Upper-middle Income Countries Research Articles

Reducing air pollution does not necessarily reduce related adults' mortality burden: Variations in 177 countries with different economic levels

Prolonged exposure to PM2.5 is associated with increased mortality. However, reducing air pollution concentrations does not necessarily reduce the related burden of deaths. Here, we aim to estimate the variations in PM2.5-related mortality due to contributions from key factors – PM2.5 concentration, population exposure, and healthcare levels – for 177 countries from 2000 to 2018 at the 1-km grid scale according to the Global Mortality Exposure Model (GEMM) model. We find that global reductions in PM2.5-related deaths mainly come from high and upper-middle income countries, where lowered air pollutant concentration and better healthcare can offset mortality burdens caused by increasing exposed populations. Changes in population exposure to PM2.5 contribute the most (54 %) to change in global related deaths over the examined period, followed by changes in healthcare (−42 %) and pollution concentrations (4 %). The impacts vary across countries and regions within them due to other drivers, which are significantly influenced by development status. Policies aiming at reducing PM2.5 associated health risks need to account for country-specific balances of these key socioeconomic drivers.

Significant regional disparities in riverine microplastics

Research on riverine microplastics has gradually increased, highlighting an area for further exploration: the lack of extensive, large-scale regional variations analysis due to methodological and spatiotemporal limitations. Herein, we constructed and applied a comprehensive framework for synthesizing and analyzing literature data on riverine microplastics to enable comparative research on the regional variations on a large scale. Research results showed that in 76 rivers primarily located in Asia, Europe, and North America, the microplastics abundance of surface water in Asian rivers was three times that of Euro-America, while the sediment in Euro-American was five times that of Asia, indicating significant regional variations (p<0.001). Additionally, based on the income levels of countries, rivers in lower-middle and upper-middle income countries had significantly (p<0.001) higher abundance of microplastics in surface water compared to high-income countries, while the opposite was true for sediment. This phenomenon is preliminarily attributed to varying levels of urbanization across countries. Our proposed framework for synthesizing and analyzing microplastics literature data provides a holistic understanding of microplastics disparities in the environment, and can facilitate broader discussions on management and mitigation strategies. Environmental implicationsThrough literature synthesis, we gathered data on microplastics from 76 rivers, mainly distributed in Asia and the Euro-American regions. Our extensive regional analysis showed notable variations in the presence of microplastics within surface water and sediment across these regions, underlining crucial aspects of managing riverine microplastic pollution. It suggests that developed countries need to concentrate on sediment-based microplastics, whereas developing countries should give precedence to microplastics found in water samples.

Vaccine-Preventable Disease Outbreaks among Healthcare Workers: A Scoping Review.

Outbreaks of vaccine preventable diseases (VPDs) in health care workers (HCWs) can result in morbidity and mortality and cause significant disruptions to health care services, patients and visitors as well as an added burden on the health system. This scoping review is aimed to describe the epidemiology of VPD outbreaks in HCW, caused by diseases which are prevented by the ten vaccines recommended by World Health Organization (WHO) for HCWs. In April 2022 CINAHL, MEDLINE, Global Health and EMBASE were searched for all articles reporting on VPD outbreaks in HCWs since the year 2000. Articles were included regardless of language and study type. Clinical and epidemiological characteristics of VPD outbreaks were described. Our search found 9363 articles, of which 216 met inclusion criteria. Studies describing six of the ten VPDs were found: influenza, measles, varicella, tuberculosis, pertussis and rubella. Most articles (93%) were from high- and upper middle-income countries. While most outbreaks occurred in hospitals, several influenza outbreaks were reported in long term care facilities. Based on available data, vaccination rates amongst HCWs were rarely reported. We describe several VPD outbreaks in HCWs from 2000 to April 2022. The review emphasises the need to understand the factors influencing outbreaks in HCWs and highlight importance of vaccination amongst HCWs.

Pediatric anesthesiology in Brazil, Chile, and Mexico.

