the spatial analysis (autocorrelation, hot-spot and interpolation), ArcGIS version 10.7 software, and for the SaTScan analysis, SaTScan version 10.1 software was used. Descriptive statistics were presented using frequency tables and percentages. We employed multilevel logistic regression to investigate associated factors. In the multivariable analysis, variables with a p-value of ≤0.05 are considered as a significant factor associated with co-occurrence of overweight/obesity and anemia among women aged 15-49 years. The overall co-occurrence of overweight/obesity and anemia among women in sub-Saharan Africa was 12% (95%CI: 9-14%). The spatial analysis revealed that the co-occurrence of overweight/obesity and anemia among women significantly varied across sub-Saharan Africa. (Global Moran's I = 0.583163, p<0.001). In the spatial window, the primary-cluster was located in Liberia, Guinea, Gambia, Sira Leon, Mauritania, Mali, Cameron and Nigeria with a Log-Likelihood Ratio (LRR) of 1687.30, and Relative Risk (RR) of 2.58 at a p-value < 0.001. In multilevel analysis, women aged 25-34 years (AOR = 1.91, 95%CI: 1.78, 2.04), women aged 35-49 years (AOR = 2.96, 95% CI: 2.76, 3.17), married (AOR = 1.36, 95% CI: 1.27, 1.46), widowed (AOR = 1.22, 95%CI: 1.06, 1.40), divorced (AOR = 1.36, 95% CI: 1.23, 1.50), media exposure (AOR = 1.31, 95%CI: 1.23, 1.39), middle income (AOR = 1.19, 95%CI: 1.11, 1.28), high income/rich (AOR = 1.36, 95%CI: 1.26, 1.46), not working (AOR = 1.13, 95% CI:1.07, 1.19), traditional contraceptive utilization (AOR = 1.39, 95%CI: 1.23, 1.58) and no contraceptive use (AOR = 1.27, 95%CI: 1.20, 1.56), and no health insurance coverage (AOR = 1.36, 95%CI: 1.25, 1.49), were individual level significant variables. From community-level variables urban residence (AOR = 1.61, 95%CI: 1.50, 1.73), lower middle-income country (AOR = 2.50, 95%CI: 2.34, 2.66) and upper middle-income country (AOR = 2.87, 95%CI: 2.47, 3.34), were significantly associated with higher odds of co-occurrence of overweight/ obesity and anemia. The spatial distribution of the co-occurrence of overweight/obesity and anemia was significantly varied across the sub-Saharan African country. Both individual and community-level factors were significantly associated with the co-occurrence of overweight/obesity and anemia. Therefore, public health programmers and other stalk holders who are involved in maternal healthcare should work together and give priority to hotspot areas of co-occurrence in sub-Saharan Africa.

Auditory Risk Factors at Birth and Language Development at 2 Years of Age: A Longitudinal Analysis.

Aim. To analyze the relationship between auditory risk factors at birth and subsequent language development in toddlerhood. Methods. Participants are 136 children from a longitudinal birth cohort follow-up at age 2 years. They were divided into 2 groups: One comprising 105 children without hearing risk factors at birth and another comprising 31 children with auditory risk factors at birth but normal hearing. Results. In children with and without risk factors, the combination of socio-emotional, socio-economic, and auditory risk factors at birth significantly predicted language development at age 2 years. Family socio-economic status had a significant impact on overall child development, even after controlling for socio-emotional development and the presence of risk factors. Conclusions. The study was conducted in an upper-middle income country with a socialized health care system. It underscores the importance of a holistic approach to early childhood language development, taking into account biological, socioeconomic, and emotional factors.

Peer-reviewed publications in orthopaedic surgery from lower income countries: A comparative analysis.

