Upper-middle Income Countries Research Articles

Quantile analysis of the aspirational middle class in Malaysia: spending behaviour emulation or dissociation?

PurposeThis paper focusses on how the educated and less-educated middle class react differently to income increases, against an intertwined literature backdrop of Engel's law, quality of life, aspirational and conspicuous consumption. The paper seeks to answer two main questions: Is there evidence of the middle class, particularly the educated, trying to emulate the upper class by shifting towards aspirational consumption? Is there any distinct expenditure behaviour amongst the middle class?Design/methodology/approachCombining the Malaysian 2016 Household Expenditure Survey (HES) and the 2016 Consumer Price Indices datasets, quantile estimations are applied on the merged dataset of 14,326 households.FindingsThere is evidence of the educated middle class emulating the upper class in terms of food share, home furnishing and starchy produce expenditure behaviour. The less-educated middle class exhibits a predilection for home furnishing expenditures when income increases, whilst the educated shows signs of dissociating themselves from such material acquisitions. The paper concludes that the middle class is collectively an aspirational class, but with diverging paths towards upward social mobility between the educated and less-educated households.Originality/valueAspirational consumption of the middle class has not been given detailed empirical treatment at the household micro-level in the literature, especially for upper-middle income countries like Malaysia. The paper starts off by detecting an anomaly in the Engel's food share coefficients, where the middle class sees unexpected larger declines in food share than those of the upper class. This is the paper's departure point from the literature.

The COVID-19 Pandemic Identifies Significant Global Inequities in Hemodialysis Care in Low and Lower-Middle Income Countries—An ISN/DOPPS Survey

IntroductionIt is unknown how the COVID-19 pandemic has affected the care of vulnerable chronic hemodialysis (HD) patients across regions, particularly in low and lower-middle income countries (LLMICs). We aimed to identify global inequities in HD care delivery during the COVID-19 pandemic.MethodsThe ISN and the Dialysis Outcomes and Practice Patterns Study (DOPPS) conducted a global online survey of HD units between March and November, 2020, to ascertain practice patterns and access to resources relevant to HD care during the COVID-19 pandemic. Responses were categorized according to World Bank income classification for comparisons.ResultsSurveys were returned from 412 facilities in 78 countries: 15 (4%) in low-income countries (LICs), 111 (27%) in lower-middle income countries (LMICs), 145 (35%) in upper-middle income countries (UMICs), and 141 (34%) in high-income countries (HICs). Respondents reported that diagnostic tests for SARS-CoV-2 were unavailable or of limited availability in LICs (72%) and LMICs (68%) as compared with UMICs (33%) and HICs (20%). The number of patients who missed HD treatments was reported to have increased during the COVID-19 pandemic in LICs (64%) and LMICs (67%) as compared with UMICs (31%) and HICs (6%). Limited access to HD, intensive care unit (ICU) care, and mechanical ventilation among hospitalized patients on chronic dialysis with COVID-19 were also reportedly higher in LICs and LMICs as compared with UMICs and HICs. Staff in LLMICs reported less routine testing for SARS-CoV-2 when asymptomatic as compared with UMICs and HICs—14% in LICs and 11% in LMICs, compared with 26% and 28% in UMICs and HICs, respectively. Severe shortages of personal protective equipment (PPE) were reported by the respondents from LICs and LMICs compared with UMICs and HICs, especially with respect to the use of the N95 particulate-air respirator masks.ConclusionStriking global inequities were identified in the care of chronic HD patients during the pandemic. Urgent action is required to address these inequities which disproportionately affect LLMIC settings thereby exacerbating pre-existing vulnerabilities that may contribute to poorer outcomes.

