Upper-middle Income Research Articles

Welfare regimes and socioeconomic inequalities in edentulism: A multilevel analysis of 40 countries

Abstract Aim To evaluate the association between welfare regimes with edentulism and to investigate if it modifies the magnitude of socioeconomic inequalities in edentulism. Methods We analysed data from 40 high-, middle- and low-income countries collected between 2007 and 2018, encompassing 117397 individuals 20 years or older. The main outcome was edentulism and welfare regimes were the main exposure and effect modifier. Individual level variables were sex, age and quintiles of the wealth score. Multilevel logistic regression was used to estimate the odds of being edentulous and cross-level interaction terms between individual wealth and country factors were tested. Findings Individuals at the lowest wealth quintile had a consistently higher prevalence of edentulism. The highest age-sex standardised prevalence of edentulism was found in Eastern European countries (9.9%) followed by Informal Security (9.4%), while the lowest was among the Insecurity regime (1.4%) followed by the Social Democratic regime (4.7%). Liberal countries presented the highest magnitude of absolute and relative inequalities, where the lowest quintile had OR = 16.7 (95%CI: 10.5-26.5) times more chances of being edentulous and 14.4 percentage points higher prevalence. Low-income countries in the Insecurity Regime in social and labour market presented the lowest level of inequalities. Among HIC and upper-middle income countries, Social Democratic regime had the lowest absolute inequalities (4.0 percentage points difference between highest and lowest quintiles) and the Informal Security regime had the lowest relative differences between the highest and lowest quintiles (OR = 3.21, 95%CI: 2.83-3.63). Interpretation Our findings suggest that policies in some welfare regimes might improve oral health while reducing inequalities. High and upper-middle-income countries presented a high level of edentulism and inequalities. Key messages • Larger socioeconomic inequalities in edentulism were found in high-income countries with liberal policies. • A possible benefit of welfare policies on prevalence and inequalities in edentulism may be only evident among industrialised countries.

Examining The Impact of Macroeconomics Factors on Carbon Emissions in Selected 7-ASEAN Members: A Panel Data Analysis

This study investigates the relationships between urbanization, economic growth, energy consumption, transportation, and carbon emissions in seven ASEAN countries from 2011 to 2022. As released by the World Health Organization (WHO), more than 80 percent of the world’s population living in urban areas were exposed to air quality levels that were above the WHO limits. The region that is most affected comes from those nations categorized as low to middle-income countries. Hence, it is best to examine why these 7 ASEAN nations categorized from the lower to upper-middle income countries are not able to control the increase in the level of their carbon emissions. The analysis would also identify the appropriate empirical model suitable for the data. Using panel data analysis applying econometric modeling which are the Pooled Ordinary Least Square, Fixed Effects Model, and Random Effects Model, the findings support the Environmental Kuznets Curve hypothesis, revealing that urbanization and economic growth significantly increase carbon emissions. The study emphasizes the need for renewable energy adoption and sustainable urban planning to reduce carbon footprints. Key recommendations include enhancing energy efficiency and promoting cleaner transportation technologies to achieve sustainable economic growth in the ASEAN region.

Keeping your butter safe: groundwork for a new measure of development

The development of a nation is traditionally measured by GDP per capita, with countries classified as low, lower-middle, upper-middle and high income economies. What is overlooked is that some of the goods consumed by people and part of the GDP, such as barbed wires and private police, are not valued in themselves but are protective measures against crime and corruption, to ensure that goods that are valued are safe. This suggests the need to redefine GDP to measure the true value of what a nation consumes and saves. This paper proposes a new measure and spells out its microeconomic foundation.

Evaluating the benefits of emicizumab prophylaxis for haemophilia A with inhibitors: A cost-effectiveness and budget impact analysis in Thailand's upper-middle income setting.