Musculoskeletal (MSK) disease is a substantial global burden, especially in lower income countries. However, limited research has been published on MSK health by scholars from these countries. We aimed to study the distribution of authorships, including trends in peer-reviewed orthopaedic publications based on each author's affiliated institution's country income status. Based on a bibliometric search, 119 orthopaedic-related journals were identified using the Journal Citation Reports database. Details of all scientific articles published in these journals between 2012 and 2021 were used to study trends and association between each of the author's affiliated institution's country income status, using the World Bank Classification. Of the 133,718 unique articles, 87.6% had at least one author affiliation from a high-income country (HIC), 7.0% from an upper-middle income country (UMIC), 5.2% from a lower-middle income country (LMIC), and 0.2% from a low-income country (LIC). Overall, these articles were cited 1,825,365 times, with 92.5% of citations from HIC-affiliated authors and<0.1% from LIC-affiliated authors. Over the 10-year study period, HIC-affiliated articles demonstrated the largest increase in the number of publications (9107-14,619), compared to UMIC-affiliated (495-1214), LMIC-affiliated (406-874), and LIC-affiliated articles (4-28). There are large and persistent disparities in orthopaedic research publications based on the country income status of the author's affiliated institution, especially in the higher impact orthopaedic journals. Efforts should be made to increase opportunities for scholars from LICs and LMICs to publish their research in high-impact orthopaedic journals.

Oral health in emerging countries and suggestions for adjusted care strategies

Objective: Investigation into the oral health status of selected emerging countries from different regions of the world, so as to capture a broad spectrum of oral health reality prevailing in fast-growing middle-income countries, the aim being to present helpful steps towards adjusted strategies that improve the dental health of the entire population. Method: Using a composite indicator, the Dental Health Index, the oral health of entire populations is measured and compared with the aid of these quantifiable results. The study relies on existing data, where possible, from national representative surveys. Results: The best performer is the upper middle-income country of China. It is followed by India and Vietnam, two lower middle-income states, which placed second and third, although the two latter populations are largely untouched by professional dental activities. This finding is scientifically challenging to explain and needs further investigation. The relative wealthiest country, Malaysia, ranks in the sixth place while Brazil, with one of the highest dentist per capita ratios in the world, places only eighth, just ahead of the Philippines which ranks last in the study. Conclusion: Over the last decade, the awareness and the willingness shown by all countries to improve their precarious oral care situations resulted in the successful implementation of dental care strategies. However, the main obstacles - the widespread shortage of dentists and the poor oral health awareness among the population, particularly those living in poor and/or rural areas - can only be overcome by development-stage adjusted strategies. The broad use of teledentistry (TD) and priority education and training of mid-level dental professionals could be promising instruments for solving these shortcomings in a manageable period of time and under limited financial resources. To attract additional financial and technical resources and expertise, public/private partnerships should also be encouraged.

Harmonising dietary datasets for global surveillance: methods and findings from the Global Dietary Database.

The Global Dietary Database (GDD) expanded its previous methods to harmonise and publicly disseminate individual-level dietary data from nutrition surveys worldwide. Analysis of cross-sectional data. Global. General population. Comprehensive methods to streamline the harmonisation of primary, individual-level 24-h recall and food record data worldwide were developed. To standardise the varying food descriptions, FoodEx2 was used, a highly detailed food classification and description system developed and adapted for international use by European Food Safety Authority (EFSA). Standardised processes were developed to: identify eligible surveys; contact data owners; screen surveys for inclusion; harmonise data structure, variable definition and unit and food characterisation; perform data checks and publicly disseminate the harmonised datasets. The GDD joined forces with FAO and EFSA, given the shared goal of harmonising individual-level dietary data worldwide. Of 1500 dietary surveys identified, 600 met the eligibility criteria, and 156 were prioritised and contacted; fifty-five surveys were included for harmonisation and, ultimately, fifty two were harmonised. The included surveys were primarily nationally representative (59 %); included high- (39 %), upper-middle (21 %), lower-middle (27 %) and low- (13 %) income countries; usually collected multiple recalls/ records (64 %) and largely captured both sexes, all ages and both rural and urban areas. Surveys from low- and lower-middle v. high- and upper-middle income countries reported fewer nutrients (median 17 v. 30) and rarely included nutrients relevant to diet-related chronic diseases, such as n-3 fatty acids and Na. Diverse 24-h recalls/records can be harmonised to provide highly granular, standardised data, supporting nutrition programming, research and capacity development worldwide.

Understanding household-level risk factors for zero dose immunization in 82 low- and middle-income countries.