Latin America comprises an extensive and diverse territory composed of 33 countries in the Caribbean, Central, and South America where Romance languages-languages derived from Latin are predominantly spoken. Economic disparities exist, with inequitable access to pediatric surgical care. The Latin American Surgical Outcomes Study in Pediatrics (LASOS-Peds), a multi-national collaboration, will determine safety of pediatric anesthesia and perioperative care. Below, we provide a descriptive initiative to share how pediatric anesthesia in Brazil, Chile, and Mexico operate. Theses descriptions do not represent all of Latin America. Brazil an upper middle-income country, population 203 million, has a public system insufficiently resourced and a private system, resulting in inequitable safety and accessibility. Surgical complications constitute the third leading cause of mortality. Anesthesiology residency is 3 years, with required rotations in pediatric anesthesia; five hospitals offer pediatric anesthesia fellowships. Anesthesiology is a physician-only practice. A Pediatric Anesthesia Committee within the Brazilian Society of Anesthesiology offers education through seasonal courses and workshops including pediatric advanced life support. Chile is a high-income country, population 19.5 million, the majority cared for in the public system, the remainder in university, private, or military systems. Government efforts have gradually corrected the long-standing anesthesiology shortage: twenty 3-year residency programs prepare graduates for routine pediatric cases. The Chilean Society of Anesthesiology runs a 1-month program for general anesthesiologists to enhance pediatric anesthesia skills. Pediatric anesthesia fellowship training occurs in Europe, USA, and Australia, or in two 2-year Chilean university programs. Public health policies have increased the medical and surgical pediatric specialists and general anesthesiologists, but not pediatric anesthesiologists, which creates safety concerns for neonates, infants, and medically complex. Chile needs more pediatric anesthesia fellowship programs. Mexico, an upper middle-income country, with a population of about 126 million, has a five-sector healthcare system: public, social security for union workers, state for public employees, armed forces for the military, and a private "self-pay." There are inequities in safety and accessibility for children. Pediatric Anesthesiology fellowship is 2 years, after 3 years residency. A shortage of pediatric anesthesiologists limits accessibility and safety for surgical care, driven by added training at low salary and hospital under appreciation. The Mexican Society of Pediatric Anesthesiology conducts refresher courses, workshops, and case conferences. Insufficient resources and culture limits research.

A scoping review of continuing education models and statutory requirements for pharmacists globally

BackgroundIn the dynamic field of pharmacy amongst a diverse array of countries with disparate income levels, pharmacists play a pivotal role in integrating emerging scientific knowledge into their practice while adapting to evolving therapeutic interventions and expanding service delivery responsibilities. Lifelong Learning (LLL) is cultivated through continuing professional education (CPE) and continuing professional development (CPD), indispensable components ensuring sustained professional competence and heightened patient care quality. The global landscape witnesses diverse LLL activities tailored to pharmacists’ learning needs and preferences. This scoping review maps and synthesises a comprehensive global perspective on the existing knowledge regarding CPE/CPD models, statutory requirements, and pharmacists’ preferences for LLL activities.ObjectiveTo comprehensively investigate global models of CPE/CPD for pharmacists’ and examine the statutory requirements governing pharmacists’ registration and licensure.MethodA literature search of PubMed, Google Scholar, Web of Science, and the University of KwaZulu-Natal library search engine was undertaken for studies between January 2012 and February 2023. The article selection and reporting followed the recommendations made by PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) guidelines. The articles were tabulated based on their respective country’s income level, continuing education models employed, country-specific statutory requirements, and pharmacists’ preferences for LLL activities.ResultsOf the initial 3974 publications identified through the database search, 24 studies met the review criteria. The majority of the articles originated from high-income countries (HICs) (14/24, 58.3%), and most employed the mandatory CPD points system (21/24, 87.5%). However, in some HICs and upper-middle income countries (UMICs), the CPE/CPD is non-mandatory. While most countries (19/24, 79.2%) offer various LLL formats, the preference of pharmacists remains primarily face-to-face learning (13/24, 54.2%). However, workplace learning (3/24, 12.5%) and blended learning (7/24, 29.1%) are mentioned in some studies.ConclusionDiverse models of CPE/CPD alongside statutory requirements persist globally and evolve, shaped by varied implementation experiences. HICs lead in CPD models, while the implementation in low- and middle-income countries (LMICs) and low-income countries (LICs) requires further exploration for inclusivity and effectiveness. A few UMICs are either initiating or in early stages of implementing the CPD models. Structured planning for LLL activities is increasingly a global requirement for pharmacists’ licensure. The essential progression of pharmacy practice in developing healthcare systems necessitates a mandatory CPD model. Ongoing research is crucial to fortify the implementation, align and unify the CPD model with evolving pharmacy profession needs.

The Analysis of Natural Disaster Risk Impact on Labor Market Outcomes: Does It Lead to Middle-Class Workers Decrease?