In Thailand, an upper-middle-income country, managing haemophilia A (HA) with inhibitors poses significant challenges, often necessitating bypassing agents (BPAs) for bleeding control. This study evaluates the cost-effectiveness and budget impact of emicizumab, a novel prophylactic agent, as an alternative to both episodic and prophylactic BPA treatments from a societal perspective. A Markov model was employed to estimate the lifetime societal costs and outcomes of emicizumab prophylaxis for HA patients with inhibitors. Treatment efficacy, cost, and epidemiological data were obtained through a comprehensive literature review and incorporated into the model. A 5-year budget impact analysis complemented the cost-utility analysis, with a 3% annual discount rate applied to future costs and outcomes. In the base-case scenario, emicizumab prophylaxis in HA patients aged 2 years and above demonstrated superior cost-effectiveness, yielding 18.1 quality-adjusted life years (QALYs) per patient over a lifetime and resulting in cost savings of 138 million Thai Baht (THB) compared to BPA prophylaxis. Compared to episodic BPA treatment, emicizumab yielded 30.5 QALYs and saved 25 million THB per patient. The 5-year budget impact was projected at 1775 million THB. Emicizumab offers a cost-saving approach for HA treatment with inhibitors in Thailand, promising significant health benefits and budgetary savings. This supports its potential inclusion in Thailand's National List of Essential Medicines to enhance haemophilia care access. Managing haemophilia A (HA) with inhibitors in Thailand, an upper-middle-income country, faces challenges due to limited access to effective treatments or newer drugs for bleeding management. Emicizumab prophylaxis found to as a cost-effective and viable alternative to traditional treatments, effectively preventing bleeding in Thai HA patients over 2 years old with inhibitors. Demonstrating improved clinical outcomes and reduced costs, emicizumab prophylaxis outperforms episodic BPA treatments, positioning it as a superior treatment option for HA patients with inhibitors in Thailand.

Sex, vaccination status, and comorbidities influence long COVID persistence

BackgroundThere is interest in the public health impact of Long COVID, defined as symptoms that persist or begin after SARS-CoV-2 infection. We aimed to identify demographic and clinical risk factors associated with Long COVID over time in an Upper Middle-Income Country (UMIC) and potential biomarkers predictive of symptom trajectory. MethodsProspective cohort study of adults with mild SARS-COV-2 during the Omicron period. We tracked symptom persistence and IgG antibody titers against the spike S1 subunit. ResultsOf 383 participants, 276 had confirmed SARS-CoV-2 infection. Long COVID persisted for ≥ two months in 21 % and ≥ 12 months in 5 %. The most common symptoms were fatigue, upper respiratory symptoms, and myalgia/arthralgia: 15 % had fatigue for ≥ one month, 10 % for ≥ two months, and 5 % ≥ three months. Upper respiratory symptoms lasted ≥ one month in 17 %, ≥ two months in 7 %, and ≥ three months in 3 %. Fully 9 % reported myalgia/arthralgia lasting ≥ one month, 6 % ≥ two months, and 4 % ≥ three months. Risk factors for symptom persistence included female sex, not being fully vaccinated, and comorbidities. Participants experiencing persistent fatigue had lower anti-S1 IgG titers. ConclusionsIn this population, symptom persistence declined after the acute phase, but 5 % of participants did not fully recover. Even in a population that was almost fully vaccinated, women, individuals with comorbidities, and the few remaining people who were unvaccinated were at greater risk for Long COVID. Immunoglobulins may have utility as a biomarker of Long COVID fatigue in this population.

Retinoblastoma with and without Extraocular Tumor Extension: A Global Comparative Study of 3435 Patients

