Upper-middle Income Research Articles

EVALUATING THE EFFICIENCY OF COUNTRIES' DIGITALIZATION IN TERMS OF FINANCIAL INCLUSION BY USING DEA

The aim of the study is to evaluate the efficiency of countries in digitalization in terms of financial inclusion, in other words, their success in digitalization. Within the scope of the study, 117 countries were grouped as high, upper-middle, lower middle and low income and subjected to Data Envelopment Analysis. In the study conducted for the year 2021, four input variables related to the utilization and access of digital financial services were identified, along with ten corresponding output variables. Efficient countries were determined in the study based on the constant and variable return scale model for output. Digital efficiency has been identified in financial inclusion was detected in 25 countries based on variable returns and 18 countries based on constant returns in high-income countries. In upper-middle-income countries, digital efficiency in financial inclusion was identified in 12 countries based on variable returns and 9 countries based on constant returns. 16 countries in the lower middle and low income categories demonstrated digital efficiency in financial inclusion using variable returns, while 9 countries detected digital efficiency using constant returns. In the study, the comprehensive analysis of the success of digitalization in financial inclusion at the level of countries divided into income groups by using data envelopment analysis reveals the originality of the study.

Implementation of a Global Pediatric Trauma Course in an Upper Middle–Income Country: A Pilot Study

IntroductionOver 90% of pediatric trauma deaths occur in low- and middle-income countries (LMICs), yet pediatric trauma-focused training remains unstandardized and inaccessible, especially in LMICs. In Brazil, where trauma is the leading cause of death for children over age 1, we piloted the first global adaptation of the Trauma Resuscitation in Kids (TRIK) course and assessed its feasibility. MethodsA 2-day simulation-based global TRIK course was hosted in Belo Horizonte in October 2022, led by one Brazilian and four Canadian instructors. The enrollment fee was $200 USD, and course registration sold out in 4 d. We administered a knowledge test before and after the course and a postcourse self-evaluation. We recorded each simulation to assess participants’ performance, reflected in a team performance score. Groups received numerical scores for these three areas, which were equally weighted to calculate a final performance score. The scores given by the two evaluators were then averaged. As groups performed the specific simulations in varying orders, the simulations were grouped into four time blocks for analysis of performance over time. Statistical analysis utilized a combination of descriptive analysis, Wilcoxon signed-rank tests, Kruskal–Wallis tests, and Wilcoxon rank-sum tests. ResultsTwenty-one surgeons (19 pediatric, one trauma, one general) representing four of five regions in Brazil consented to study participation. Women comprised 76% (16/21) of participants. Overall, participants scored higher on the knowledge assessment after the course (68% versus 76%; z = 3.046, P < 0.001). Participants reported improved knowledge for all tested components of trauma management (P < 0.001). The average simulation performance score increased from 66% on day 1% to 73% on day 2, although this increase was not statistically significant. All participants reported they were more confident managing pediatric trauma after the course and would recommend the course to others. ConclusionsCompletion of global TRIK improved surgeons’ confidence, knowledge, and clinical decision-making skills in managing pediatric trauma, suggesting a standardized course may improve pediatric trauma care and outcomes in LMICs. We plan to more closely address cost, language, and resource barriers to implementing protocolized trauma training in LMICs with the aim to improve patient outcomes and equity in trauma care globally.

Analyzing Macroeconomic Indicators that May Affect Economic Growth in Sub-Saharan African Countries: A Panel Data Analysis in the Context of Income Level Classification (1990-2019)