In 2021, an estimated 18 million children did not receive a single dose of routine vaccinations and constitute the population known as zero dose children. There is growing momentum and investment in reaching zero dose children and addressing the gross inequity in the reach of immunization services. To effectively do so, there is an urgent need to characterize more deeply the population of zero dose children and the barriers they face in accessing routine immunization services. We utilized the most recent DHS and MICS data spanning 2011 to 2020 from low, lower-middle, and upper-middle income countries. Zero dose status was defined as children aged 12-23 months who had not received any doses of BCG, DTP-containing, polio, and measles-containing vaccines. We estimated the prevalence of zero-dose children in the entire study sample, by country income level, and by region, and characterized the zero dose population by household-level factors. Multivariate logistic regressions were used to determine the household-level sociodemographic and health care access factors associated with zero dose immunization status. To pool multicountry data, we adjusted the original survey weights according to the country's population of children 12-23 months of age. To contextualize our findings, we utilized United Nations Population Division birth cohort data to estimate the study population as a proportion of the global and country income group populations. We included a total of 82 countries in our univariate analyses and 68 countries in our multivariate model. Overall, 7.5% of the study population were zero dose children. More than half (51.9%) of this population was concentrated in African countries. Zero dose children were predominantly situated in rural areas (75.8%) and in households in the lowest two wealth quintiles (62.7%) and were born to mothers who completed fewer than four antenatal care (ANC) visits (66.5%) and had home births (58.5%). Yet, surprisingly, a considerable proportion of zero dose children's mothers did receive appropriate care during pregnancy (33.5% of zero dose children have mothers who received at least 4 ANC visits). When controlled for other factors, children had three times the odds (OR = 3.00, 95% CI: 2.72, 3.30) of being zero dose if their mother had not received any tetanus injections, 2.46 times the odds (95% CI: 2.21, 2.74) of being zero dose if their mother had not received any ANC visits, and had nearly twice the odds (OR = 1.87, 95% CI: 1.70, 2.05) of being zero dose if their mother had a home delivery, compared to children of mothers who received at least 2 tetanus injections, received at least 4 ANC visits, and had a facility delivery, respectively. A lack of access to maternal health care was a strong risk factor of zero dose status and highlights important opportunities to improve the quality and integration of maternal and child health programs. Additionally, because a substantial proportion of zero dose children and their mothers do receive appropriate care, approaches to reach zero dose children should incorporate mitigating missed opportunities for vaccination.

Do Multinational Enterprises Matter for Economic Development?

The aim of the paper is to determine the effect of Multinational Enterprises on economic development, measured by the Human Development Index, in a group of 58 high and upper-middle income countries where they operated from 2005-2016, while considering the role of free trade agreements. We follow a robust dynamic panel data econometric methodology. For our analysis, we considered the total sample and sub-samples of countries based on their trade status. The results indicate that Multinational Enterprises drive economic development by favoring the expansion of people’s capabilities. Therefore, measured by added value, the economic activity of this type of company tends to enrich the life of society as well as the fundamental freedoms in the foreign country in which they operate. The effects of Multinational Enterprises on economic development are higher in countries with a large number of Free Trade Agreements, which means that intensification of free trade favors the MNE’s role in social goals.

Authorship inequalities in global health research: the IeDEA Southern Africa collaboration

BackgroundThe International epidemiology Databases to Evaluate AIDS conducts research in several regions, including in Southern Africa. We assessed authorship inequalities for the Southern African region, which is led by South...