PurposeTo study the treatment, and outcomes of children with retinoblastoma (RB) with extraocular tumor extension (RB-EOE) and compare them with RB without extraocular tumor extension (RB-w/o-EOE). DesignMulticenter intercontinental collaborative prospective study from 2017 to 2020. RB-EOE cases included those with overt orbital tumor extension in treatment-naïve patients. Cases with microscopic orbital extension detected post-enucleation were excluded from the study. ParticipantsA total of 319 children with RB-EOE and 3116 children with RB-w/o-EOE Intervention(s)Chemotherapy, enucleation, exenteration, radiotherapy. Main outcomes(s)Systemic metastasis and death. ResultsOf the 3435 RB patients included in this study, 309 (9%) were from low-income countries, 1448 (42%) from lower-middle income, 1012 (29%) from upper-middle income, and 666 (19%) patients from high-income countries. There was an inverse relationship between the percentage of RB-EOE and national income level, with 96 (31%) patients from low-income countries, 197 (6%) lower middle-income, 20 (2%) upper-middle income, and 6 (1%) patients from high-income countries (p=0.0001). The outcomes were statistically significant for RB-EOE compared to RB-w/o-EOE: systemic metastasis (32% vs 4% respectively; p=0.0001) and metastasis-related death (63% vs 6% respectively; p=0.0001). Multimodal treatment was the most common form of treatment (n=177; 54%) for RB-EOE, with most cases undergoing a combination of intravenous chemotherapy and enucleation (n=97; 30%). Adjuvant external beam radiotherapy after surgery (enucleation/orbital exenteration) was given in only 68 (21%) cases. Kaplan-Meier analysis for systemic metastasis and metastasis-related death in RB-EOE was 28% and 57% at 1 year, 29% and 60% at 2 years, and 29% and 61% at 3 years, respectively. Cox regression analysis revealed that the risk for death from RB-EOE was greater in patients aged >4 years than <2 years (hazard ratio (HR)=2.912; p<0.001) and for unimodal (surgery or intravenous chemotherapy) and bimodal (surgery and intravenous chemotherapy) treatment than trimodal treatment (surgery, intravenous chemotherapy and external beam radiotherapy) (HR=2.023; p=0.004 and HR 1.819; p=0.027 respectively). ConclusionRetinoblastoma with extraocular tumor extension is associated with a higher risk for metastasis and death. Patients with RB-EOE are likely to benefit from trimodal treatment (intravenous chemotherapy, surgery, and external beam radiotherapy) rather than treatment protocols excluding external beam radiotherapy.

Association of Socioeconomic Variables with Primary Cesarean Section.

Socioeconomic characteristics may be associated with cesarean section (CS) rates. We probe the relationship between socioeconomic variables and primary cesarean section (PCS) by studying indicators of socioeconomic status (SES) in a population-based study in New York City. This was a retrospective study of all 80,506 women in New York City who gave birth to a live child during 2018, and who met inclusion and exclusion criteria. Data were drawn from the New York City Department of Health and Mental Hygiene and the US Census. The main outcome measure was performance of PCS as compared with vaginal birth. Approximately 21% of neonates were delivered by PCS. Multivariate multilevel mixed-effects logistic regression analysis showed higher odds for PCS for women with an upper-middle class median household income of US$108,500 to $380,499 (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.07-1.76, P = 0.001), and the percentage enrolled in the Supplemental Nutrition Assistance Program (OR 1.01, 95% CI 1.001-1.012, P = 0.02). Lower odds for PCS occurred for all middle-class categories of per capita income: US$32,500 to $54,499 (OR 0.91, 95% CI 0.84-0.99, P = 0.02), US$54,500 to $108,499 (OR 0.76, 95% CI 0.66-0.88, P < 0.001), and US$108,500 to $380,499 (OR 0.80, 95% CI 0.66-0.96, P = 0.02). No significant association occurred for women receiving public assistance. Patient preferences in favor or against CS may be related to SES. There may be conflicts between obstetric care that is maximally beneficial and a patient's desire for delivery mode. Clinicians should be aware of the potential implications of this dilemma.

Country and continent-wise trends in mortality rates of ovarian cancer from 1980-2021: An analysis of GBD study 2021.

