Search Results (110)

Access to health care is a fundamental human right established in various legal frameworks worldwide. However, increasing evidence indicates that individuals with physical disabilities in rural Ethiopia continue to face barriers and disparities in accessing health care, leading to unmet needs and worsening health. Guided by Critical Disability Theory and Intersectionality Theory, this instrumental case study explored the barriers to accessing primary health care (PHC) for adults with physical disabilities in rural Ethiopia and examined how disability intersects with poverty, gender, and rurality to shape exclusion. Following purposeful sampling, we conducted 14 interviews and one focus group discussion (n = 7) with adults with physical disabilities, supplemented by PHC facility infrastructure observation. Using reflexive thematic analysis, we identified intersecting barriers across four domains: physical and environmental barriers, socioeconomic marginalization, socio-cultural stigma and attitudinal barriers, and systemic weaknesses in health service delivery. This revealed that disability-related barriers are rooted in structural ableism and intersecting inequities, underscoring the urgent need for inclusive policies and disability-inclusive practices. Such practices include enforcing accessibility standards, expanding community-based health insurance to cover disability-specific needs, supporting transportation, and providing disability-specific training for health professionals. Implementing these practices is essential to advancing disability rights and ensuring equitable health access in Ethiopia. Full article

Background/Objectives: Seasonal influenza imposes a significant burden on pediatric public health. Despite official recommendations and full insurance coverage, vaccination rates among children in Slovakia remain critically low. This study aims to analyze the attitudes, beliefs, and determinants of parental hesitancy regarding childhood influenza vaccination in the post-pandemic context. Methods: A single-center cross-sectional survey was conducted between February and March 2025 using convenience sampling among parents of children attending a pediatric immunoallergology center. An anonymous questionnaire collected data on demographics, risk perception, and attitudes. Data from 301 parents were analyzed using descriptive statistics, chi-squared tests, and odds ratios (OR) to identify key predictors of hesitancy. Results: Only 27.6% of parents expressed willingness to vaccinate their children, while 42.5% were opposed and 29.9% hesitant. Statistical analysis revealed no significant association between parental university education and vaccination intent (p > 0.05), indicating that vaccine hesitancy in this specific setting was present across all educational backgrounds. However, the source of information proved to be a critical determinant: consulting a pediatrician significantly increased the odds of acceptance (OR = 6.32; 95% CI: 3.54–11.28), whereas reliance on the internet and social media was a significant predictor of refusal (OR = 0.29; 95% CI: 0.17–0.50). The primary reported barrier was fear of adverse effects (70.4%), which significantly outweighed doubts about efficacy (30.2%). Conclusions: Parental hesitancy in Slovakia is a widespread phenomenon pervasive across all educational backgrounds, driven primarily by safety concerns and digital misinformation. The contrast between the protective influence of pediatricians and the negative impact of digital media underscores that clinical encounters are currently the most effective firewall against hesitancy. Public health strategies must therefore pivot from general education to empowering pediatricians with active, presumptive communication strategies. Full article

Background/Objectives: The diagnostic and therapeutic landscape of amyloidosis has evolved significantly with the introduction of non-invasive imaging and novel agents. However, contemporary real-world data reflecting these recent changes—particularly regarding the burden and prognostic impact of cardiac involvement—remain limited. We aimed to evaluate up-to-date temporal trends in the incidence, prevalence, and outcomes of amyloidosis using a nationwide cohort spanning the recent era. Methods: Using the Korean National Health Insurance Service database, we identified 5165 patients with newly diagnosed amyloidosis. Cardiac amyloidosis was defined by the presence of heart failure, cardiomyopathy, atrial fibrillation, or pacemaker implantation. Propensity score matching was performed to compare mortality risks between patients with and without cardiac involvement. Temporal trends in outcomes were analyzed across three periods (2009–2013, 2014–2018, and 2019–2022). Results: The incidence and prevalence of amyloidosis steadily increased, with a marked rise observed after 2019. Cardiac involvement was identified in 44.6% of patients and was associated with significantly higher risks of all-cause death (hazard ratio [HR] 1.396; 95% CI 1.214–1.606) and cardiovascular death (HR 1.879; 95% CI 1.254–2.816) in the matched cohort. Notably, while all-cause mortality gradually declined over the study period, cardiovascular mortality showed no significant improvement, remaining persistently high even in the most recent cohort. Conclusions: In this contemporary nationwide cohort, the burden of amyloidosis has grown over the past decade. Despite improvements in overall survival, the persistent risk of cardiovascular mortality highlights a critical unmet need for targeted cardiovascular management in this population. Full article

Background and Objectives: Mobile Eye Units (MEUs) have emerged as practical innovations to overcome geographic, financial, and systemic obstacles to eye care. Although numerous programs operate across the United States and Canada, a narrative review describing their structure, implementation and services, remain limited. This narrative review examines various MEUs models in the United States and Canada, using real-world examples to highlight each model’s structure, services, populations served, and key benefits and limitations. Methods: We performed a narrative review of peer-reviewed and gray literature published from 1990 to August 2025, identifying mobile eye units in the United States and Canada. Programs were grouped into four operational models based on services, equipment, and implementation characteristics. Ophthalmology residency program websites in the United States were also reviewed to assess academic involvement in mobile outreach. Results: We identified four operational MEU models: Fully Equipped Mobile Units (FEMUs), Semi-Mobile Outreach Units (SMOUs), School-Based Vision Mobile Units (SBVMUs), and Hybrid Teleophthalmology Units (HTOUs). FEMUs provide comprehensive on-site diagnostic capabilities but require substantial financial and logistical resources. SMOUs are lower-cost and flexible but offer more limited diagnostics. SBVMUs facilitate early detection in children and reduce school-based access barriers but depend on school coordination. HTOUs expand specialist interpretation through remote imaging, although their success relies on reliable digital infrastructure. Across all models, follow-up and continuity of care remain major implementation challenges. Approximately 21% of U.S. ophthalmology residency programs publicly report involvement in mobile outreach. Conclusions: MEUs play a critical role in reducing geographic and structural barriers to eye care for underserved populations across United States and Canada. However, limited outcome reporting, particularly regarding follow-up rates and continuity of care, hinders broader assessment of their effectiveness. Strengthening the integration of MEUs with patient navigators, integrated electronic health record, insurance support and support of local health networks is essential for improving long-term sustainability and impact. Full article

