Upper-middle Income Research Articles

Treatment Rates for Mental Disorders Among Children and Adolescents

Mental disorders among children and adolescents are global health concerns. Published studies have provided discordant results regarding treatment rates for mental disorders among youths. To estimate combined treatment rates for several common psychiatric disorders among children and adolescents. PubMed, Web of Science, PsycINFO, Scopus, and Embase were searched from database inception until September 23, 2022, and supplemented with hand-searching of reference lists. Included studies were those that used validated methods to report treatment rates for any mental disorder, depressive disorders, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and behavior disorders among children and adolescents. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Two reviewers independently assessed study eligibility, extracted data, and scored quality. Studies with a Joanna Briggs Institute score of 5 or more were included in the meta-analysis. Treatment rates were pooled using random-effects models. Subgroup analyses were performed to investigate the association with treatment rates of factors, such as year of data collection, World Health Organization region, age, income level, timeframe of diagnosis, informant source, service type, sample origin, and internalizing or externalizing disorder. Treatment rates for mental disorders among children and adolescents were the main outcomes, measured as percentage estimates. Forty studies were included in the analysis, comprising 310 584 children and adolescents, with boys accounting for 39% of participants (sex was not reported in 10 studies). The pooled treatment rate was 38% (95% CI, 30%-45%) for any mental disorder, 36% (95% CI, 29%-43%) for depressive disorders, 31% (95% CI, 21%-42%) for anxiety disorders, 58% (95% CI, 42%-73%) for ADHD, and 49% (95% CI, 35%-64%) for behavior disorders. Age, income level, and region were significantly associated with the combined treatment rates of mental disorders in children and adolescents. The treatment rate for depressive disorders was higher among adolescents than children (36% [95% CI, 25%-46%] vs 11% [95% CI, 0%-25%]), whereas the treatment rate for anxiety disorders was higher among children than adolescents (64% [95% CI, 52%-75%] vs 20% [95% CI, 9%-30%]). The treatment rate for any mental disorder in lower-middle income countries was 6% (95% CI, 2%-14%), in upper-middle income countries was 24% (95% CI, 2%-47%), and in high-income countries was 43% (95% CI, 35%-52%). For depressive disorders, treatment rates were higher in the Americas (40% [95% CI, 30%-51%]) than in Europe (28% [95% CI, 13%-43%]) and the Western Pacific region (6% [95% CI, 1%-16%]). This study suggests that, in general, the treatment rates for mental disorders among children and adolescents were low, especially for depression and anxiety. Targeted intervention policies and effective measures should be designed and implemented to improve treatment rates of psychiatric disorders among youths.

Benefit or burden? An exploratory analysis of the impact of anti‐money laundering regulations on sustainable development in developing economies

AbstractOver the years, efforts have been put in place to address money laundering activities including financial crime and illicit funding controls. These efforts have been recognized to promote financial integrity and effective governance systems. They have been further adjudged by the United Nations' sustainable development (Goal‐16) with a major concern to achieve peaceful, just and inclusive development. Previous studies reveal that money laundering activities have major implications for economic growth. However, little is known about the main implications of anti‐money laundering (AML) regulations on sustainable development. On this note, this study contributes to the ongoing debate by investigating the relationship between AML regulations and sustainable development in 72 developing economies, consisting 29 upper middle income, 33 low middle income and 10 low income countries. Using instrumental variable generalized method of moment (IV‐GMM), panel quantile estimation technique and dynamic panel threshold analysis, the findings are as follows. First, AML regulations promote sustainable development. Second, the panel quantile regression reveals that countries with moderate AML regulations attain higher sustainable development than those with excessive regulations. Further results on regional analysis show that AML regulations are more effective in Latin America, South Asia, Europe & Central Asia and Middle East & North Africa than in Sub‐Saharan Africa and East Asia & Pacific. These results are robust and stable after conducting a number of robustness analyses. The study suggests that effective AML regulations should be moderate and well‐implemented to further improve economic, social and environmental sustainability in developing countries.

