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Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms for screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approaches carried out in developing countries and from the available managerial guidelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives.

Automatically inferring user demographics from social media posts is useful for both social science research and a range of downstream applications in marketing and politics. We present the first extensive study where user behaviour on Twitter is used to build a predictive model of income. We apply non-linear methods for regression, i.e. Gaussian Processes, achieving strong correlation between predicted and actual user income. This allows us to shed light on the factors that characterise income on Twitter and analyse their interplay with user emotions and sentiment, perceived psycho-demographics and language use expressed through the topics of their posts. Our analysis uncovers correlations between different feature categories and income, some of which reflect common belief e.g. higher perceived education and intelligence indicates higher earnings, known differences e.g. gender and age differences, however, others show novel findings e.g. higher income users express more fear and anger, whereas lower income users express more of the time emotion and opinions.

BackgroundGrowing spatial social and economic polarisation may be an important societal determinant of health, but only a few studies have used the recently developed Index of Concentration at the Extremes (ICE) to analyse the impact of joint concentrations of privilege and privation on health outcomes. We explore use of the ICE to investigate risk of hypertension in an urban, multiracial/ethnic, and predominantly working-class study population of US adults.MethodsWe generated novel ICE measures at the census tract level that jointly assess extreme concentrations of both income and racial/ethnic composition. We then linked the ICE measures to data from two observational, cross-sectional studies conducted in the Boston metropolitan area (2003–2004; 2008–2010; N=2145).ResultsThe ICE measure for extreme concentrations of white compared with black residents was independently associated with lower odds of hypertension (OR=0.76; 95% CI 0.62 to 0.93), controlling for race/ethnicity, age, gender, smoking, body mass index, household income, education and self-reported exposure to racial discrimination. Even stronger associations were observed for the ICE measures that compared concentrations of high-income white residents versus low-income residents of colour (OR=0.61; 95% CI 0.40 to 0.96) and high-income white versus low-income black residents (OR=0.48; 95% CI 0.29 to 0.81).ConclusionsResults suggest public health studies should explore the joint impact of racial/ethnic and economic spatial polarisation on population health.

This study aims to determine whether the effect of income inequality on economic growth is realised through transmission channels theoretically expressed. This relationship is examined for 143 countries and the periods between 1980 and 2017 through positive and negative channels. These countries are divided into two groups by considering their income levels and they are analysed with panel data econometric techniques. Although the findings provide evidence that high inequality adversely affects economic growth, it can be stated that this inference cannot be generalized when countries' income levels are taken into account. Countries with higher inequality tend to have higher fertility rates and less innovative activity. The financial market imperfections in developing countries adversely affect human capital investments. On the other hand, high inequality tends to increase saving propensity in developed countries and provides evidence for the positive channel. The findings highlight the complexity of the impact of income inequality on economic growth. Therefore, indirect impact needs to be scrutinized and policy recommendations need to be carefully designed.

This study determines the relationship between economic growth, foreign direct investment, energy intensity, and carbon dioxide emissions along the Belt and Road initiative considering their income classification. The study employs data from 1995 to 2015, the panel unit root test, Westerlund cointegration test, augmented mean group estimation, and the Dumitrescu-Hurlin Granger causality test. The empirical results indicate that (1) the data from all income group had cross-sectional association; (2) the variables are integrated of order 1 after first difference; (3) The variables under discussion were cointegrated; (4) at 1% increase in energy consumption, carbon dioxide emissions increased by 0.8606%, 0.9082%, 0.91815%, and 0.8043% in high-, upper-middle-, lower-middle-, and low-income countries, respectively; (5) a bidirectional causal relationship was found between foreign direct investment and carbon dioxide across all income groups. Energy intensity has a bidirectional association with carbon dioxide in low-, upper-middle-, and high-income countries but one-way association in lower-middle-income countries. These recent methodologies take cross-sectional dependence into account in their estimation and findings show that the causal affiliations together with long-run estimated effects amid employed variables are influenced by the different income levels of Belt and Road countries in a tender to reduce carbon dioxide emissions. The empirical results point to some important policy implications.

Background The associations between socioeconomic status and community-acquired pneumonia outcomes in adults have been studied although studies did not always document a relationship. The aim of this multicenter observational study was to determine the association between socioeconomic status and community-acquired pneumonia outcomes in the elderly, in the context of a public health system providing universal free care to the whole population. Methods A total of 651 patients aged ≥65 years hospitalized due to community-acquired pneumonia through the emergency departments of five Spanish public hospitals were recruited and followed up between May 2005 and January 2007. The primary outcomes studied were: length of stay, intensive care unit admission, overall mortality and readmission. Socioeconomic status was measured using both individual and community data: occupation [categorized in six social groups (I, II, III, IVa, IVb and V)], educational level (≤ primary level or ≥ secondary level) and disposable family income of the municipality or district of residence [>12,500 € (high municipality family income) and ≤12,500 € (low municipality family income)]. The six social groups were further categorized as upper/middle social class (groups I-IVb) and lower class (group V). Bivariate and multivariate analyses were performed. OR and their 95% confidence intervals were calculated. All statistical tests were two tailed and statistical significance was established as p < 0.05. Results 17.7% of patients lived in a municipality or district with a high municipality family income and 63.6% were upper/middle social class (I-IVb). Only 15.7% of patients had a secondary education. The adjusted analysis showed no association between pneumonia outcomes and social class, educational level or municipality family income. However, length of stay increased significantly in patients in whom the factors, living alone and being a smoker or ex-smoker coincided (p < 0.001). Conclusions We measured socioeconomic status using both individual and community data and found no association between social class, educational level or municipality family income and the variables of pneumonia outcomes. The lack of differences between social classes supports the provision of universal, equitable health care by the public health system.