THE IMPACT OF HUMAN CAPITAL ON THE GLOBAL INDEX OF INNOVATION

Natela Tsiklashvili &#x0D; E-mail: natia.tsiklashvili@bsu.edu.ge &#x0D; Professor, Doctor of Economics, Batumi Shota Rustaveli State University &#x0D; Batumi, Georgia&#x0D; https://orcid.org/0000-0003-0638-7376&#x0D; &#x0D; Nato Jabnidze &#x0D; E-mail: jabnidze.nato@bsu.edu.ge &#x0D; Associate Professor, Doctor of Economics, Batumi Shota Rustaveli State University &#x0D; Batumi, Georgia&#x0D; https://orcid.org/0000-0002-5557-6109&#x0D; &#x0D; Tamila Turmanidze &#x0D; E-mail:tamila.turmanidze@bsu.edu.ge &#x0D; Assist. Professor, Doctor of Economics, Batumi Shota Rustaveli State University &#x0D; Batumi, Georgia&#x0D; https://orcid.org/0000-0003-4710-2285&#x0D; &#x0D; Abstract. The global innovation index is used to evaluate the innovation environment in the country. The components included in this index mainly consider human knowledge and education. Human capital is one of the most important drivers of economic growth and innovation.&#x0D; The growth of investments in human capital will contribute to the growth of the economic value of education, the correct distribution of resources, and the correct management of state policy.&#x0D; The purpose of our research is to justify the need to invest in human capital and to evaluate its effectiveness, which is the main factor in the development of the innovative economy in the current period. In order to evaluate the effectiveness between the innovative economy and human capital, we conducted a study in companies. The research examines the attitude of employers and employees working in the Adjara region towards professional growth events (training/seminars) that are directly related to innovative technologies.&#x0D; Spending on education today is one of the most important ways to earn a higher income in the future. The amount of human capital in a country depends on education, that's why in developed countries, the effectiveness and strategies of investing in education are measured by the cost-benefit ratio.&#x0D; According to the Global Innovation Index, Georgia is in the category of upper-middle income countries. According to the 2022 report, Georgia showed high results in only 2 out of 7 categories.&#x0D; However, it should also be noted that the components of the index are based more on quantitative indicators than on qualitative indicators, so a single index cannot be a perfect estimator.

444. The disruptive effects of COVID-19 on the incidence of hospital acquired staphylococcus aureus bacteremia (HA-SAB) and its associated factors with mortality in a tertiary teaching hospital in an upper-middle income country

Abstract Background Hospital acquired bacteremia is predominantly caused by Staphylococcus aureus. Given its virulence, patients may experience serious complications that can be difficult to diagnose at the time of the infection leading to increased morbidity and mortality. The objective of this study is to evaluate the incidence of hospital-acquired Staphylococcus aureus bacteremia (HA-SAB) and its risk factors associated with mortality among hospitalized patients in Universiti Malaya Medical Centre (UMMC), a tertiary teaching hospital in Malaysia Methods This is a retrospective analysis of patients with HA-SAB admitted to UMMC over three time periods (P) in relation to the COVID-19 pandemic; P1 beginning of the pandemic (July 2020-May 2021), P2 during the peak of pandemic (June 2021-June 2022) and P3 recovery phase (July 2022-March 2023). We included patients ≥18 years old who fulfilled the criteria for HA-SAB. HA-SAB was defined as the first positive blood culture performed ≥48 hours after admission in patients with no evidence of infection at the time of admission. HA-SAB rates per 100 days admission and its risk factors associated with mortality were analyzed. Results A total of 287 cases of HA-SAB were identified (P1=80, P2=151 and P3=56) and the overall mortality rate was 31%. The HA-SAB rate increased by 42% from 0.19 (P1) to 0.33 (P2) per 100 admission days and decreased to 0.15 per 100 admission days (P3). On multivariate analysis, risk factors associated with mortality among patients with HA-SAB were older age (OR: 1.04, 95% Cl: 1.02-1.06), use of arterial lines (OR: 4.30, 95% Cl:1.57-11.5) and secondary bloodstream infection (BSI) (OR: 0.39, 95% Cl: 0.22 - 0.70). Conclusion The COVID-19 pandemic was associated with substantial increase in HA-SAB rate. This was likely due to changes in infection control measures in general and line care prevention bundle specifically to cope with the pandemic such as extended use of personal protective equipment (PPE), and non-adherence to the 5-moments of hand hygiene especially changing gloves between patients. Older age, use of arterial lines and secondary BSI were significantly associated with mortality among patients with HA-SAB. Disclosures All Authors: No reported disclosures

Analisis Pengaruh Pengeluaran Pemerintah terhadap Kualitas Sumber Daya Insani Perspektif Maqasyid Syariah: Bukti Empiris di Negara-Negara Berkembang OKI