Indonesia, as a country that is progressing towards an upper middle-income country, is facing a high incidence of disasters. Understanding how disasters impact living standards is still relatively difficult due to the lack of relevant studies in the literature. Therefore, the study aims to analyze the likelihood of individuals who were in areas with a high risk of disaster becoming middle-class workers. In this study, the incidence of disasters is represented by the disaster risk index, which comprises three components, namely the hazard, vulnerability, and capacity components in each province and regency/city based on the definition carried out by the National Disaster Management Agency (BNPB). By using logistics methods, this study found that individuals living in areas with a high risk of disaster tend to have a lower chance of becoming middle-class workers. In overcoming the labor market challenges faced by regions with high disaster risk, careful policy steps are needed that focus on strengthening capacity and reducing the risk of high investment costs. Enhancing disaster-resistant infrastructure and community networks as well as improving access to social protection services and promoting economic recovery are priorities.

Microbiota analysis in individuals with type two diabetes mellitus and end‑stage renal disease: A pilot study.

Chronic kidney disease (CKD) is a widespread health concern, which affects ~9.1% of the global population and 12-15% of individuals in upper-middle income countries. Notably, ~2% of patients with CKD progress to end-stage renal disease (ESRD), which leads to a substantial decline in the quality of life, an increased risk of mortality and significant financial burden. Patients with ESRD often still suffer from uremia and uremic syndromes, due to the accumulation of toxins between dialysis sessions and the inadequate removal of protein-bound toxins during dialysis. A number of these toxins are produced by the gut microbiota through the fermentation of dietary proteins or cholines. Furthermore, the gut microbial community serves a key role in maintaining metabolic and immune equilibrium in individuals. The present study aimed to investigate the gut microbiota patterns in individuals with type 2 diabetes mellitus (T2DM) and ESRD via quantitative PCR analysis of the 16S and 18S ribosomal RNA of selected members of the gut microbiota. Individuals affected by both T2DM and ESRD displayed distinctive features within their intestinal microbiota. Specifically, there were increased levels of Gammaproteobacteria observed in these patients, and all subjects exhibited a notably increased presence of Enterobacteriaceae compared with healthy individuals. This particular microbial community has established connections with the presence of inflammatory processes in the colon. Moreover, the elevated levels of Enterobacteriaceae may serve as an indicator of an imbalance in the intestinal microbiota, a condition known as dysbiosis. In addition, the Betaproteobacteria phylum was significantly more prevalent in the stool samples of patients with both T2DM and ESRD when compared with the control group. In conclusion, the present pilot study focused on gut microbiome alterations in T2DM and ESRD. Understanding the relationship between dysbiosis and CKD may identify new areas of research and therapeutic interventions aimed at modulating the gut microbiota to improve the health and outcomes of individuals with CKD and ESRD.

Examining the influence of global smoking prevalence on stroke mortality: insights from 27 countries across income strata

BackgroundThis study investigates the influence of Global Smoking Prevalence (GSP) on Stroke Death Rates (SDR) across 27 countries categorized into High-Income Countries (HIC), Upper Middle-Income Countries (UMIC), Lower Middle-Income Countries (LMIC), and Low-Income Countries (LIC).MethodsAnalysing data from two distinct periods (1990–1999 and 2010–2019), countries exhibiting an increased SDR were selected. The study uses a polynomial regression model, treating income groups as cross-sectional and years as time series data.ResultsResults from the regression model reveal that 17 countries observed a significant impact of GSP on SDR, with only Turkey, Solomon Islands, and Timor-Leste resulting in negative values. However, the study emphasises that out of all 27 countries, the highest occurrence of the impact of GSP on SDR has been reported in the LMIC stratum for the period under review.ConclusionIt is evident that GSP affects the risk of incidence of stroke death, specifically in the LMIC stratum. Furthermore, it has been identified that GSP is a major preventable risk factor affecting global mortality. To mitigate the risk of stroke death attributable to smoking prevalence, necessary preventive steps should be adopted to encourage smoking cessation, and essential policies should be implemented to reduce the burden of SDR.