Financial Inclusion, Poverty, and Income Inequality: Evidence from High, Middle, and Low-income Countries

The past two decades have witnessed a high national importance to financial inclusion around the world. This paper intends to explore the impact of financial inclusion on poverty reduction and income inequality in the world, high, middle, and low-income countries. For this purpose, a new composite financial inclusion was constructed with three dimensions for finding various macroeconomic variables affecting the level of financial inclusion for 122 economies, including 32 from high-income, 38 from upper middle income, 38 from lower middle income, and 14 from low-income countries. Then the impact of financial inclusion, on poverty and income inequality, for the world and then for high, middle, and low-income countries was investigated. The estimates reveal that rule of law significantly affects financial inclusion for the world, high, middle, and low-income countries. But age dependency ratio influences the financial inclusion only for our full sample. However, population density significantly decreases financial inclusion just in the full sample and Upper middle-income countries. Education completion impacts significantly financial inclusion just in upper middle income. While literacy has a higher impact on financial inclusion in high-income countries. The findings also indicate that financial inclusion is significantly correlated with lower poverty for the full sample. The link between financial inclusion and income inequality has been found for high-income countries and lower-middle-income countries.

A longitudinal study of dominant E. coli lineages and antimicrobial resistance in the gut of children living in an upper middle-income country

Objectives:The gastrointestinal tract constitutes a complex and diverse ecosystem. Escherichia coli is one of the most frequently studied and characterised species in the gut ecosystem; nevertheless, there has been little research to determine their diversity and population dynamics in the intestines of children over time. We analysed the turnover or dominant E. coli isolates in children faecal matter during 1 year.Methods:In this prospective study, a fresh faecal sample was obtained from children longitudinally over one year (30 faecal samples at sampling period 1 and 22 faecal samples at sampling periods 2 and 3). From each stool sample, five E. coli colonies were randomly selected (n = 405 E. coli isolates total) in order to characterize the genotype and phenotypic antimicrobial resistance patterns.Results:We were unable to find same E. coli dominant clone in faecal matter from 30 children in different sampling periods. Whole-genome sequencing of three isolates belonging to ST131 found in one child during the sampling period I and II indicated that isolates were three different ST 131 clones that carried extended-spectrum β-lactamase (ESBL) genes.Conclusion:We found that all numerically dominant E. coli lineages in children’s intestines were transient colonisers, and antimicrobial resistance phenotypes of these strains varied significantly over time without any apparent selective force.

Growth and growth disparities in Africa: Are differences in renewable energy use, technological advancement, and institutional reforms responsible?

Despite the tremendous average growth of the African countries over the last two decades, there is yet evidence of wide cross-country income gaps. In the same vein, there are variations in some important unconventional growth indicators in the region, making us to hypothesize that they could be responsible for the growth differences. Thus, this study examines the effect of renewable energy consumption, technology, and institutional reforms on the growth and growth disparities in Africa using the Augmented Mean Group (AMG) estimator. We find that renewable energy insignificantly impacts economic growth in the upper middle-income countries (UMIC) and lower middle-income countries (LMIC), but the impact is negative for the lower-income countries (LIC). Technology only spurs growth in the UMIC and LMIC, but it is stronger for the former. For institutional quality, its impact is more heterogeneous in that it varies across the income groups and across its sub-components. On average, however, it matters more for the growth of the LMIC than the UMIC, while it is insignificant for the LIC. Putting the entire African region into perspective, all the indicators are drivers of growth, although their impacts are still low, especially renewable energy consumption. Among others, policy makers should realize that neglecting these unconventional factors and income differences of the countries is inimical to the accurate modelling and projection of African growth.

Changes in the prevalence of decayed permanent teeth in Brazil and upper-middle income countries in the years 1990 and 2017

The distribution of caries is uneven and strongly associated with the different socioeconomic profiles of countries. The scope of this study was to describe the changes in the prevalence of decayed permanent teeth in Brazil and in upper-middle income countries for the years 1990 and 2017. It is a descriptive study based on secondary data extracted from the Global Burden of Disease. The 53 countries included in the upper-middle income group were included. Caries prevalence estimates were collected for the years 1990 and 2017. The percentage change in prevalence was calculated between the two years. The values of the Human Development Index (HDI) for each country were also collected. The results show the trend of a reduction in the prevalence of decayed permanent teeth in Brazil and in most upper-middle income countries. The prevalence of untreated caries in Brazil was 38.17% in 1990 and 37.46% in 2017. Brazil occupies the 41st position in the ranking of the reduction in the prevalence of caries among the 53 countries evaluated. The countries that achieved the greatest reductions in the prevalence of caries were those with an improvement in their HDI. In this respect, the need to review public oral health policies is revealed, as well as a reflection on addressing the inequities present in the countries surveyed.