Brazil’s national champions strategy (2007–13): A critical appraisal

The recent multiple crises have led to a renaissance of the role of the state in the economy throughout the world. Hence, industrial policy is once again back at the agenda of academic and policy debates in advanced as well as emerging economies. We want to contribute to this debate by discussing the controversial results of a recent case of industrial policy—the “national champions” strategy of the Brazilian National Development Bank (BNDES) between 2007 and 2013. Being the centerpiece of Brazil’s move toward a more state-led economic model in the late 2000s, its successes and failures should be of great importance to the ongoing debate about industrial policy, state capitalism, and development. The national champions strategy has become an integral part of contemporary state capitalist models, with China being the most outstanding example. By looking at the Brazilian case, an upper-middle income democracy, and therefore a more representative case for countries with similar political settings, the paper aims to provide a critical appraisal of revived industrial policies in the early 21stcentury as a separate policy tool of the newly emerging variety of state capitalism. We apply a political economy approach to highlight the context-sensitivity and institutional embeddedness of firms and the complementarities between several institutional spheres as resources and constraints for companies’ competitiveness and internationalization. The paper aims to contribute to the current debate about state-financed firm internationalization in general and the viability of a national champions strategy in particular.

Can increased economic complexity and reduced carbon emissions of the logistics industry go hand in hand? Evidence from countries along the Belt and Road

At present, the main focus of research lies in examining the connection between economic complexity and carbon emissions as a whole, but there is a scarcity of quantitative investigations on the link between the above variables within specific industries. Therefore, this study introduces economic complexity as a new variable to build a panel model within the traditional Environmental Kuznets Curve framework. Based on the data of the countries along the Belt and Road from 1998 to 2018, we used the Granger causality test to examine the causal relationship between variables, and use the Fully Modified Ordinary Least Square and Dynamic Ordinary Least Square methods to estimate the coefficients of variables. The key factor linking economic complexity and carbon emissions in the logistics industry is technology innovation Economic complexity can explain and predict the changes in carbon emissions of logistics industry more reasonably, and the relationship between them in line with the environmental kuznets curve hypothesis. Only high-income countries can increase economic complexity while reducing carbon emissions of logistics industry. Based on the empirical analysis, it is suggested that upper-middle income and lower middle-income countries can formulate relevant policies and regulations, and high-income countries can improve the relevant policies and regulations to promote the reduction of carbon emissions of the logistics industry. Studying the impact of economic complexity on carbon emissions in the logistics industry can help better predict and respond to the impact of climate change on the logistics industry.

The Role of Public Expenditures in Education Indicators: Analysis of Upper Middle Income Countries with SD and COCOSO Methods

Beşeri sermayede eğitime yapılan yatırım büyük rol oynamaktadır. Eğitim performanslarında kamunun eğitim harcamaları, okul kaydı ve işsizlik oranı gibi kriterlerin önemini ortaya koyan bu çalışmanın amacı; Dünya Bankası’nda üst-orta gelir grubunda yer alan 18 ülkenin eğitim göstergeleri açısından performansını incelemektir. Bu amaç kapsamında; Gayri Safi Yurtiçi Hasıla (GSYH) içinde kamunun eğitime yaptığı harcamalarının oranı, ortaöğretime yapılan okul kaydı, yükseköğretime yapılan okul kaydı, eğitime yapılan kamu harcamalarının toplam kamu harcamalarına oranı, ilköğretimi tamamlama oranı ve işsizlik oranı kriterlerinden yararlanılmıştır. Kullanılan kriterlerin ağırlıkları standart sapma (SD) yöntemiyle hesaplanmıştır. Elde edilen sonuca göre; performansı belirleme noktasında en önemli kriterlerin sırasıyla işsizlik oranı, eğitime yapılan kamu harcamalarının toplam kamu harcamalarına oranı, ortaöğretime yapılan okul kayıt oranı, yükseköğretime yapılan okul kayıt oranı, ilköğretimi tamamlama oranı ve eğitime yapılan kamu harcamalarının GSYH'ye oranı olduğu saptanmıştır. Çalışmada ülkeler arası sıralama, CoCoSo yöntemi kullanılarak analiz edilmiştir. Bu analizin sonucunda değerlendirilen ülkelerin performans sıralaması, belirlenen kriterlere göre elde edilmiştir. Moldova, Kazakistan ve Belarus en iyi performansa sahip ülkeler iken; Gürcistan, Ermenistan ve Ürdün en düşük performansa sahip ülkeler olarak tespit edilmiştir.