148 Background: Ovarian cancer is one of the major causes of cancer related deaths in women worldwide. Early detection, primarily via ultrasound , can result in lower mortality and morbidity. We present a comprehensive evaluation derived from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, depicting the ovarian cancer associated mortality pattern from 1980 to 2021. Methods: Data were methodically retrieved from the Global Burden of Diseases (GBD) study, which included age-standardized death rates, Years of Lost Life (YLL), and disability-adjusted life years (DALYs). The dataset was stratified globally and categorized by continent, with Africa divided into Northern, Southern, Eastern, Western, and Central regions, and by World Bank income levels. Joinpoint Regression was employed to determine average annual percentage changes (AAPC). Results: Globally, the Age standardized death rates (ASDR) for ovarian cancer had an overall decline from 1980 to 2021. In 1980, the ASDR was 4.64 (95% UI: 4.3-5.14), and it declined to 4.05 (AAPC: -0.315; 95% CI: -0.35 to -0.27) in 2021. Globally, the disability-adjusted life-years (DALYs) rate was 132.4 (95% UI: 121.3–145.6) per 100,000 people in 1990, and it decreased to 115.14 (AAPC: -0.44; 95% CI: -0.52 to -0.36) in 2021. From 1990 to 2021, the age-standardized years of life lost (YLL) showed a uniform drop with an AAPC of -0.36 (95% CI: -0.40 to -0.31). However, in continent wise analysis, while the Americas and Europe had continuously declining ASDRs, Asia and Africa had an increasing trend throughout the predetermined time frame. From 1980 to 2021, America had an AAPC of -0.67 (95% CI: -0.69 to -0.65). Similarly, Europe also had a decreasing trend from 1980 to 2021 with an AAPC of -0.48 (95% CI: -0.50 to -0.45). The AAPC for Africa was 1.203 (95% CI: 1.19 to 1.21), showing a greater incline compared to the other continents. The AAPC for Asia was 0.54 (95% CI: 0.527 to 0.563). During further analysis of the African region, we observed that southern and eastern Africa had the highest ASDRs. According to World Bank income levels, low-income and lower-middle-income countries had increasing death rates, while high and upper-middle income countries had decreasing death rates from 1980 to 2021. Conclusions: The study disclosed a global decline in ovarian cancer fatality rates from 1980 to 2021. Although significant progress has been made in the Americas and Europe, mortality rates have risen in Asia and Africa, with southern and eastern Africa exhibiting particularly high rates. An increase in death rates is also observed in low- and lower-middle-income countries, contrasting with an overall decrease globally and in high-income nations.

Evaluating national infection prevention and control minimum requirements: evidence from global cross-sectional surveys, 2017–22

WHO infection prevention and control (IPC) minimum requirements provide standards to reduce the risk of infection during health-care delivery. We aimed to investigate the global implementation of these requirements at national levels and the progress of doing so across 2021-22 compared with 2017-18 to identify future directions for interventions. National IPC focal points were invited to complete an online survey measuring IPC minimum requirements from July 19, 2021, to Jan 31, 2022. The primary outcome was the proportion of countries meeting IPC minimum requirements. Country characteristics associated with this outcome were assessed with beta regression. Subset analyses were conducted to compare the 2021-22 indicators with a WHO IPC survey conducted in 2017-18 and to assess the correlation of the proportion of IPC minimum requirements met with the results of other WHO metrics. 106 countries (ie, 13 low income, 27 lower-middle income, 33 upper-middle income, and 33 high income) participated in the survey (56% response rate). Four (4%) of 106 met all IPC minimum requirements. The highest scoring IPC core component was multimodal improvement strategies and the lowest was IPC education and training. The odds of meeting IPC minimum requirements was higher among high-income countries compared with low-income countries (adjusted odds ratio 2·7, 95% CI 1·3-5·8; p=0·020). Compared with the 2017-18 survey, there was a significant increase in the proportion of countries reporting an active national IPC programme (65% to 82%, p=0·037) and a dedicated budget (26% to 44%, p=0·037). Evaluation of the IPC minimum requirements compared with other survey instruments revealed a low positive correlation. To build resilient health systems capable of withstanding future health threats, urgently scaling up adherence to WHO IPC minimum requirements is essential. WHO. For the French and Spanish translations of the abstract see Supplementary Materials section.