Estimating the potential for global dissemination of pandemic pathogens using the global airline network and healthcare development indices

Pandemics have the potential to incur significant health and economic impacts, and can reach a large number of countries from their origin within weeks. Early identification and containment of a newly emerged pandemic within the source country is key for minimising global impact. To identify a country’s potential to control and contain a pathogen with pandemic potential, we compared the quality of a country’s healthcare system against its global airline connectivity. Healthcare development was determined using three multi-factorial indices, while detailed airline passenger data was used to identify the global connectivity of all countries. Proximities of countries to a putative ‘Worst Case Scenario’ (extreme high-connectivity and low-healthcare development) were calculated. We found a positive relationship between a country’s connectivity and healthcare metrics. We also identified countries that potentially pose the greatest risk for pandemic dissemination, notably Dominican Republic, India and Pakistan. China and Mexico, both sources of recent influenza and coronavirus pandemics were also identified as among the highest risk countries. Collectively, lower-middle and upper-middle income countries represented the greatest risk, while high income countries represented the lowest risk. Our analysis represents an alternative approach to identify countries where increased within-country disease surveillance and pandemic preparedness may benefit global health.

Identifying unanswered questions and setting the agenda for future systematic research in Multiple Sclerosis. A worldwide, multi-stakeholder Priority Setting project

BackgroundEliciting the research priorities of people affected by a condition, carers and health care professionals can increase research value and reduce research waste. The Cochrane Multiple Sclerosis and Rare Disease of CNS Group, in collaboration with the Cochrane Neurological Sciences Field, launched a priority setting exercise with the aim of prioritizing pressing questions to ensure that future systematic reviews are as useful as possible to the people who need them, in all countries, regardless of their economic status. MethodSixteen high priority questions on different aspects of MS were developed by members of a multi-stakeholder priority setting Steering Group (SG). In an anonymous online survey translated into 12 languages researchers, clinicians, people with MS (PwMS) and carers were asked to identify and rank, 5 out of 16 questions as high priority and to provide an explanation for their choice. An additional free-text priority research topic suggestion was allowed. ResultsThe survey was accessible through MS advocacy associations’ social media and Cochrane web pages from October 20, 2020 to February 6, 2021. 1.190 responses (86.73% of all web contacts) were evaluable and included in the analysis. Responses came from 55 countries worldwide, 7 of which provided >75% of respondents and 95% of which were high and upper-middle income countries. 58.8% of respondents live in the EU, 23% in the Americas, 8.9% in the Western Pacific, 2.8% in the Eastern Mediterranean and 0.3% in South Eastern Asia. About 75% of the respondents were PwMS. The five research questions to be answered with the highest priority were: Question (Q)1 “Does MRI help predict disability worsening of PwMS?” (19.9%), Q5 “What are the benefits and harms of treating PwMS with one disease-modifying drug compared to another?” (19.3%), Q3 “Does multidisciplinary care by teams of different social and health professionals improve health outcomes and experiences for PwMS?” (11.9%), Q16 “Does psychological health affect disease progression in PwMS?” (9.2%) and Q10 “What are the benefits and harms of exercise for PwMS?” (7.2%). The multivariable logistic regression analysis indicated a significant influence of geographic area and income level on the ranking of Q1 and a marginal for Q16 as top a priority after accounting for the effect of all other predictors. Approximately 50% of the respondents indicated that they had an important additional suggestion to be considered. ConclusionThis international collaborative initiative in the field of MS offers a worldwide perspective on the research questions perceived as pivotal by a geographically representative sample of multiple stakeholders in the field of MS. The results of the survey could guide the prioritization of research on pharmacological and non-pharmacological interventions which could be meaningful and useful for PwMS and carers, avoiding the duplication of efforts and research waste. High quality systematic reviews elicited by priority setting exercises may offer the best available evidence and inform decisions by healthcare providers and policy-makers which can be adapted to the different realities around the world.

Burden of Covid-19 restrictions: National, regional and global estimates.