The purpose of the study was to ascertain whether the export-import coverage ratio (EXIM), the income of natural resources (NATR), labour force participation rate (LFPR), and foreign direct investment (FDI) had a positive or negative impact on economic growth for 34 Sub-Saharan African countries using data from 1990 to 2019. The change in Gross Domestic Product Per Capita (%) is used in the study as a proxy for the economic growth variable, and Sub-Saharan African nations were categorized based on the United Nations' income classification system to create more homogeneous groups and consequently more accurate analysis results. To do this, 34 Sub-Saharan African nations were divided into three income categories: lower-middle-income, upper-middle-income, and low-income. The income categories established by the UN were considered while drawing this distinction. This divide led to the analysis of 18 low-income nations, 12 lower-middle-income countries, and 4 upper-middle-income countries. One of the dynamic panel data analysis techniques, the two-step system GMM panel data analysis, was used as the econometric analysis approach. According to the estimations, FDI in lower-middle-income sub-Saharan African countries was statistically significant and inversely related to economic growth; it was observed that the coverage ratio of exports to imports has a statistically significant and linear relationship. None of these independent variables were found to influence economic growth in low-income sub-Saharan African countries. There is a statistically significant correlation between the LFPR and NATR and economic development in the upper-middle income category of nations analyzed. As a result, the influence of factors varied and fluctuated on economic growth based on the income levels of different groups.

Trends in childhood intussusception in a Nigerian tertiary hospital.

Early presentation, high rate of successful non-operative treatment, low morbidity and mortality in childhood intussusception is common in High and Upper Middle-Income Countries but not in many Lower middle- and Low-income countries. To assess the trends in the profile, treatment modalities and outcomes of intussusception in our hospital. Retrospective study over a 12-year period divided into two 6-year periods. Data entry/analysis was done using SPSS and various indices were compared between these two periods. Two-tailed t-test for two independent means was used to compare means while two-tailed Fisher exact tests were used to compare categorical variables. Results were presented as tables, means, ranges, percentages and a p-value less than 0.05 was deemed statistically significant. There was a significant increase in the proportion of successful non-operative treatment (18.6% vs 34%, p=0.03), reduction in the incidence of operative manual reduction (27.1% vs 12.8%; p=0.026), reduction in operative treatment (78.5% vs 63.9%, p=0.034), increased utilization of pre-intervention ultrasound (75% vs96.7%, p<0.0001) and reduction in hospital stay duration (10.47 ±7.95days vs 7.24±4.86 days; p=0.004). Contribution of successful non-operative treatment to the overall treatment of intussusception significantly increased while that of operative manual reduction significantly reduced and bowel resection showed no change. Preoperative utilization of ultrasonography significantly increased while mean duration of admission reduced significantly, but late presentation, morbidity and mortality rates had no significant changes.

Global urbanization and ruralization lessons of clean energy access gap

While energy access is improving across economic groups globally, here remains the monumental challenge of clean energy inequality that has further aggravates climate-related problems. To further address clean energy inequality, this study offers novel understanding on the forces behind clean energy access divide associated with urbanization and ruralization by employing the case of the high, low, lower-middle, and upper-middle income economies in the period 2010 to 2021. By using empirical analysis, the results reveal that (i) annual growth in the economy, and (ii) literacy parity between male and female further worsen clean energy access between urban and rural population. Contrarily, innovative activities reduce urban-rural clean energy access by an elasticity of 3.510. These findings, in theory and practice, provide policy insight toward specifically achieving the United Nation's Sustainable Development Goals 7 and 10, and other global challenges.

Does Social Media Penetration Enhance Democratic Institutions? Evidence from Varieties of Democracy Data

AbstractWe examine whether social media enhances democracy using cross-sectional data from 145 countries. We used Facebook penetration as a proxy for social media. Also, based on the complex definition of democracy, high-level indices, such as egalitarian, participatory, liberal, electoral, and deliberative democracies, were used to capture democracy. Our endogeneity-corrected results documented that high social media penetration, on average, enhances all forms of democracy. In descending order, social media penetration has contributed more to enhancing democracy in high-income economies, followed by lower-middle and upper-middle income economies. In low-income economies, social media penetration has a negative effect on democracy indices. We also documented heterogeneity in the findings based on regions. Marginal analysis also revealed that the positive effect of social media on democracy is higher in countries with higher internet penetration. We suggest that with appropriate interventions, policymakers could leverage social media to enhance democratic institutions.

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.

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.

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.

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.

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

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.