Impact of political relationships on virtual land flow from China's food trade

The increasing backlash against globalization has shifted public opinion towards being against trade. This situation puts food trade, which is resources constrained and susceptible to political relations, into a complex dilemma. Due to the concerns on agricultural endowments, food trade needs to be considered with strategic interests because of its sensitivity and fragility. Using virtual land as a measurement to analyse the resource flows behind the food trade can provide an objective perspective on what extent a country depends on the trade. Overlaying worldwide trade disputes and political interventions, establishing solid trade relationships is increasingly becoming urgent. This study uses an extended gravity model, assesses the virtual land traded by China with 10 species over 20 years, and provides insights on establishing politics-oriented trade relationships, further testing how this political mechanism works in the food trade. The results demonstrate that memorandums of understanding are the fundamental institutional layer to guarantee trading activities and promote smooth transactions for both sides; state visits are determinable factors in establishing bilateral relationships and it significantly promote upper-middle income countries, which crucially impacts the trading system. As those endeavors undertaken by executive departments are often ignored, more attention should be paid to them during interactive stages. Political relations show differences in food trade among different countries and varieties. The promoting effect of political relations is stronger in middle and high-income countries, and the impact on Russia and Ukraine is more significant than others. Compared within varieties, foreign state visits and endeavor presents more positive on pork.

Assessing and correcting neighborhood socioeconomic spatial sampling biases in citizen science mosquito data collection

Climatic, ecological, and socioeconomic factors are facilitating the spread of mosquito-borne diseases, heightening the importance of vector surveillance and control. Citizen science is proving to be an effective tool to track mosquito populations, but methods are needed to detect and account for small scale sampling biases in citizen science surveillance. In this article we combine two types of traditional mosquito surveillance records with data from the Mosquito Alert citizen science system to explore the ways in which the socioeconomic characteristics of urban neighborhoods result in sampling biases in citizen scientists’ mosquito reports, while also shaping the spatial distribution of mosquito populations themselves. We use Barcelona, Spain, as an example, and focus on Aedes albopictus, an invasive vector species of concern worldwide. Our results suggest citizen scientists’ sampling effort is focused more in Barcelona’s lower and middle income census tracts than in its higher income ones, whereas Ae. albopictus populations are concentrated in the city’s upper-middle income tracts. High resolution estimates of the spatial distribution of Ae. albopictus risk can be improved by controlling for citizen scientists’ sampling effort, making it possible to provide better insights for efficiently targeting control efforts. Our methodology can be replicated in other cities faced with vector mosquitoes to improve public health responses to mosquito-borne diseases, which impose massive burdens on communities worldwide.

Examining the Influence of ICT Penetration on Gender Disparities: A Data Panel Econometric Analysis of the Seven Southeast Asian Developing Countries

The aim of the study is to analyze to which Information and Communications Technology (ICT) penetration affects gender disparities in seven Southeast Asia’s developing countries. ICT indicators are measured through the individuals using the internet, mobile phone subscriptions, and internet subscriptions. Aside, the seven Southeast Asia’s developing countries include Indonesia, Cambodia, Laos, Malaysia, Thailand, Philippines, and Vietnam. These countries are selected as they have comparable economic development stage from lower to upper-middle income economics on the basis 2022’s World Bank Country Income Classification. The data panel econometrics is carried out to measure the effect of the independent variables towards gender disparity. Gender disparity is represented by the Gender Inequality Index. The time series data is yearly from 2000 to 2022. The econometric assessment shows the individual internet ownership and subscription have a negative and significant effect to gender disparity. It means that more internet penetration can lower the gender disparity in those seven countries. The academic implication is to enhance economic consideration towards more internet penetration and access to reduce gender disparity. In the heart of policymaking, our research indicates more internet accessibility to reduce gender disparity. As in the common knowledge, the internet is a source of information and knowledge to society