SummaryBackgroundA growing literature has documented the high global morbidity, mortality and mental health burden associated with the current Covid-19 pandemic. In this paper, we aimed to quantify the total utility and quality of life loss resulting from Covid-19-related government restrictions imposed at the national, regional and global levels.MethodsWe conducted quality of life online surveys in France, India, Italy, UK and the United States of America between June 21st and September 13th 2021, and used regression models to estimate the average quality of life loss due to light and severe restrictions in these countries. We then combined estimated disutility weights from the pooled sample with the latest data on Covid-19 restrictions exposure in each country to estimate the total disutility generated by restrictions at the national, regional and global level. We also embedded a discrete choice experiment (DCE) into the online survey to estimate average willingness to pay to avoid specific restrictions.FindingsA total of 947 surveys were completed. Thirty-five percent of respondents were female, and 69.5% were between 18 and 39 years old. The weighted average utility weight was 0.71 (95% CIs 0.69–0.74) for light restrictions, and 0.65 (0.63–0.68) for severe restrictions. At the global scale, this implies a total loss of 3259 million QALYs (95% 3021, 3496) as of September 6th, 2021, with the highest burden in lower and upper middle-income countries. Utility losses appear to be particularly large for closures of schools and daycares as well as restaurants and bars, and seem relatively small for wearing masks and travel restrictions.InterpretationThe results presented here suggest that the QALY losses due to restrictions are substantial. Future mitigation strategies should try to balance potential reductions in disease transmission achievable through specific measures against their respective impact on quality of life. Additional research is needed to determine differences in restriction-specific disutilities across countries, and to determine optimal policy responses to similar future disease threats.FundingNo funding was received for this project.

Interventions to increase youth employment: An evidence and gap map.

Globally, 13% of the youth are not in education, employment or training (NEET). Moreover, this persistent problem has been exacerbated by the shock of Covid-19 pandemic. More youth from disadvantaged backgrounds are likely unemployed than those from better off backgrounds. Thus, the need for increased use of evidence in the design and implementation of youth employment interventions to increase effectiveness and sustainability of interventions and outcomes. Evidence and gap maps (EGMs) can promote evidence-based decision making by guiding policy makers, development partners and researchers to areas with good bodies of evidence and those with little or no evidence. The scope of the Youth Employment EGM is global. The map covers all youth aged 15-35 years. The three broad intervention categories included in the EGM are: strengthening training and education systems, enhancing labour market and, transforming financial sector markets. There are five outcome categories: education and skills; entrepreneurship; employment; welfare and economic outcomes. The EGM contains impact evaluations of interventions implemented to increase youth employment and systematic reviews of such single studies, published or made available between 2000 and 2019. The primary objective was to catalogue impact evaluations and systematic reviews on youth employment interventions to improve discoverability of evidence by decision makers, development patterners and researchers, so as to promote evidence-based decision making in programming and implementation of youth employment initiatives. Twenty databases and websites were searched using a validated search strategy. Additional searches included searching within 21 systematic reviews, snowballing 20 most recent studies and citation tracking of 10 most recent studies included in the EGM. The study selection criteria followed the PICOS approach of population, intervention, relevant comparison groups, outcomes and study design. Additional criterion is; study publication or availability period of between 2000 and 2021. Only impact evaluations and systematic reviews that included impact evaluations were selected. A total of 14,511 studies were uploaded in EPPI Reviewer 4 software, upon which 399 were selected using the criteria provided above. Coding of data took place in EPPI Reviewer basing on predefined codes. The unit of analysis for the report is individual studies where every entry represents a combination of interventions and outcomes. Overall, 399 studies (21 systematic reviews and 378 impact evaluations) are included in the EGM. Impact evaluations (n = 378) are much more than the systematic reviews (n = 21). Most impact evaluations are experimental studies (n = 177), followed by non-experimental matching (n = 167) and other regression designs (n = 35). Experimental studies were mostly conducted in both Lower-income countries and Lower Middle Income countries while non-experimental study designs are the most common in both High Income and Upper Middle Income countries. Most evidence is from low quality impact evaluations (71.2%) while majority of systematic reviews (71.4% of 21) are of medium and high quality rating. The area saturated with most evidence is the intervention category of 'training', while the underrepresented are three main intervention sub-categories: information services; decent work policies and; entrepreneurship promotion and financing. Older youth, youth in fragility, conflict and violence contexts, or humanitarian settings, or ethnic minorities or those with criminal backgrounds are least studied. The Youth Employment EGM identifies trends in evidence notably the following: Most evidence is from high-income countries, an indication of the relationship between a country's income status and research productivity.The most common study designs are experimental.Most of the evidence is of low quality. This finding serves to alert researchers, practitioners and policy makers that more rigorous work is needed to inform youth employment interventions. Blending of interventions is practiced. While this could be an indication that blended intervention could be offering better outcomes, this remains an area with a research gap.