Rules of the Game and Credibility of Implementation in the Control of Corruption

Research suggests that institutions affect the levels of corruption in a country. We take these arguments a step further and examine whether it is the presence of inclusive institutions and/or the credible and consistent implementation of institutions that matter, as regards corruption. We use a novel approach to theoretically conceptualise and empirically operationalise institutions along two analytically distinct dimensions: the nature of the institutions (the de jure dimension), and the extent to which they are credibly and consistently implemented over time (the de facto dimension), using a panel dataset for 148 countries covering 2012 to 2018. We find that formal institutions are most effective in reducing corruption when the rules are credibly and consistently implemented. Furthermore, this effect appears to operate differently at different levels of national income. The nature of the formal institutions appears important across income levels, but particularly so at the upper middle income level, while the credible and consistent implementation of these institutions is primarily influential at upper middle income levels. We explain why this may be the case and elaborate on the policy implications.

Exploring Preconceptions as Barriers to Peritoneal Dialysis Eligibility: A Global Scenario-Based Survey of Kidney Care Physicians

IntroductionDespite growing number of patients requiring kidney replacement therapy peritoneal dialysis (PD) is underutilized globally. A contributory factor may be clinician myths around its use. The aim of this study was to explore perceptions around PD initiation by clinicians according to various physical, social and clinical characteristics of patients. MethodsAn online global survey (English, Thai) was administered to ascertain nephrologists’ and nephrology trainees’ decisions on recommending PD as a treatment modality. Results645 participants (522 nephrologists; 123 trainees; 56% male) from 54 countries (66% high income countries (HICs), 22% upper middle income, 12% low middle income countries and 1% from lower income countries) completed the survey. 81% of respondents identified as attending physicians/consultants with 19% trainees or other. PD was recommended for most scenarios including repeated exposures to heavy lifting, swimming (especially in a private pool and ocean), among patients with cirrhosis or cognitive impairment with available support, and those living with a pet if a physical separation can be achieved during PD. Certain abdominal surgeries were more acceptable to proceed with peritoneal dialysis (hysterectomy 90%) compared to others (hemicolectomy 45%). Similar variation was noted for different types of stomas (nephrostomies 74%; suprapubic catheters 53%; ileostomies 27%). ConclusionsThe probability of recommending PD in various scenarios was greater among clinicians from HICs, larger units and consultants with more clinical experience. There is a disparity in recommending PD across various clinical scenarios driven by experience, unit-level characteristics and region of practice. Globally, evidence-informed education is warranted to rectify misconceptions to enable greater PD uptake.

Evolving trends in prostate cancer: Disparities across income levels and global regions (1990-2019).

25 Background: Prostate Cancer, the third most commonly diagnosed cancer in 2020 and the fifth leading cause of cancer mortality worldwide, has exhibited significant disparities in global prevalence and impact over recent decades. This study assesses the trends in incidence, mortality, and disability-adjusted life years from prostate cancer in the World Bank regions based on country income levels from 1990 to 2019. Methods: The Global Burden of Disease Study database was used to extract Age-standardized incidence rates (ASIR), age-standardized (ASDR), and life years (DALYs) for prostate cancer from different World Bank regions based on income levels from 1990 to 2019. Annual percentage change was also acquired. Mortality-to-incidence ratios (MIR) were then computed. Trends were assessed using Joinpoint regression. Results: Between 1990 and 2019, ASIRs increased across all income levels, with the greatest growth in the upper middle income (+64.7%). While ASDRs decreased in high income, upper middle income, and lower middle income levels, they notably increased in low income levels (+14.3%). DALYs decreased in high income and upper middle income levels, primarily in the high income (-25.7%), and increased in lower middle and low income levels, primarily in the low income (+13.8%). MIRs decreased in all countries, with the largest decrease in high income levels (-50%). In the last 30 years, high income countries have consistently observed the highest ASIR (2019: 77.5/100,000). However, in 1990 high income countries also had the highest ASDRs and DALYs. Interestingly, by 2019 this pattern shifted, with low income surpassing high income countries in both. Conclusions: Over the last 30 years, the incidence of prostate cancer has been rising regardless of income level. Despite the universal decrease of MIRs implying improved outcomes, screening, and therapeutical strategies, the contrasting trends in ASDRs and DALYs across income levels underscore the disparities in health outcomes. Higher income countries experienced highest cancer incidence but also the highest decrease in the mortality rates while lower income countries faced the opposite challenges with lower increase but higher mortality rates. [Table: see text]