From Theory to Practice: Examining the True Impact of Institutional Quality on Innovation Commercialization

Does better corruption controls as institutional quality measure affect commercialization of innovation? Institutional quality from corruption control perspective is very important to be considered for making strong strategic policies favorable for innovation commercialization. Using panel data consists of 15-year time span (2001-2015) covering 143 countries, initial regression estimates with robust check along with fixed effects presents that better corruption controls are positively effective in promoting innovation commercialization in the country which is further verified by using GMM estimates. Our preferred specifications imply that corruption effects on innovation commercialization is worse in Middle East and North American (MENA) regions which is around negative 65% especially in upper middle income and Catholic countries. Apart from the exports of high-tech products, other demand and supply side contributors of innovation commercialization are also important to account for. While improving the research and development aspects, the policy makers must also have to plan strategically for improving these channels which may help in improving the institutional quality in the country including investment in improving the grass root literacy levels, flexible facilities for entrepreneurial incubators, and optimal utilization of population growth with urbanization measures in the country.

Telephonic follow-up after day case pediatric surgery in an upper middle income country: A pilot study.

One third of South African children live in households with no employed adult. Telemedicine may save patients and the strained public health sector significant resources. We aimed to determine the safety and benefits of telephonic post-operative follow-up of patients who presented for day case surgery at CHBAH from 1 January-31 March 2023. A prospective descriptive study on patients undergoing day case surgery was performed. Healthy patients greater than 6years old whose caregivers spoke English and had access to a smartphone were included. Data on the total number of telephonic follow-ups, operative complications, need for in person review, satisfaction with telephonic follow-up, and savings in transport costs and time by avoiding in person follow-up were collected. A total of 38 telephonic follow-ups were performed. Six (15.8%) patients presented for in person review due to the detection of major complications (2, 5.3%), minor complications (2, 5.3%), and parental concern (2, 5.3%) during telephonic follow-up. All caregivers reported being satisfied with telephonic follow-up. Total savings in transport costs were R4452 (US $ 248.45). The majority of patients (29, 76.3%) had at least one unemployed parent. Seven caregivers (18.4%) avoided taking paid leave and 2 (5.3%) unpaid leave from work due to follow-up being performed telephonically. Innovation is necessary in order to expand access to safe, affordable, and timely care. In this selected group, telephonic follow-up was a safe, acceptable, and cost-effective intervention. The expansion of such a program has the potential for significant savings for patients and the healthcare system.

Portfolio analysis of global tobacco control research funding at the National Cancer Institute, 2000-2019.

Research in low- and middle-income countries (LMICs), where the majority of global tobacco users reside, is critical to addressing the global tobacco epidemic. This analysis describes the global tobacco control research portfolio funded by the National Cancer Institute from fiscal years 2000 to 2019. We used the National Institutes of Health Query, View, Report database to identify extramural grants relevant to global tobacco control research. Abstracts were analyzed to describe grant characteristics, including topic areas, tobacco products, countries, and regions of focus. Bibliometric and co-authorship network analyses were performed for publications associated with relevant grants. Of the 93 relevant grants with foreign (non-US) involvement, the majority (83.9%) supported research in upper and lower middle-income countries. The majority of grants (86.0%) focused on cigarettes, with a small subset of grants addressing smokeless tobacco, waterpipe use, or other non-cigarette products. Most grants focused on at least one of the six tobacco control policy measures in the World Health Organization MPOWER package; almost half (48.4%) focused on monitoring tobacco use and around one-third (32.3%) focused on offering tobacco cessation treatment, while other MPOWER measures received less attention in the research portfolio. While most of these grants, and the funding initiatives that supported them, emphasized research in low- and middle-income countries (LMICs), only 3 of 93 grants were awarded directly to LMIC-based institutions. There is a critical need for research to develop and test strategies to adapt, implement, and scale up evidence-based interventions across diverse LMIC settings. This study identified gaps in research activity that should be addressed to strengthen global tobacco control research capacity.

Intracranial non-germinomatous germ cell tumors in children and adolescents: how can the experience from an uppermiddle-income country contribute to the worldwide effort to improve outcomes?