The effects of greenfield foreign direct investment and cross‐border mergers and acquisitions on energy intensity in upper-middle income countries and low- and lower-middle income countries

ABSTRACT This study examines the effects of greenfield foreign direct investment (FDI) and cross‐border mergers and acquisitions (M&As) on energy intensity for a sample of 35 upper-middle-income countries (UMICs) and a sample of 49 low- and lower-middle-income countries (LLMICs). It is the first to examine the energy intensity effects of greenfield FDI and cross‐border M&As for subgroups of developing countries with different levels of income. It is also the first study of its kind to use stationary and non-stationary panel methods. The main findings are: first, both greenfield FDI and cross-border M&As have an insignificant impact on energy intensity in LLMICs, and second, while the effect of cross-border M&As on energy intensity is insignificant in UMICs, greenfield FDI exerts a negative and significant impact on energy intensity in UMICs.

Evaluation of the environmental Kuznets curve hypothesis in a tourism development context: evidence for 15 Latin American countries

AbstractThe tourism sector is growing rapidly, and this has greatly stimulated economic growth around the world; however, the environmental degradation that this implies cannot be ignored. In order to achieve sustainable tourism, it is important to study the link between tourism and environmental quality. Therefore, the objective of this study was to investigate the relationship between tourism and CO2 emissions from 1995 to 2018 in a sample of 20 Latin American countries. Econometric techniques of cointegration and causality were used to evaluate the relationship between these variables. To test the consistency of cointegration vectors, the dynamic ordinary least squares (DOSL) model was applied for individual countries and the panel dynamic ordinary least squares (PDOLS) model for groups of countries. The results show that tourism revenues have a negative effect on the global panel and upper‐middle‐income countries (UMICs). This result is statistically significant. However, as tourism revenues increase, they start to have a positive and significant effect on CO2 emissions per capita, globally and in UMICs. These results, which are contrary to the theory, form a U shape, which does not support the ecological Kuznets curve.

‘I know what I should be feeding my child’: foodways of primary caregivers of Child Support Grant recipients in South Africa

ABSTRACT Background Despite South Africa being an upper middle-income country producing enough food to sustain its population, and having an advanced social welfare system, it has high levels of food insecurity at the household-level. Food insecurity is linked to malnutrition and undernutrition in children. This manuscript addresses gaps in knowledge about food choices and practices of primary caregivers of children in receipt of South Africa’s largest cash transfer programme, the Child Support Grant (CSG). Objective The main objective of the study was to explore CSG caregivers’ foodways and the choices they made about what food to buy, where to buy it and for what reasons, in Langa in the Western Cape and Mt Frere in the Eastern Cape. Methods We conducted a total of 40 in-depth interviews and 5 focus group discussions with primary caregivers of Child Support Grant recipients younger than 5 years in the Eastern and Western Cape provinces. Results Caregivers’ food choices were less influenced by cultural practices and personal preferences, than by financial and physical constraints in terms of what and where to access food. Constraints in food choices were chiefly a consequence of the small amount of the grant, as well as a food environment that only availed foods of a certain quality and type in these low-income communities Conclusions The foodways of recipients of social assistance can only be better aligned with nutrition messaging and policy if there are changes in the monetary value of cash transfers, and the food environments of low-income households which determine access to, availability and affordability of nutritious food. Local informal food enterprises play an important role in the food system of CSG recipients and need to be considered in any strategies that seek to reform the food system of low-income communities in South Africa and similar settings