Global, regional, and national burden of inflammatory bowel disease, 1990–2021: Insights from the global burden of disease 2021

PurposeThe prevalence of inflammatory bowel disease (IBD) is on the rise worldwide. We utilizes data from the Global Burden of Diseases (GBD) 2021 to analyze the national-level burden of IBD, trends in disease incidence, and epidemiological characteristics.MethodsDetailed information on IBD was gathered from 204 countries and territories spanning 1990 to 2021, sourced from the GBD 2021. Calculations were performed for incidence rates, mortality rates, disease-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs). These trends were analyzed based on region, nationality, age, gender, and World Bank income level stratifications.ResultsThe global age-standardised incident rate (ASIR) of IBD increased from 4.22 per 100000 in 1990 to 4.45 per 100000 in 2021. However, the age-standardised mortality rate (ASMR) decreased from 0.60 per 100000 in 1990 to 0.52 per 100000 in 2021. Similarly, the age-standardised DALYs rate decreased from 21.55 per 100000 in 1990 to 18.07 per 100000 in 2021. Gender comparisons showed negligible differences in disease burden. The greatest increase in IBD-associated ASIR and ASMR occurred in World Bank upper-middle income region (EAPCs, 1.25) and World Bank high-income region (EAPCs, 1.00), respectively. Regionally, East Asia experienced the largest increase in ASIR (EAPCs, 2.89). Among 204 countries, China had the greatest increases in ASIR (EAPCs, 2.93), Netherlands had the highest ASMR in 2021 (2.21 per 100000).ConclusionsGlobal incidence rate of IBD have been increasing from 1990 to 2021, while the DALYs and mortality have been decreasing. The escalating incident rates in select Asian regions deserves further attention.

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

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

Healthcare personnel acceptance and recommendations for influenza vaccine in twelve low- and middle-income countries: A pooled analysis from 2018 to 2020

BackgroundAlthough healthcare personnel (HCP) are targeted for influenza vaccination they typically underutilize vaccines especially in low- and middle-income countries. We explored knowledge, attitudes, and practices of HCP about seasonal influenza vaccines (SIV) to identify factors associated with and modifiable barriers to SIV uptake. MethodsWe pooled individual-level data from cross-sectional surveys about SIV conducted among health workers in 12 low- and middle- income countries during 2018–2020 (i.e., Albania, Armenia, Cote d’Ivoire, Kenya, Kyrgyzstan, Lao PDR, Lebanon, Morocco, North Macedonia, Tunisia, Tajikistan, and Uganda). Eleven countries used a standard protocol and questionnaire based on the Health Belief Model to measure perceptions of susceptibility and severity of influenza disease, benefits of, barriers to, and motivators for vaccination. We analyzed attitudes and perceptions among HCP, including acceptance of vaccine for themselves and willingness to recommend vaccines to patients, grouped by the presence/absence of a national influenza vaccination program. Models were adjusted for geographic region. ResultsOur analysis included 10,281 HCP from 12 countries representing four of the six World Health Organization regions: African, Eastern Mediterranean, European, and Western Pacific. The sample was distributed across low income (LIC) (3,183, 31 %), lower-middle (LMIC) (4,744, 46 %), and upper-middle income (UMIC) (2,354, 23 %) countries. Half (50 %) of the countries included in the analysis reported SIV use among HCP in both the year of and the year preceding data collection while the remainder had no influenza vaccination program for HCP. Seventy-four percent (6,341) of HCP reported that they would be willing to be vaccinated if the vaccine was provided free of charge. HCP in LICs were willing to pay prices for SIV representing a higher percentage of their country’s annual health expenditure per capita (6.26 % [interquartile range, IQR: 3.13–12.52]) compared to HCP in LMICs and UMICs. HCP in countries with no SIV program were also willing to pay a higher percentage for SIV (5.01 % [IQR: 2.24–8.34]) compared to HCP in countries with SIV programs.. Most (85 %) HCP in our analysis would recommend vaccines to their patients, and those who would accept vaccines for themselves were 3 times more likely to recommend vaccines to their patients (OR 3.1 [95 % CI 1·8, 5·2]). ConclusionIncreasing uptake of SIV among HCP can amplify positive impacts of vaccination by increasing the likelihood that HCP recommend vaccines to their patients. Successful strategies to achieve increased uptake of vaccines include clear guidance from health authorities, interventions based on behavior change models, and access to vaccine free-of-charge.