Non-germinomatous germ cell tumors (NGGCT) accounts for one third of intracranial GCT. While the germinoma group have an excellent overall survival, the standard of practice for children with NGGCT is still under evaluation. Describe the results of the of the Brazilian consortium protocol. Since 2013, 15 patients with a diagnosis of NGGCT by histopathology and/or serum/cerebrospinal fluid (CSF) tumor markers, βHCG >200mlU/ml and/or positive alpha-fetoprotein were treated with neoadjuvant chemotherapy with carboplatin, cyclophosphamide and etoposide followed by ventricular radiotherapy (RTV) of 18Gy with boost (32Gy) to the primary site. Metastatic patients underwent craniospinal irradiation (CSI) and "slow responders" to the four initial cycles of CT, to autologous stem cell transplantation (ASCT) followed by CSI. Mean age, 13.1 years. Thirteen males. Primary sites: pineal (n=12), suprasellar (n=2) and bifocal (n=1). Four patients were metastatic at diagnosis. Eight patients had CSF and/or serum alpha-fetoprotein levels > 1,000ng/ml. Tumor responses after chemotherapy demonstrated complete in six cases and partial in seven, with "second-look" surgery being performed in five cases, and two patients presenting viable lesions being referred to ASCT. The main toxicity observed was hematological grades 3/4. Two patients with metastatic disease, one with Down Syndrome and AFP > 1,000ng/ml and the other with choriocarcinoma and pulmonary metastases, developed progressive disease resulting in death, as well as two other patients without evidence of disease, due to endocrinological disorders. Event-free and overall survival at 2 and 5 years were 80% and 72.7%, respectively, with a mean follow-up of 48 months (range, 7-107). Despite the small number of patients, in our series, treatment with six cycles of chemotherapy and RTV with focal boost for localized disease (n=11) and ACST for identified slow responders (n=2) seem to be effective strategies contributing to the overall effort to improve outcomes of this group of patients.

Screening Men and Women above the Age of 50 Years for Abdominal Aortic Aneurysm: A Pilot Study in an Upper Middle Income Country

Screening for abdominal aortic aneurysm (AAA) is recommended in high risk populations based on local conditions. Differences in lifestyle and risk factors between countries with different income status make risk stratification based on geographic location necessary. The majority of epidemiological studies on AAA have reported data from high income countries. The aim of this study was to explore the prevalence and risk factors for AAA in an upper middle income country in Eastern Europe. A pilot screening project for AAA, supported by a mass media campaign, was conducted in 2023 in seven cities in Serbia. Ultrasound evaluation of the abdominal aorta was performed by a registered vascular surgeon on individuals who agreed to participate. Participants who attended screening completed a questionnaire on demographic and clinical information. To assess risk factors for AAA, univariable logistic regression analysis was performed to compute the odds ratio (OR) with 95% confidence interval (CI). Multivariable logistic regression was subsequently performed with adjustments for sex, age, family history of AAA, and other relevant factors. A total of 4 046 participants (51.2% male and 48.8% female; mean age 68.8 ± 7.6 years) responded to the campaign. An aneurysm was found in 195 (4.8%) screened individuals (8.2% of men and 1.3% of women). In males aged 50 - 64 years, the prevalence of AAA was 5.4%. Male sex, older age, family history of AAA, being a smoker or ex-smoker, being overweight, and alcohol consumption were predictors of AAA in the univariable analysis. After adjustments in the multivariable analysis, male sex (OR 8.04, 95% CI 4.87 - 13.28), older age (OR 1.04, 95% CI 1.02 - 1.07), positive family history (OR 2.47, 95% CI 1.61 - 3.78), smoker status (OR 3.10, 95% CI 2.10 - 4.59), ex-smoker status (OR 2.13, 95% CI 1.39 - 3.27), and being overweight (OR 1.85, 95% CI 1.25 - 2.74) were independent risk factors for AAA. The prevalence of AAA has not been reduced in all countries, and screening strategies might be changed based on local epidemiological data. The results of this pilot study underline the importance of exploring the prevalence of AAA in populations with a high prevalence of smoking.

Abdominal Aortic Aneurysm Screening in a Population Older Than 50 in an Upper Middle Income Country

Abdominal Aortic Aneurysm Screening in a Population Older Than 50 in an Upper Middle Income Country

Smoking Susceptibility and Trends Among Nonsmoking Adolescents: An International Study.

Smoking susceptibility is defined as a lack of firm decision against smoking, usually starts in the preparation and/or initiation stages of smoking behavior, and is a strong predictor of smoking experimentation during adolescence. However, the recent global prevalence and trends in smoking susceptibility among adolescents are not well documented. This study assessed global smoking susceptibility and secular trends among nonsmoking adolescents. Smoking susceptibility was analyzed using the most recent data from the Global Youth Tobacco Survey from 129 countries, where the data from each country were drawn from at least 1 survey conducted at any time between 1999 and 2020. Moreover, data from 82 countries were used to assess the average annual rate of change (AARC) in smoking susceptibility over time. Smoking susceptibility among nonsmoking adolescents was 19.6%. A U-shaped relationship was observed between susceptibility and a country's economic level. Most countries showed no changes in susceptibility over time. Countries with a significant upward trend in susceptibility were primarily high-income and upper middle-income countries in the American region. At the World Health Organization regional level, susceptibility significantly decreased in the European region (AARC: -3.5%; 95% confidence interval, -5.8 to -0.8); however, it significantly increased in the American region (AARC: 2.2%; 95% confidence interval, 1.3-3.1). Smoking susceptibility remains a serious public health challenge among adolescents worldwide. More public health policies are needed to reduce susceptibility and to control its upward trend in the American region and high-income countries.