The Non-adherence Scope in Stroke: A Narrative Review

<p style="text-align: justify;">Stroke is among the most significant disease burden globally, with upper middle-income countries having the highest prevalence. Worldwide stroke burden is credited to modifiable risk factors related to underlying comorbidities and the patients&rsquo; lifestyle. Non-adherence to medication is an added liability which cause substantial loss in terms of money, time, and effort of various stakeholders. There is a lack of behavioural interventions with significant results to overcome intentional non-adherence to stroke preventative medication. A narrative review was selected for analysis to gain a general understanding and defining of intentional non-adherence. The results of this review identified several criteria of perception, belief, and attitude of stroke patients&rsquo; intrinsic and extrinsic characteristics of medication taking and treatment behaviour which are potential modifiable factors to sustain stroke prevention. <p style="text-align: justify;"><strong>Key words:</strong> Stroke, Non-adherence, Behaviour, Belief, Intrinsic and Extrinsic factors, Medication taking behaviour.

Feasibility Study of Transanal Irrigation Using a Colostomy Irrigation System in Patients With Low Anterior Resection Syndrome.

Low anterior resection syndrome has a negative impact on quality of life. Intestinal irrigation is a method of lavage consisting of a scheduled evacuation. This study aims to evaluate functional and quality-of-life outcomes in patients with low anterior resection syndrome after transanal irrigation using a colostomy irrigation system. This was a prospective case series. This study presents a single-center experience at a tertiary oncological center in an upper-middle-income country. Patients classified as having minor or major low anterior resection syndrome 12 months after their operation were selected. Transanal irrigation was performed using an ostomy irrigation kit. Questionnaires assessing patients' bowel function (low anterior resection syndrome and Wexner score) and quality of life (Short Form-36 questionnaire) were applied before and after treatment. The primary outcomes were low anterior resection syndrome score and quality-of-life improvement after a 12-month treatment. Of the 22 patients included, 20 had major and 2 had minor low anterior resection syndrome, with a median score of 39, especially high rates of incontinence for liquid stool (21; 95.5%), clustering (21; 95.5%), and urgency (17; 77.3%). All patients successfully completed the 3-day training, and there were no complications during the treatment. After the 12-month period, the median score was 8, with 90% of the patients classified as having "no syndrome" and great improvement in all domains of this score. The most improved quality-of-life sections were patient vitality (p = 0.025) and physical (p = 0.002), social (p = 0.001), and emotional aspects (p = 0.001). The study was limited by its small sample size and the limited follow-up period. This study presents a safe implementation protocol of an ostomy irrigation device for transanal irrigation. It also adds to the literature that transanal irrigation is a safe, effective, and easily implemented procedure for patients with low anterior resection syndrome with a significant improvement in quality of life. See Video Abstract at http://links.lww.com/DCR/B563.ESTUDIO DE FACTIBILIDAD DE LA IRRIGACIÓN TRANSANAL UTILIZANDO EL SISTEMA DE IRRIGACIÓN PARA COLOSTOMÍA EN PACIENTES CON SÍNDROME DE RESECCIÓN ANTERIOR BAJAANTECEDENTES:El síndrome de resección anterior baja tiene un impacto negativo en la calidad de vida de los pacientes. La irrigación intestinal es un método de lavado que consiste en evacuaciones programadas.OBJETIVOS:Evaluar los resultados de la funcionalidad e impacto en la calidad de vida de los pacientes con síndrome de resección anterior y baja posterior a la irrigación transanal utilizando un sistema de irrigación de colostomía.DISEÑO:Es estudio prospectivo de una serie de casos.ESCENARIO:En este estudio se muestra la experiencia de un centro oncológico de tercer nivel en un país en vías de desarrollo.PACIENTES:Aquellos clasificados como síndrome con afección en menor o mayor grado doce meses después de la cirugía.METODO:Se efectuó irrigación transanal utilizando un equipo de irrigación de estomas. Se aplicaron cuestionarios para valorar la función intestinal de los pacientes (síndrome de resección anterior baja y la escala de Wexner) y para calidad de vida (Cuestionario Corto-36) antes y después del tratamiento.EVALUACION DE LOS RESULTADOS PRINCIPALES:Los principales resultados se obtuvieron de la escala del síndrome de resección baja y la mejoría en la calidad vida doce meses después de tratamiento.RESULTADOS:De los veintidós pacientes incluidos, veinte presentaron manifestaciones mayores del síndrome de resección baja y dos, manifestaciones menores. Con una media de treinta y nueve, se encontraron, especialmente, altos índices de incontinencia a líquidos (21; 95'5%) hiperdefecación "clustering" (21; 95'5%) y urgencia (17; 77'3%). Todos los pacientes completaron en forma satisfactoria el entrenamiento de tres días sin presentarse complicaciones durante el tratamiento. Al término del mes doce la media fue de ocho, con el 90% de los pacientes clasificados como "sin síndrome" y se observó una mejoría substancial en todos los puntos de la evaluación. Las secciones de calidad de vida que mostraron una mejoría significativa fueron: la vitalidad del paciente (p = 0'025), física (p = 0'002), social (p = 0'001) y emocional (p = 0'001).LIMITACIONES:El tamaño de la muestra es pequeño y el tiempo de seguimiento corto.CONCLUSIONES:Este estudio muestra la implementación de un protocolo seguro para la irrigación de estomas mediante un dispositivo transanal. Además contribuye con el concepto en la literatura de que la seguridad de la irrigación transanal es seguro, efectivo y facilmente reproducible para pacientes con síndrome de resección anterior baja con una mejoría significativa en la calidad de vida. Consulte Video Resumen en http://links.lww.com/DCR/B563. (Traducción-Dr. Miguel Esquivel-Herrera).