The purpose of this study is to examine the impact of government expenditure on education and health on enhancing the quality of human resources in developing nations that are members of the OIC under maqasyid sharia. This study employs panel data and spans eight emerging nations (upper middle-income countries) from 2011 to 2020. The panel data model employed is the random effect model. The findings reveal that the variable of government spending on education has no effect on the growth of human resource quality. Government health investment has a considerable beneficial impact on the development of human resources in OIC emerging nations. When examined concurrently, government investment in education and health has a considerable beneficial effect on human capital development. Thus, long-term and coordinated investment in these two areas can bring significant rewards in terms of boosting human capital quality. According to maqasyid sharia, government expenditure in these two areas can assist individuals in achieving goals such as defending religion, soul, mind, children, and property in order to attain Falah

Nudging International Sustainable Practices Confirmed with Renewable Energy Consumption

The study explores the resemblance of the countries based on renewable energy consumption (% of total energy consumption). A simplistic clustering approach is applied to implement the segmentation using the gap statistic method. The paper deals with the comparability of countries from the perspective of income level and geographical distribution. The clustering-based results reveal that the values of most mean clusters representing major economies have deteriorated over the past few years. The High and Upper-middle income countries are found to be not following sustainable practices, while Low and Lower-middle income countries are relying much on renewable energy consumption. The outcome is also presented as clusters for geographical distribution and a cross-section distribution of Income level-Region for all economies sampled. The study may assist in policy-making in the wake of the global clean energy transition.

Mortality, cardiovascular disease and long covid at 3 months in individuals hospitalized with covid-19- a whf study

Abstract Background COVID-19 pandemic presents a number of unpredictable and long-lasting challenges. Understanding the short- and long-term effects of COVID-19 infection is crucial for better planning of preventive and management strategies for future pandemics. This study aims to determine short- and long-term clinical sequelae among COVID-19 hospitalized patients across low-middle-, upper-middle and high-income countries. Methods This global, multi-centre, prospective cohort study across 16 countries aimed to recruit 3300 patients hospitalized with COVID-19. We evaluated persistent long COVID symptoms, re-admissions, death, cardiovascular disease complications, new onset hypertension or diabetes, reinfection with COVID-19, vaccination, quality of life and costs at 1, 3, 6, 9-12-months post-hospital discharge using a standardized questionnaire over the phone. We are reporting interim descriptive analysis including demographic characteristics and short-term (3-month) clinical sequelae among COVID-19 hospitalized patients. Results We present baseline characteristics and follow-up data for 1,474 patients at the 3 months visit after hospital discharge. The patients were predominantly Asian (97%), male (55%) with a mean age (SD) of 56 (19.6) years and from low- and middle-income (82%), upper middle-income (4%) and high-income (14%) countries. 60% of the patients had received 2 doses of COVID-19 vaccination. 92% patients had fever and 90% had cough when admitted to hospital. More than one-third of patients (38%) reported at least one long COVID-19 symptom. Most commonly reported long COVID-19 symptoms were fatigue (22%), memory impairment, concentration, or decision-making (15%), and feeling more anxious (11%). Nearly half of the patients reported mild fatigue (46%) and 8% had severe fatigue. Less than 1% of patients reported loss of smell or taste. Most commonly reported post-discharge complications (new onset illnesses) were pulmonary embolism (8%), kidney involvement (2%) and new onset hypertension (1%). A quarter of patients reported problems in self-care, and 7%-12% patients reported pain or mobility issues or anxiety/depression. At 3-month follow-up, 3% of the patients had died and the most common causes of death were sudden cardiac arrest (33%), liver dysfunction/end stage renal disease (31%) and stroke or respiratory illness (13%). Conclusions Three months after hospitalized COVID-19, our interim analysis revealed a 3-month mortality rate of 3% mostly due to sudden cardiac arrest, liver dysfunction, stroke and respiratory diseases (relatively higher compared to studies from other regions). Patients commonly reported persistent symptoms, such as fatigue, memory/concentration impairment, and anxiety. Further, long-term follow-up data will guide health policies to prevent and manage long COVID sequelae worldwide.Table 1Figure 1