BackgroundPrevious research has shown socioeconomic inequality in prevalence and onset of depressive disorders. It is not yet clear whether perceived financial strain is associated with depressive and/or anxiety disorders in addition to an objective indicator, such as income. This study examines whether financial strain is associated with the prevalence and onset/recurrence of depressive and/or anxiety disorders, above income.MethodsData are from the Netherlands Study of Depression and Anxiety. Associations between financial strain, income and presence of depressive and/or anxiety disorder at baseline were assessed among 2937 participants (18–65 years). Impact of financial strain and income on 4-year onset/recurrence of depressive and/or anxiety disorders were examined among 1250 participants without a depressive or anxiety disorder at baseline. Depressive and anxiety disorders were determined with the Composite-International-Diagnostic-Interview. Financial strain and income were assessed in an interview.ResultsParticipants with mild or severe financial strain had higher odds of being depressed (OR=1.68, 95% CI 1.35 to 2.09; OR=3.88, 95% CI 2.58 to 5.81) or remitted (OR=1.56, 95% CI 1.24 to 1.96; OR=1.99, 95% CI 1.27 to 3.11) at baseline compared with healthy controls, after adjusting for income. Mild or severe financial strain was not associated with onset/recurrence of depressive and/or anxiety disorders during follow-up (OR=1.08, 95% CI 0.83 to 1.42; OR=1.05, 95% CI 0.64 to 1.73).ConclusionsFinancial strain was associated with having a depressive and/or anxiety disorder, above the effect of income. Healthcare and social services should be alert to this association, even for higher income households. However, financial strain and income were not related with 4-year onset/recurrence of depressive and/or anxiety disorders.

Background The aim of this study was to measure differences in quality-adjusted life expectancy (QALE) by income in Korea at the national and district levels. Methods Mortality rates and EuroQol-5D (EQ-5D) scores were obtained from the National Health Information Database of the National Health Insurance Service and the Korea Community Health Survey, respectively. QALE and differences in QALE among income quintiles were calculated using combined 2008–2014 data for 245 districts in Korea. Correlation analyses were conducted to investigate the associations of neighborhood characteristics with QALE and income gaps therein. Results QALE showed a graded pattern of inequality according to income, and increased over time for all levels of income and in both sexes, except for low-income quintiles among women, resulting in a widened inequality in QALE among women. In all 245 districts, pro-rich inequalities in QALE were found in both men and women. Districts with higher QALE and smaller income gaps in QALE were concentrated in metropolitan areas, while districts with lower QALE and larger income gaps in QALE were found in rural areas. QALE and differences in QALE by income showed relatively close correlations with socioeconomic characteristics, but relatively weak correlations with health behaviors, except for smoking and indicators related to medical resources. Conclusions This study provides evidence of income-based inequalities in health measured by QALE in all subnational areas in Korea. Furthermore, QALE and differences in QALE by income were closely associated with neighborhood-level socioeconomic characteristics.

In income classification shifting, firms shift recurring income components (in core earnings) that are income reducing to items commonly assumed to be nonrecurring (special items) to increase core earnings, which are used by analysts and investors to forecast future earnings and value a firm. Some special items tend to extend over multiple quarters and are more amenable to classification shifting because it is easier to shift core expenses into those items (continuous special items). Nevertheless, as the recurrence of special items increases, the market perceives them more like recurring earnings components (Cready et al. in Account Rev 85(5):1577–1615, 2010), which reduces the benefits of classification shifting. Therefore, we hypothesize that when special items are continuous and first in a sequence of quarterly continuous special items, firms are more likely to use them to shift income than when continuous special items are last in the series. Our results confirm our expectations. The findings highlight that the location of a continuous special item in a sequence of continuous special items affects the likelihood of income classification shifting.

Objectives: To test the hypothesis that manual workers are at higher risk of death than are non-manual employees when living in municipalities with higher income inequality. Design: Hierarchical regression was used for the analysis were individuals were nested within municipalities according to the 1990 Swedish census. The outcome was all-cause mortality 1992–1998. The income measure at the individual level was disposable family income weighted against composition of family; the income inequality measure used at the municipality level was the Gini coefficient. Participants: The study population consisted of 1 578 186 people aged 40–64 years in the 1990 Swedish census, who were being reported as unskilled or skilled manual workers, lower-, intermediate-, or high-level non-manual employees. Results: There was no significant association between income inequality at the municipality level and risk of death, but an expected gradient with unskilled manual workers having the highest risk and high-level non-manual employees having the lowest. However, in the interaction models the relative risk (RR) of death for high-level non-manual employees was decreasing with increasing income inequality (RR = 0.77; 95% CI, 0.63–0.93), whereas the corresponding risk for unskilled manual workers increased with increasing income inequality (RR = 1.24; 95% CI, 1.06–1.46). The RRs for skilled manual, low- and medium- level non-manual employees were not significant. Controlling for income at the individual level did not substantially alter these findings, neither did potential confounders at the municipality level. Conclusions: The findings suggest that there could be a differential impact from income inequality on risk of death, dependent on individuals' social position.