The effect of Foreign direct investment and financial development on economic growth: Evidence from global income countries

Prior researchers have explored the role of FDI and economic growth or financial development and economic growth in a particular sample of countries or region while no collective studies on the effect of FDI, banks and stock market on economic growth in region or income-based groups have been conducted yet. Using a balanced panel data set of the globe of 193 upper middle income (UMI), lower middle income (LMI) and high income (HMI) countries for the period of 1998 to 2018, the study ever the first time explore the role of FDI, banks and stock markets financial development on economic growth by employing static methods and Dynamic approaches which contributes to the scarce literature on the collective and across income-based groups of countries. All model findings for the global panel indicates that FDI affect economic growth significantly and positively in the global panel, lower middle income (LMI) and upper middle income (UMI) countries where it’s not true for high income (HI) countries. Banking sector development also affect economic growth significantly but negatively in the global panel, high income and upper middle-income countries while not significant for the lower middle income (LMI) countries. Stock market development also affects economic growth significantly but negatively in the global panel. Furthermore, the result concludes that FDI have a larger effect on economic growth than does banks or stock market financial development. This study suggest high income countries regards improving FDI attraction, lower middle income (LMI) countries in regards improve banking sector and collectively suggest to improve major driver and functioning of banking sector and stock markets to spur economic growth. This study is beneficial for the government channels and financial sector of the study countries to make further decision.

Pulmonary Tuberculosis and Risk of Lung Cancer: A Systematic Review and Meta-Analysis.

Pulmonary tuberculosis (TB) is a known risk factor for lung cancer. However, a detailed analysis of lung cancer type, age, sex, smoking, and TB burden associated with geographic and socioeconomic status has not been performed previously. We systematically appraised relevant observational studies reporting an association between pulmonary TB and lung cancer. All studies were included in the primary analysis, and studies that used robust TB diagnostic methods, such as validated medical diagnostic codes, were included in the secondary analysis. Thirty-two articles were included. The association between the history of pulmonary TB and diagnosis of lung cancer was statistically significant (OR 2.09, 95% CI: 1.62–2.69, p < 0.001). There was a high heterogeneity (I2 = 95%), without any publication bias. The analysis indicated a high association in advanced articles describing stringent pulmonary TB diagnosis (OR 2.26, 95% CI: 1.29–3.94, p = 0.004). The subgroup analyses suggested a significant association in countries with medium or high TB burdens, from East Asia and the Pacific region, and upper-middle income countries. Heterogeneity within the subgroups remained high in a majority of the subgroup analyses. A meta-regression analysis revealed that younger patients showed a significantly higher association between TB and lung cancer (regression coefficient = 0.949, p < 0.001). The history of pulmonary TB is an independent risk factor for lung cancer, especially in younger patients diagnosed with pulmonary TB. Clinicians should be aware of this association while treating young patients with a history of pulmonary TB.