Burden of alcohol use and inclusion of alcohol use disorder medications in the essential medicine lists across 132 countries: An observational study

Harmful use of alcohol effects the health of the population. The treatment coverage of alcohol use disorders (AUD) varies among countries. The study aimed to determine the inclusion of AUD medicines in various national Essential Medicine Lists (EMLs) and its association with alcohol consumption. It was a secondary data analysis of alcohol consumptions and AUD related medicines in EML. Data were extracted from the WHO Global Essential Medicines database and the WHO Global Status Report on Alcohol and Health 2018. Data were extracted for 194 countries. Only 132 of 194 countries (68.0%) had EML, and among the 132 countries only 27.3% had included AUD medicines in their EML. Only 36 countries had included any of the AUD medicines in their EML. Disulfiram was included by 23 countries, while Acamprosate and Naltrexone was included by only four and 19 countries, respectively. Among the countries, 36.1% were from upper-middle income countries and 16.65 from low-income countries. The inclusion of AUD medicines in national EML was neither associated with alcohol consumption parameters nor the alcohol consumption related policy parameters. Considering the high prevalence of AUD and its complications, there is an urgent need to focus on including AUD medicines in national EML for making AUD treatment available and accessible across the world.

Assaying ramifications of climate change over productivity growth in developing countries

Maintaining an appropriate balance between mitigating global warming and boosting economic growth is a significant and complex challenge for all global governments and institutions. Developing countries are having difficulty reducing their negative impacts on the environment, even though their economies are thriving. Hence, the objective of this study is to comprehensively examine the impacts of temperature change, carbon dioxide emissions, human health, capital stock, and energy use over productivity growth for 105 developing countries. For this purpose, annual data for 1996–2022 is collected, and the dynamic generalized method of moments technique is applied to test the impacts of the concerned indicators on productivity growth. The empirical findings reveal that temperature change and carbon dioxide emissions have direct negative impacts, whereas human health positively boosts the productivity growth of developing countries. Additionally, to confirm the robustness and reliability of the findings, this study also analyzed by segregating the whole sample into lower-middle income and upper-middle income countries. Further, temperature change has been observed to be moderating in amplifying the adverse impacts on productivity growth through carbon dioxide emissions and human health. This study suggests the policymakers of developing countries should integrate climate resilience into infrastructure planning and development to resist extreme weather events associated with temperature rise to decrease global warming and boost economic growth and development. Then, they will have greater odds of achieving an ecologically friendly economy that can mitigate the impacts of climate change, inevitably encourage and support sustainable growth, and raise the well-being of society.

Attaining global peace and tourism competitiveness: linkages between tourism, security measures and economic stability