Fertility Intentions Among Reproductive-Age Women - Three Provinces, China, 2023.

Low fertility rates have become the most important risk affecting the balanced development of the population in China. About 80.0% of childless women had fertility intentions, 31.9% of women with one child and 11.3% of women with two children intended to have a second and third child, respectively. Women with one child who had an agricultural Hukou, were younger than 30 years old, were remarried, and had received a deduction or reimbursement for childbirth expenses during their first delivery were more willing to have a second child. Women with two children who had an agricultural Hukou and a upper-middle personal income, were self-employed, and had two daughters were more willing to have a third child. In China, women's willingness to have more children is not optimistic. To increase their desire for more children, creating a more favorable fertility environment for reproductive-age women and providing more preferential fertility policies for pregnant women will be necessary.

The Effects of Prenatal Iron Supplementation on Offspring Neurodevelopment in Upper Middle- or High-Income Countries: A Systematic Review

Iron supplementation is commonly recommended for the prevention and treatment of maternal iron deficiency (ID) or iron deficiency anemia (IDA). However, the impacts of prophylactic of therapeutic prenatal iron supplementation on child neurodevelopment in upper middle-income (UMI) and high-income countries (HICs), where broad nutritional deficiencies are less common, are unclear. To investigate this, we conducted a systematic review, searching four databases (Medline, CINAHL, EMBASE, Cochrane Library) through 1 May 2023. Randomized controlled trials (RCTs) assessing oral or intravenous iron supplementation in pregnant women reporting on child neurodevelopment (primary outcome: age-standardized cognitive scores) were eligible. We included three RCTs (five publications) from two HICs (Spain and Australia) (N = 935 children; N = 1397 mothers). Due to clinical heterogeneity of the RCTs, meta-analyses were not appropriate; findings were narratively synthesized. In non-anemic pregnant women, prenatal iron for prevention of IDA resulted in little to no difference in cognition at 40 days post-partum (1 RCT, 503 infants; very low certainty evidence). Similarly, the effect on the intelligence quotient at four years was very uncertain (2 RCTs, 509 children, very low certainty evidence). No RCTs for treatment of ID assessed offspring cognition. The effects on secondary outcomes related to language and motor development, or other measures of cognitive function, were unclear, except for one prevention-focused RCT (302 children), which reported possible harm for children’s behavioral and emotional functioning at four years. There is no evidence from UMI countries and insufficient evidence from HICs to support or refute benefits or harms of prophylactic or therapeutic prenatal iron supplementation on child neurodevelopment.

Disease Burden, Risk Factors, and Temporal Trends in Breast Cancer in Low‐ and Middle‐Income Countries: A Global Study

ABSTRACTIntroductionBreast cancer poses significant health risks to women and strains healthcare systems extensively. In low‐ and middle‐income countries (LMICs), limited resources and inadequate healthcare infrastructures further exacerbate the challenges of breast cancer prevention, treatment, and awareness.MethodsWe examined the prevalence, risk factors, and trends of breast cancer in LMICs. Data on disability‐adjusted life years (DALYs) and breast cancer risk factors were extracted from the Global Burden of Disease (GBD) databases for 203 countries or territories from 1990 to 2019. LMIC DALY rates were examined using joinpoint regression analysis.ResultsAmong the income groups, the lower middle‐income category had the highest DALYs value, with 1787 years per 100,000 people. LMICs collectively accounted for 74% of the global burden of DALYs lost due to breast cancer in 2019. However, it remained relatively consistent in lower middle income countries (LMCs). In LMCs, the risk associated with metabolic syndromes was higher compared to that with behavioral factors alone. For the past three decades, breast cancer incidences increased significantly in LMCs (average annual percent change [AAPC]: 1.212, confidence intervals [CI]: 1.51–1.87, p &lt; 0.001), upper middle income countries (AAPC: 1.701, CI: 1.12–1.48, p &lt; 0.001), and low‐income countries (AAPC: 1.002, CI: 1.57–1.68, p &lt; 0.001).ConclusionThis research shows how breast cancer in LMICs is aggravated by low resources and healthcare infrastructure. To effectively combat breast cancer in these areas, future strategies must prioritize improvements in healthcare infrastructure, awareness campaigns, and early detection mechanisms.