Economic Growth Model of Ecuador with Upper Middle Income to Explain and Predict Productivity during the Period 2000-2022

Economic growth is one of the most widely used measures of a country's macroeconomic performance, although it is not without its critics. There are strong arguments that per capita gross domestic product growth can reflect an important part of the success or failure of policies implemented in an economy. The objective, to analyse Ecuador's economic growth model with high average income to explain and predict productivity over the period 2000-2022. The materials and methods, this line of research addresses a hypothetical-deductive and descriptive level of inquiry, by developing aspects from the global perspective concerning economic theory and implicit models of classical growth; such as the model that describes the Cobb-Douglas production function, to explain and predict the temporal behaviour of Ecuador's economic development. The above, in order to establish a correlational analysis of the contributions of the macroeconomic determinants of productivity. The response variable to be measured has been the gross domestic product per capita (GDPpc ) with respect to the independent variables: Domestic Savings (S), Gross Fixed Capital Formation (FBKF), Government Final Consumption Expenditure (G), Exports (E) and as a control variable represented by Labor Force (L). A systematic documentary search was carried out through databases: Scielo, Scopus, Google Scholar and Science Direct, to support the present research with contributions with articles of temporal relevance within the last 5 years. In addition, it was based on annual secondary data extractions from official sources such as the Central Bank of Ecuador (BCE) and the World Bank (WB), according to the temporal coverage from 2000 to 2022. Results, 23 temporal observations were analysed to build an econometric model under the adaptation of a Cobb Douglas production function to explain and predict the behavior of elasticity in Ecuador's economic growth, which establishes that 99.81% of the total variability present in the data is explained by the model that includes variations in savings, gross fixed capital formation, labour force, government final consumption expenditure and exports in the analysed period. Conclusions, the imports variable is eliminated as it is not statistically significant, the resulting model complies with the basic assumptions and the corresponding economic validation in terms of the signs of the estimates for the determinants of economic growth in Ecuador.

The relationship between technology and emissions: Evidence from different income level countries and economic sectors

Each economic sector contributes differently to carbon emissions; hence the environmental impact of technological advancement may also differ across sectors; even more so, the same economic sectors might perform differently in different economic environments in countries.This study investigates the heterogeneous effect of aggregate and green technology on sectoral carbon emissions in a sample of 45 countries divided into three income categories (high-income, upper middle income, and lower middle income) between 1999 and 2018. The focus is on carbon emissions from five sectors (power, manufacturing, transport, petrol, and building). To do so, the two steps DIFF-GMM and the Feasible Generalised Least Square (FGLS) econometric methods are used. We proxied technological progress by four commonly used indicators (patents applications, R&D expenditure, ICT, and science and technology publications) and an aggregated one combining them.For the full sample analysis, results show that aggregate technology increases carbon emissions in all sectors except the building sector. Renewable energy significantly lowers emissions from all sectors, except the petrol sector. Aggregate technology is positively associated with carbon emissions across sectors in upper-middle-income and lower-middle-income countries, while negatively for the manufacturing and building sector in high-income countries.

INSTITUTIONAL QUALITY, INCOME LEVEL, AND DEBT SUSTAINABILITY: NEW EVIDENCE USING DYNAMIC PANEL THRESHOLD REGRESSION

Most countries have suffered from prolonged budget deficits over the past two decades. This situation has made researchers and policymakers aware of the challenges to debt sustainability. This study investigates the threshold effect of institutional quality on debt sustainability in a panel of 82 countries, focussing on various threshold effects at different income levels. All the countries selected for this study fell under the categories of high income (HI), upper middle income (UMI), and lower-middle and low income (LMLI) based on the World Bank classifications. The dynamic threshold panel regression results indicate the presence of a threshold effect of institutional quality on the fiscal reaction function (including debt sustainability and cyclical fiscal policy) in all the countries with different income levels. In HI countries, fiscal adjustment weakens if institutional quality surpasses the threshold value of institutional quality. The fiscal adjustment in UMI countries is similar to that in HI countries but statistically insignificant. By contrast, governments in LMLI countries can promote sustainable debt if their institutional quality exceeds the threshold value. Thus, policymakers in LMLI countries need to prioritise their efforts to raise the level of institutional quality to promote debt sustainability.