Financial development, ecological transition, and economic growth in Sub-Saharan African countries: the performing role of the quality of institutions and human capital.

Even though the ecological transition is considered the next big challenge for Africa, few studies have examined its scope regardless of the massive financing that is required and the stakes on other sectors. This study analyzes the links between financial development, ecological transition, and economic growth in Sub-Saharan Africa from 1980 to 2019. The Dumitrescu and Hurlin causality tests, Pedroni and Westerlund cointegration, and the Augmented Mean Group algorithm are applied on a sample of forty-eight countries. The findings support that institutional quality and human capital are crucial, but their effects can only be observed in high-income and upper middle-income countries. The level of economic development matters, and there is a threshold beyond which the effects of renewable energies and human capital occur on the performance of the financial system. Trade openness and investments seem also to be positive and significant on ecological transition only in these countries. Furthermore, there is substitutability between non-renewable and renewable energy consumption in these countries, while in lower middle-income and low-income countries, there is complementarity. The study concludes by highlighting key policy recommendations to sustain ecological transition.

Strategies to improve the quality of midwifery care and developing midwife-centered care in Iran: analyzing the attitudes of midwifery experts

BackgroundIn recent years, extensive studies have been designed and performed in the context of providing midwifery care in developed countries, which has been unfortunately neglected in some low resources and upper middle-income countries such as Iran. This study was conducted to identify the best strategies for improving the quality of midwifery care and developing midwife-centered care in Iran.MethodsThis was a qualitative study using focus group discussion and content analysis method. Data were collected from 121 participants including midwifery board members, gynecologists, heads of midwifery departments, midwifery students, in charge midwives in hospitals, and midwives in the private sector. Focused-group discussions were used for data collection, and data were analyzed using content analysis method.ResultsThe main themes extracted from the participants’ statements regarding improving the quality of midwifery care were as follows: Promotion and development of education, Manpower management, Rules, and regulations and standards for midwifery services, and Policy making.ConclusionThis study showed that to improve midwifery care, health policy makers should take into account both the quality and quantity of midwifery education, and promote midwifery human resources through employment. Furthermore, insurance support, encouragement, supporting and motivating midwives, enhancing and improving the facilities, providing hospitals and maternity wards with cutting-edge equipment, promoting and reinforcing the position of midwives in the family doctor program, and using a referral system were the strategies proposed by participants for improving midwifery care. Finally, establishing an efficient and powerful monitoring system to control the practice of gynecologists and midwives, promoting the collaborative practice of midwives and gynecologists, and encouraging team-work with respect to midwifery care were other strategies to improve the midwifery services in Iran. Authorities and policymakers may set the stage for developing high quality and affordable midwifery care by relying on the strategies presented in this study.

The impact of technological and social capabilities on innovation performance: a technological catch-up perspective

The literature on technological capabilities has highlighted the effects of innovation on economic growth. However, further analysis is required to determine how innovation factors affect the technological catch-up process outputs. The main purpose of the present study is therefore to determine the impacts of innovation-building factors (i.e., technological and social capabilities) on the innovation outputs. The role of market and innovation financing in technological catch-up has also been investigated. Partial least squares structural equation modeling has been employed to identify which factors have the most significant effects on this process. We have extracted twelve hypotheses from the catch-up theory and then investigated the effects of the factors on the outputs in seventy countries during 2013–2019. The results illustrate that human capital and research are influential factors regarding technological catch-up in middle (and upper-middle) income countries. Relationships between academic and industrial sectors are essential for educational and research expenditures. Furthermore, business sophistication has a more significant effect on high-income countries rather than middle-income countries.