PurposeThe Sustainable Development Goal (SDG) 16 outlines sustainability as associated with peace, good governance and justice. The perception of international tourists about security measures and risks is a key factor affecting destination choices, tourist flow and overall satisfaction. Thus, we investigate the impact of armed forces personnel, prices, economic stability, financial development and infrastructure on tourism.Design/methodology/approachThis research used data from 130 countries from 1995 to 2019, which were divided into four income groups. This study employs a two-step generalized method of moments (GMM) technique and a novel tourism index comprising five relevant indicators of tourism.FindingsA 1% increase in armed forces personnel expands tourism in all income groups – 0.369% High Income Countries (HICs), 0.348% Upper Middle Income Countries (UMICs), 0.247% Lower Middle Income Countries (LMICs) and 0.139% Low Income Countries (LICs). The size of the tourism-safety coefficient decreases from high to low-income groups. The impact of inflation is significantly negative in all panels, excluding LICs. The reduction in tourism was 0.033% in HICs, 0.049% in UMICs and 0.029% in LMICs for a 1% increase in prices. The increase in the global tourism index is more in LICs (0.055%), followed by LMICs (0.024%), UMICs (0.009%) and HICs (0.004%) for a 1% expansion in the gross domestic product (GDP)/capita growth. However, the magnitude of the growth-led tourism impact is greater in developing countries. A positive impact of foreign direct investment (FDI) inflow was found in all panels like 0.016% in HICs, 0.050% in UMICs and 0.119% in LMICs for a 1% increase in FDI inflow. The rise in the global tourism index is 0.097% (HICs), 0.124% (UMICs) and 0.310% (LMICs) for a 1% rise in the financial development index. The increase in the global tourism index is 0.487% (HICs), 0.420% (UMICs) and 0.136% (LICs) for a 1% rise in the infrastructure index.Research limitations/implicationsEmpirical analysis infers important policy implications such as (a) establishment of a peaceful environment via recruitment of security personnel, use of safe city cameras, modern technology and law enforcement; (b) provision of basic facilities to tourists like sanitation, drinking water, electricity, accommodation, quality food, fuel and communication network and (c) price stability through different tools of monetary and fiscal policy.Originality/valueFirst, it explains the effect of security personnel on a comprehensive index of tourism instead of a single variable of tourism. Second, it captures the importance of economic stability (i.e., economic growth, financial development and FDI inflow) in the tourism–peace nexus.

Estimating annual ambient air pollution using structural properties of road networks

In recent years, the world has become increasingly concerned about air pollution. Particularly, High-Income Countries (HIC) and Upper Middle-Income Countries (UMIC) are implementing systems to monitor air pollution on a large scale to aid decision-making. Such efforts are essential, but they have at least three shortcomings: (1) they are costly; (2) they are slow to deploy; and (3) they focus on urban areas, which leads to urban-rural inequalities. Here, we show that we can estimate annual air pollution using open-source information about the structural properties of roads; we focus on England and Wales in the United Kingdom (UK) in this paper, although we argue that our methods are independent of specific country features. Our approach is an inexpensive method of estimating annual air pollution concentrations to an accuracy level that can underpin policymakers’ decisions while providing an estimate in all districts, not just urban areas. Furthermore, we contend that our process is interpretable and explainable.

Colorectal Cancer Screening Programs in Latin America

Colorectal cancer (CRC) is a leading cause of cancer-related mortality globally, with increasing incidence and mortality in Latin America. CRC screening programs can reduce disease burden, but information on screening programs in Latin America is limited. To describe characteristics (eg, type of program, uptake, neoplastic yield) of CRC screening programs in Latin America. PubMed, Ovid MEDLINE, EMBASE, Cochrane, PsycINFO, Web of Science Core Collection, LILACS, and SciELO were searched from inception to February 2023. Relevant references from bibliographies, conference proceedings, and gray literature were considered. The search strategy included English, Spanish, and Portuguese terms. Included were studies of CRC screening programs in Latin America using fecal immunochemical test (FIT) or colonoscopy as the primary screening method. Four reviewers independently assessed study eligibility based on titles, with review of abstracts and full texts as needed. Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed for data abstraction and quality assessment. Descriptive information was extracted, and data were pooled using a random-effects model. Program performance indicators included rates of participation and FIT positivity, adenoma detection rate (ADR), advanced adenoma detection rate (AADR), CRC detection rate, and colonoscopy quality indicators. There were 17 studies included from upper middle-income and high-income countries in Latin America with a total of 123 929 participants. Thirteen studies used FIT as the initial screening method, whereas 4 used screening colonoscopy. The participation rate in FIT-based programs was 85.8% (95% CI, 78.5%-91.4%). FIT positivity rates were 15.2% (95% CI, 9.6%-21.8%) for the 50-ng/mL threshold and 9.7% (95% CI, 6.8%-13.0%) for the 100-ng/mL threshold. For FIT-based studies, the pooled ADR was 39.0% (95% CI, 29.3%-49.2%) and CRC detection rate was 4.9% (95% CI, 2.6%-7.9%); for screening colonoscopy-based studies, the pooled ADR was 19.9% (95% CI, 15.5%-24.8%) and CRC detection rate was 0.4% (95% CI, 0.1%-0.8%). This systematic review and meta-analysis suggests that CRC screening in upper middle-income countries in Latin America is feasible, detecting rates of neoplasia comparable with those of high-income regions. Population-based screening programs should be developed or enhanced in these settings. There is a knowledge gap regarding feasibility and yield of screening programs in lower middle-income countries.