Establishing Consensus on Essential Resources for Musculoskeletal Trauma Care Worldwide: A Modified Delphi Study.

Despite evidence that formalized trauma systems enhance patient functional outcomes and decrease mortality rates, there remains a lack of such systems globally. Critical to trauma systems are the equipment, materials, and supplies needed to support care, which vary in availability regionally. The purpose of the present study was to identify essential resources for musculoskeletal trauma care across diverse resource settings worldwide. The modified Delphi method was utilized, with 3 rounds of electronic surveys. Respondents consisted of 1 surgeon with expertise in musculoskeletal trauma per country. Participants were identified with use of the AO Trauma, AO Alliance, Orthopaedic Trauma Association, and European Society for Trauma and Emergency Surgery networks. Respondents rated resources on a Likert scale from 1 (most important) to 9 (least important). The "most essential" resources were classified as those rated ≤2 by ≥75% of the sampled group. One hundred and three of 111 invited surgeons completed the first survey and were included throughout the subsequent rounds (representing a 93% response rate). Most participants were fellowship-trained (78%) trauma and orthopaedic surgeons (90%) practicing in an academic setting (62%), and 46% had >20 years of experience. Respondents represented low-income and lower-middle-income countries (LMICs; 35%), upper-middle income countries (UMICs; 30%), and high-income countries (HICs; 35%). The initial survey identified 308 unique resources for pre-hospital, in-hospital, and post-hospital phases of care, of which 71 resources achieved consensus as the most essential. There was a significant difference (p < 0.0167) in ratings between income groups for 16 resources, all of which were related to general trauma care rather than musculoskeletal injury management. There was agreement on a core list of essential musculoskeletal trauma care resources by respondents from LMICs, UMICs, and HICs. All significant differences in resource ratings were related to general trauma management. This study represents a first step toward establishing international consensus and underscores the need to prioritize resources that are locally available. The information can be used to develop effective guidelines and policies, create best-practice treatment standards, and advocate for necessary resources worldwide. This study utilized the Delphi method representing expert opinion; however, this work did not examine patient management and therefore does not have a clinical Level of Evidence.

MicroRNA silencing in a whole worm cestode model provides insight into miR-71 function

Parasites belonging to the class Cestoda include zoonotic species such as Echinococcus spp. and Taenia spp. that cause morbidity and mortality in endemic areas, mainly affecting pastoral and rural communities in low income countries but also upper middle income countries. Cestodes show remarkable developmental plasticity, implying tight regulation of gene expression throughout their complex life cycles. Despite the recent availability of genomic data for cestodes, little progress was made on postgenomic functional studies. MicroRNAs (miRNAs) are key components of gene regulatory systems that guide diverse developmental processes in multicellular organisms. miR-71 is a highly expressed miRNA in cestodes, which is absent in vertebrates and targets essential parasite genes, representing a potential key player in understanding the role of miRNAs in cestodes biology. Here we used transfection with antisense oligonucleotides to perform whole worm miRNA knockdown in tetrathyridia of Mesocestoides vogae (syn. Mesocestoides corti), a laboratory model of cestodes. We believe this is the first report of miRNA knockdown at the organism level in these parasites. Our results showed that M. vogae miR-71 is involved in the control of strobilation in vitro and in the establishment of murine infection. In addition, we identified miR-71 targets in M. vogae, several of them being de-repressed upon miR-71 knockdown. This study provides new knowledge on gene expression regulation in cestodes and suggests that miRNAs could be evaluated as new selective therapeutic targets for treating Neglected Tropical Diseases prioritised by the World Health Organization.

Global Burden of Atrial Fibrillation and Flutter by National Income: Results From the Global Burden of Disease 2019 Database.

