Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries : a prospective, international, multicentre cohort study

Background Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Interpretation Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Child death in high-income countries

Although high income countries have made substantial progress towards reducing child mortality over recent decades, rates vary markedly between and within countries, and modifiable factors continue to be identified in many deaths. A series of three articles in The Lancet has described the epidemiology of child mortality and a standardised approach to child death reviews in high income countries. Patterns of child mortality at different ages are delineated into five broad categories: perinatal, congenital, acquired natural, external, and unexplained; while contributory factors are described across four broad domains: factors intrinsic to the child, the physical environment, the social environment, and service delivery. This commentary attempts to draw on the conclusions of these three articles and make practical recommendations on strategies in three key areas with perhaps the greatest potential to further reduce child mortality in high income countries: perinatal conditions, particularly preterm birth; acquired natural conditions, such as sepsis or acute respiratory problems; and external causes, including road traffic fatalities

Financing health care in high-income countries

The main lesson from the experience of high-income countries with health care financing is a simple one: financing reforms should support the ultimate goal of universal coverage. Most high-income countries started with voluntary health insurance systems, which were then gradually extended to compulsory social insurance for certain groups and finally reached universal coverage, either as nationwide social health insurance schemes or as tax-financed national health services. The risk pooling and prepayment functions are essential. Moreover, the revenue collection mechanisms, whether as general tax revenues or payroll taxes, are secondary to the basic object of providing financial protection through effective risk pooling mechanisms. The experience of high-income countries indicates that private health insurance, medical savings accounts, and other forms of private resource collection are supplementary methods for increasing universal coverage.

Growth divergence and income inequality in OECD countries: the role of trade and financial openness. LEQS Paper No. 148/2018 October 2019

This paper analyses trade and financial openness effects on growth and income inequality in 35 OECD countries. Our model takes into account both short run and long run effects of factors explaining income divergence between and within the countries. We estimate, for the period 1995-2016, an error correction model in which per capita GDP and inequality are driven by changes over time of selected factors and by the deviation from a long run relationship. Stylised facts suggest that trade and financial openness reduce the growth gaps across the countries but not income inequality, and the effects of finance are stronger in high income countries. Nevertheless, low and middle income countries benefit more from international trade. Our contribution to the existing literature is threefold: i) we study the short and long run effects of trade and financial openness on income level and distribution, ii) we focus on developed countries (OECD) rather than on developing and iii) we provide a sensitivity analysis including in our baseline equation an institutional indicator, a trade agreement proxy and a dummy of global financial crisis. Estimates results indicate that trade openness significantly improved the conditions of OECD low income countries both in short and long run mostly, consistently with the catching up theory. It also decreased inequality, but only in low and middle income countries. Differently financial openness had a positive and significant impact only in the short run on middle income countries and increased income disparities within countries in the short term in low income countries and in the long term in high income countries

Tax rates, governance, and the informal economy in high-income countries

This paper studies the mechanisms behind the informal economy in high-income countries. About 16.3% of output in high-income OECD countries was produced informally in 2001-02. In a recent paper Davis and Henrekson [2004] show that there exists a positive relationship between tax rates and the informal economy for high-income OECD countries. Existing models of the informal economy mostly focus on developing countries. To account for the informal economy in high-income countries, build a model economy, following Lucas [1978], in which agents of different managerial abilities decide to become workers, managers of informal firms, or managers of formal firms. In contrast to formal managers, managers of informal firms do not pay taxes but run the risk of getting caught, taxed, and fined. A calibrated version of the model economy is able to generate the observed differences in informal economy of 21 high-income countries. Although tax rates are crucial for explaining the observed differences in informal economy, the quality of governance, the extent to which these tax rates are enforced, also plays an important role. Policy experiments show that by improving the enforcement of their tax policies countries can reduce informality. A smaller informal economy is accompanied by larger firms and higher productivity

"Compensations and contributions under an international carbon treaty"