Global resurgence of measles in the vaccination era and influencing factors

ObjectivesRecent years have seen increased cases of measles despite widespread vaccination. We examined the potential drivers behind the resurgence of measles. MethodsWe analyzed the trends in measles incidence and vaccine coverage from 2010 to 2019 across World Health Organization member countries using country-level linear regression models. We computed the Spearman rank correlation coefficient (ρ) between measles incidence and socioeconomic and vaccination-related variables using published data from the World Health Organization member countries to identify the key factors influencing measles incidence. ResultsBetween 2010 and 2019, global measles cases fluctuated, with a notable rise in 2019 (measles cases per million in 2019 was about 140% higher than in 2010), alongside a declining vaccination coverage in many countries (59 of 194 countries). Among 10 socioeconomic factors examined, per-capita national gross income, population literacy, urban residences, and political stability were significantly associated with measles incidence (ρ <0, and P <0.05 for all these variables). These factors likely reflect the quality of public health infrastructure (e.g. access to vaccines), particularly, in low- and middle-income countries. In addition, a stratified analysis suggests vaccine hesitancy likely contributed to measles case increases in high- and upper middle–income countries. ConclusionsThe socioeconomic determinants of measles transmission are interconnected and region-specific. The availability of public health resources and political stability significantly influence measles burdens in low- and middle-income countries, whereas vaccine hesitancy presents a unique challenge to measles elimination in high- and upper middle–income countries.

Balancing growth and sustainability: The impact of Greenfield investment on trade adjusted carbon emissions

In the last two decades, the surge in carbon emissions has escalated environmental damage and is a major concern globally. Recognized as a significant threat to humanity, unchecked environmental degradation can potentially hinder the achievement of sustainable development. As a result, accurate monitoring of carbon emissions becomes imperative for formulating effective climate policies. Taking into consideration, this study has taken the newly developed consumption-based carbon emissions measure to study the pollution haven hypothesis and examine the link between Greenfield Investment (GFI) inflows to host nations and their environmental impact for 85 developing countries from 1990 to 2020. The results show a positive correlation between Greenfield investment and Consumption-based Carbon Dioxide Emissions (CCO2) in sampled nations. Similarly, energy usage and export damage the environment because developing countries rely on conventional and old methods of energy usage. The results were further analyzed for low, lower middle, and upper middle income countries as well. The subsample outcome shows that Greenfield investment has a more damaged environment in low income countries as compared to lower middle and upper middle income countries. These insights underscore the urgency for developing countries to adopt environmentally conscious policies to attract international investors. It also emphasizes the need for stringent regulations aimed at curbing environmental pollution and complying with the Sustainable Development Goals (SDGs). Similarly, low and lower middle income countries to attract Greenfield investment, may also focus more on strict environmental pollution policies. Industries must be shifted from conventional energy methods to renewable energy sources. Sustainable Development Goals; 7, 12, and 13 can be achieved by host countries, alluring investors to invest in terms of Greenfield in renewable energy resources, which would be used in automobile transportation, to shift industries from conventional energy resources to renewable energy resources. The same Greenfield investment would also be used in bringing efficient machinery for more production in industries with minimal environmental pollution.