Background Atrial fibrillation (AF) and atrial flutter (AFL) are common conditions that can lead to significant morbidity and death. We aimed to understand the distribution and disparities of the global burden of AF/AFL as well as the underlying risk factors. Methods and Results Data on the AF/AFL burden from the Global Burden of Disease data set were analyzed for the years 1990 to 2019, with countries grouped into low, lower-middle, upper-middle, and high national income classes according to World Bank categories. Data were supplemented with World Health Organization and World Bank information. The prevalence of AF/AFL has more than doubled (+120.7%) since 1990 in all income groups, though with a larger increment in middle-income countries (+146.6% in lower-middle- and +145.2% in upper-middle-income countries). In absolute numbers, 63.4% of AF/AFL cases originate from upper-middle-income countries, although the relative prevalence is highest in high-income countries. Prevalence of AF/AFL appears to be correlated with medical doctor rate and life expectancy. The most relevant AF/AFL risk factors are unevenly distributed among income classes, with elevated blood pressure as the only risk factor that becomes less common with increasing income. The development of these risk factors differed over time. Conclusions The global burden of AF/AFL is increasing in all income groups and is more pronounced in middle-income countries, with further growth to be expected. Underdiagnosis of AF/AFL in low- and middle-income countries may contribute to lower reported prevalence. The risk factor distribution varies between income groups.

Leveraging Small Business Development Through Employment Contracts: The Mediation Effect of Job Insecurity

Following enormous de-industrialisation and a series of industrial offshoring of big corporate entities over the past decade, Small Medium and Micro Enterprises have risen into prominence by their inert abilities of employment creation and poverty mitigation, particularly in the context of developing countries such as Zimbabwe. However, their continued failure has left the nation’s economy tottering at the brink of collapse, hence paling the vision 2030 of engineering the country’s economy towards attaining upper-middle income status beyond visibility and feasibility. High labour turnover is attributed as the chief cause of this phenomenon. In view of that, the current study sought to assess the moderating role of job insecurity on the nature of employment contracts and SMME development. The nature of the employment contract is deemed instrumental in promoting work commitment towards SMME development. This work commitment is anchored on an individual’s perceptions of job security. As such, for some, the nature of the employment contract becomes the sole driver to display extra effort at work in fear of losing a job. At times, such job loss fears are largely determined by one’s family needs and responsibilities. The hypotheses are tested using a sample size of 256 individuals working and owning SMMEs. The Raosoft sample size calculator was used for the sample size determination. SPSS Process was used to test if job insecurity mediates employment contracts and small business development. The empirical outcome suggests that employment contracts have a predictive effect on SMME development and that the turnover intention had a full mediation effect between employment contracts and small business development.

Reflections on COP27: How do technological innovations and economic freedom affect environmental quality in Africa?

Studies in literature argue that technological innovation is a crucial component that could provide an enduring solution to the effects of climate change. However, we argue in this study that technology-driven climate solutions may not be sustainable in the absence of robust economic freedom, particularly in Africa where there are manifestly weak governance indices. Hence, we investigate the interaction effects of technological innovation and economic freedom on environmental quality in Africa. By doing this, we deviate from prior studies that have considered only non-interactive regressions and offer a net effect approach which allows us to simultaneously introduce economic freedom as a modulating policy variable. We utilize panel data from the Fraser Institute and the World Bank Database for the period 2000 to 2018 for 31 African nations. Using an array of econometric techniques, our initial findings disclose a significant unconditional negative impact of technological innovation and economic freedom on the proxies of environmental quality. When both variables are interacted, the net effect suggests further negative impact. We account for potential endogeneity, and our results, yet remain consistent. We then evaluate the effect across regions and income classes. Our findings suggest that technological innovation improves environmental quality in low-middle and upper-middle income African nations, whereas the opposite is observed in low-income and Western nations. Our findings offer comprehensive and policy-relevant information to African stakeholders and international organizations, on the suitable strategies to managing environmental degradation.

Food insecurity in adults with severe mental illness: A systematic review with meta-analysis.