The simulations in this paper use actual 2004 data on carbon emissions and per capita GDP from 178 countries to provide a rough estimate of how much better off high-income countries might be by compensating low-income countries to help reduce carbon emissions rather than doing it without their help; and a rough estimate of the per capita compensation to each low-income country and the per capita contribution from each high-income country under several alternative formulas that might be adopted under an international carbon treaty. The study focuses special attention on the per capita compensations to India, China, and Russia, and the per capita contributions from the United States, Japan, Germany, United Kingdom, Italy, and France, under alternative formulas. In our initial simulation, if the 46 countries with per capita GDP above $12,000 want to reduce world emissions by 1.095 billion metric tons (15$108 billion if they do it without help. But if they get optimal help from the 132 low-income countries, the total cost of reducing world emissions 1.095 billion would be only $55 billion--$27 billion for the low-income countries and $28 billion for the high-income countries-- so the world cost saving would be$53 billion and the cost saving for the high-income countries would be $80 billion. Thus, if the high-income countries compensate the low-income countries 100$27 billion), the high-income countries would still be $53 billion better off than if they had done it alone. Under the formula used in this initial simulation, China’s per capita compensation would be$7 and the U.S.’s per capita contribution would be $40.International Carbon Treaty

Is corruption anti labor?

This paper investigates the effect of corruption on trade openness in low-income and high-income countries. The results suggest corruption is anti-labor, since it reduces trade in low-income countries and increases trade in high-income countries.Openness; corruption; Stolper-Samuelson effects

Financial institutions and markets across countries and over time - data and analysis

This paper introduces the updated and expanded version of the Financial Development and Structure Database and presents recent trends in structure and development of financial institutions and markets across countries. The authors add indicators on banking structure and financial globalization. They find a deepening of both financial markets and institutions, a trend concentrated in high-income countries and more pronounced for markets than for banks. Similarly, the recent increase in cross-border lending and debt issues has been concentrated in high-income countries, while low and lower-middle income countries have experienced an increase in remittance flows. Low net interest margins, rising profitability and declining stability in high-income countries’ banking sectors characterize the recent financial sector boom in high income countries leading up to the global financial crisis of 2007.,Debt Markets,Emerging Markets,Banks&Banking Reform,Economic Theory&Research

Impact of agricultural land conversion on climate change

Climate change and land use conversion are two major global environmental issues. A claim is made that climate change has brought new challenges for global land use, while land use conversion is hardly realized as a major driver for climate change. Using mapping techniques, this study aims to investigate the relationship between climate change and agricultural land conversion (ALC), by which land is converted from agricultural to other uses (e.g., urban areas, national and natural parks, roads, industrial areas, and afforestation projects). CO2 emission is considered as the main impact of climate change, and agricultural land conversion is regarded as the most important global land use. In this study, data are obtained from two databases: the World Bank and the Food and Agriculture Organization (FAO) for the period of 1962-2011. Considering the FAO (2015) classification, the countries are categorized into five different groups (high-income non-OECD, high-income OECD, upper-middle-, lower-middle-, and low-income countries). Economies were divided into several income groups according to 2014 gross national income per capita. The results show that agricultural areas in high-income countries have decreased, while in low- to middle-income countries, they have increased. The highest CO2 emissions can be observed, especially in high-income countries, whereas the lowest CO2 emissions happen in the low- and lower-middle-income countries. The results further show that there is a positive relationship between CO2 emissions and ALC across the world. It can be observed that CO2 emission is increasing where agricultural area is declining. On the contrary, CO2 emission is declining where agricultural area is increasing

Corruption and the shadow economy: An empirical analysis

This paper analyzes the influence of the shadow economy on corruption and vice versa. We hypothesize that corruption and shadow economy are substitutes in high income countries while they are complements in low income countries. The hypotheses are tested for a crosssection of 120 countries and a panel of 70 countries for the period 1994-2002. Our results show that the shadow economy reduces corruption in high income countries, but increases corruption in low income countries. We also find that stricter regulations increase both corruption and the shadow economy.corruption; shadow economy; regulation; tax burden