Food insecurity in adults living with Severe Mental Illness (SMI) is an underresearched area worldwide. This systematic review and meta-analysis aimed to identify and collate evidence on food insecurity in adults with SMI, in high- and upper-middle income countries. A comprehensive electronic search was completed up to August 2022. Random effects meta-analysis was undertaken to determine the prevalence and the odds ratio for food insecurity in adults with SMI. Narrative synthesis explored the data further. Sixteen publications were included (13 in the meta-analysis). The prevalence estimate of food insecurity in adults with SMI was 41% (95% CI: 29% to 53%, I2 = 99.9%, n = 13). Adults with SMI were 3.31 (95% CI: 2.03 to 5.41) times more likely to experience food insecurity than comparators without SMI (z = 6.29, p < .001, I2 = 98.9%, n = 6). Food insecurity appears to be a risk factor for developing SMI. This review suggests adults with SMI living in high- or upper-middle income countries are more likely to experience food insecurity than the general population and that this relationship may be inverse. Mental health practitioners should be aware of food insecurity and support individuals with SMI to access sufficient food.

An audit of the dissemination strategies and plan included in international food-based dietary guidelines.

Food-based dietary guidelines (FBDGs) are an important resource to improve population health, however little is known about the types of strategies to disseminate them. This study sought to describe dissemination strategies and content of dissemination plans that were available for FBDGs. A cross-sectional audit of FBDGs with a published English-language version sourced from the United Nations Food and Agriculture Organization repository. We searched for publicly available dissemination strategies and any corresponding plans available in English language. Two authors extracted data on strategies, which were grouped according to the Model for Dissemination Research Framework (including source, audience, channel, and message). For guidelines with a dissemination plan, we described goals, audience, strategies, and expertise and resources according to the Canadian Institute for Health Research guidance. FBDGs from 53 countries mostly from high-income (n=28, 52.8%), upper-middle income (n=18, 34%) areas were included. n/a. The source of guidelines were most frequently health departments (79.2%). The message included quantities and types of foods, and physical activity recommendations, and 88.7% included summarised versions of main messages. The most common channel were infographics and information booklets, and the main end-users were the public. For 12 countries (22.6%), we were able to source an English-language dissemination plan, where none met all recommendations outlined by the CIHR. The public was the most frequently identified end-user and thus most dissemination strategies and plans focused on this group. Few FBDGs had formal dissemination plans and of those, there was limited detailed provided.

An ASCO leadership development project to understand barriers to clinical cancer research in the Asia-Pacific.

96 Background: There are huge challenges in conducting clinical research, with gross disparities in trial access for patients in the Asia-Pacific (APAC). ASCO initiated a leadership development program in 2021, and one of the projects involved understanding the barriers to conducting clinical research and trials regionally. Methods: We conducted a cross-sectional survey on barriers to clinical research using a 29-item questionnaire which covered potential barriers to establishing clinical groups to support trials, and respondents’ demographic and other information. We targeted oncology healthcare professionals (HCPs) from APAC via national societies, locoregional hospitals, and via social media channels. Data were collected through the SurveyMonkey platform. Countries were classified into high-income (HICs), upper-middle (UMICs), and lower-middle income countries (LMICs) according to the World Bank criterion. We hypothesized substantial differences in the responses of HCPs by income (HICs vs UMICs vs LMICs) due to political, cultural, ethical, and socioeconomic factors and evaluated the univariate association of each potential barrier using Chi-square test. Multivariable logistic regression models evaluated the association between the top five significant potential barriers and country grouping, adjusting for age, gender, specialty and affiliation. Results: Three-hundred responses were received from May to July 2022, representing 21 APAC countries and regions in total. Among these, 102 (34%), 57 (19%), and 137 (46%) HCPs practiced in HICs, UMICs, and LMICs, respectively, with 51% of respondents being female. Most HCPs practiced in medical oncology (35%), radiation oncology (29%), and surgical oncology (13%). Just under 70% of respondents had &lt;= 10 years of training. Overall, the top five reported barriers included competing demands (reported by 88% of respondents), lack of financial support (86%), healthcare access issues for patients (75%), lack of research environment and infrastructure (72%), and lack of expertise of staff (68%). Adjusting for other factors, among these barriers lack of financial support, research environment and infrastructure, expertise, and healthcare access differed significantly between HICs and LMICs with respondents from LMICs more often reporting these barriers than those from HICs (p&lt;=0.02 for all). Conclusions: This is the largest survey exploring the research and trial landscape in APAC that revealed common and specific challenges affecting different countries, thus emphasizing the importance of targeted measures when addressing these barriers. These findings will inform future potential action plans by ASCO and the APAC Regional Council such as skills training, embedding clinical research within practice and facilitating cross border interaction; to empower research in the region.

Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis.

The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations. A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study. In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6). This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.

Cytomegalovirus Active Infection in Critically Ill Children.

To describe the epidemiology, clinical characteristics and outcomes of children with cytomegalovirus (CMV) active infection in the pediatric intensive care unit (PICU) and to investigate risk factors for mortality. This was a retrospective cohort study of patients who had CMV DNA detected in blood samples and/or tracheal aspirates by polymerase chain reaction (PCR) during stay at 2 PICUs of a university hospital. Suspected cases without etiological confirmation and patients with laboratory-confirmed CMV infection before PICU admission were excluded. Demographic, clinical and outcome data were collected from medical records. From January 1, 2012, to December 31, 2019, 4748 children were admitted to the PICUs. Thirty-five (0.74%; 95% CI 0.51%-1.02%) had laboratory-confirmed CMV active infection; 71.4% were immunocompromised and 11 (31.4%) died. Patients who died were older than those who survived (median age 65 vs. 5.5 months, respectively; P = 0.048), and they received antiviral therapy for a shorter time (median 12 vs. 23 days, respectively; P = 0.001). The main causa mortis was septic shock (82%) and in most deceased patients (73%) the last CMV PCR before death was positive. PELOD score >6 was a risk factor for death (RR 2.96; 95% CI 1.07-8.21). Viral load in blood had a poor ability for the prediction of death (area under the receiver operating characteristic curve 0.62; 95% CI 0.37-0.84). The incidence of CMV active infection during PICU stay was 0.74% in an upper-middle income country with a high CMV seroprevalence. PELOD score higher than 6 was a risk factor for death. No association was observed between CMV viral load and mortality.

The Impact of Time, Region, and Income Level on Stillbirth and Neonatal Mortality in Brazil, 2000-2019

To describe trends in perinatal loss across Brazil, a country that transitioned in 2006 from a lower-middle income to an upper-middle income country, from 2000 to 2019 and analyze the effect of municipal wealth status on perinatal outcomes. We conducted an ecological cohort study, based on publicly available data from the Brazilian Ministry of Health's data repository on live births and deaths. The Atlas of Human Development in Brazil was used to associate each region with a World Bank income classification. The national neonatal mortality rate (NMR) for infants born at ≥22weeks of gestation decreased from 21.2 in 2000 to 12.4 in 2019. The stillbirth rate (SBR) decreased from 12.0 to 10.2 during this period. For infants born between 22 and 27 weeks of gestation, worsening perinatal outcomes were seen after 2012. In 2019, the median rates of neonatal mortality and stillbirth were both 4 points higher in lower- to middle-income municipalities compared with high-income municipalities (P<.01). Brazil has made significant progress in neonatal mortality and stillbirth from 2000 to 2019, yet inequity in perinatal outcomes remains and is correlated with municipal economic status. Nationally, ongoing improvement is needed for infants <28weeks of gestation, and closer exploration is needed into why there are increasing rates of negative perinatal outcomes among infants born at 22-27weeks of gestation after2012.

Is Globalization Driving the Use of Renewable Energy? A Global Macro Perspective

The contemporary world has become increasingly interdependent in terms of economic, social and political development. These various forms of interdependence, usually termed globalization, help disseminate ideas, information, products, and services around the world. Increase in globalization has also increased path-dependence, affecting economic, social, and institutional development and completing some industries, products and technologies to grow in line with the global demand and changing standards. While the role of globalization in economic growth, technology transfer and institutional development is established in literature, the role of globalization in reversing environmental deterioration is not explored yet. The current study looks at how globalization has affected renewable energy use in high, upper middle and lower middle income countries. The empirical results based on a fixed effects model show that countries differ in terms of taking advantage of different types of globalization, i.e., economic, social and political, while transitioning towards renewable energy (RE) projects. Economic globalization has a positive influence on RE usage in the case of high and lower middle income countries, Social globalization in case of high and upper middle income countries. Contrary to the positive impacts of economic and social globalization, political globalization has a negative impact on RE usage in the case of high income countries. In addition to globalization, the effect of government effectiveness, GDP per capita and CO2 vary across the groups of countries.