While the inflammatory properties of ambient air pollution may exacerbate osteoarthritis (OA), evidence on the population-level impact of multi-pollutant mixtures remains limited. This study quantifies the acute effects of short-term exposure to a complex mixture of six-criteria air pollutants on OA outpatient visits. In total, 8,146,141 OA visits from two national health insurance databases across 192 Chinese cities (2013–2017) were analyzed using a two-stage, time-stratified case-crossover design, combining conditional logistic regression with random-effects meta-analysis. The results showed that an interquartile range increase in the concentrations of PM_2.5, PM₁₀, NO₂, SO₂, O₃, and CO was associated with significant increases in OA visits of 1.75%, 2.26%, 4.01%, 3.42%, 1.98%, and 1.87%, respectively. NO₂ and SO₂ demonstrated the strongest associations across OA subtypes. Multi-pollutant models confirmed that the risk of OA visits increased significantly under combined pollutant exposure. Population attributable fractions ranged from 2.15% for PM_2.5 to 6.41% for NO₂. This large-scale analysis provides novel evidence that transient exposure to complex pollution mixtures, rather than to individual pollutants, drives OA-related healthcare demand, with gaseous pollutants (NO₂/SO₂) being critical components. Our findings advocate for integrative air quality management strategies targeting co-emitted pollutants to mitigate OA exacerbations. Full article

The Internet of Medical Things (IoMT) improves healthcare delivery through many medical applications. Because of medical data sensitivity and limited resources of wearable technology, privacy and security are significant challenges. Traditional encryption does not provide secure computation on encrypted data, and many blockchain-based IoMT solutions partially rely on centralized structures. IoMT with dynamic encryption is an innovative privacy-preserving system that combines sensitivity-based classification and advanced encryption to address these issues. The study proposes privacy-preserving IoMT framework that dynamically adapts its cryptographic strategy based on data sensitivity. The proposed approach uses a hybrid SDAIPA (SDAIA-HIPAA) classification model that integrates Saudi Data and Artificial Intelligence Authority (SDAIA) and Health Insurance Portability and Accountability Act (HIPAA) guidelines. This classification directly governs the selection of encryption mechanisms, where Advanced Encryption Standard (AES) is used for low-sensitivity data, and Fully Homomorphic Encryption (FHE) is used for high-sensitivity data. The Whale Optimization Algorithm (WOA) is used to maximize cryptographic entropy of FHE keys and improves security against attacks, resulting in an Optimized FHE that is conditionally used based on SDAIPA outputs. This proposed approach provides a novel scheme to dynamically align cryptographic intensity with data risk and avoids the overhead of uniform FHE use while ensuring strong privacy for critical records. Two datasets are used to assess the proposed approach with up to 806 samples. The results show that the hybrid OHE-WOA outperforms in the percentage of sensitivity of privacy index with dataset 1 by 78.3% and 12.5% and with dataset 2 by 89% and 19.7% compared to AES and RSA, respectively, which ensures its superior ability to preserve privacy. Full article

Background/Objectives: Oral health is a critical component of public health, yet disparities in access and financing remain significant. In Bulgaria, dental services are financed through the National Health Insurance Fund and patient co-payments, with coverage differing between children and adults. The aim of this study was to analyze the dynamics of health insurance payments and expenditures for dental care in Bulgaria over the period 2019–2025, with a focus on differences between age groups and the balance between public funding and patient contributions. Methods: A retrospective descriptive–analytical study was conducted using aggregated data from NHIF annual reports, national legislation, and secondary literature. Absolute expenditures (BGN) and relative shares (%) of dental services within total health insurance payments were examined for the period 2019–2025 (actual data). Key dental procedures analyzed included examinations, restorations, extractions, and treatment of pulpitis/periodontitis in children, as well as prosthetic rehabilitation in older adults. Descriptive statistics, trend analysis, and simple linear regression were applied to assess expenditure growth and predictability. Results: Total health insurance payments in Bulgaria nearly doubled between 2019 and 2025, increasing from 4.12 to 8.87 million BGN. Dental expenditures rose from 167,000 to 416,000 BGN, with the share of dental care rising modestly from 4.05% to 4.69%. For children, NHIF covered nearly all costs, with minimal or absent co-payments. Among adults, a co-financing model prevailed, with fixed patient contributions for basic services but full NHIF coverage for prosthetic rehabilitation in edentulous patients aged 65–69 years. Conclusions: Bulgaria’s dental care financing reflects a socially oriented model, with full coverage for children and mixed financing for adults. Strategic policy adjustments are needed to ensure sustainability, equity, and alignment with universal health coverage goals. Full article

Gastric cancer is a significant health concern in East Asia, where early risk prediction is critical for prevention. However, the scarcity of single-hospital electronic health records (EHRs) data limits the applicability and generalizability of machine learning models. To address this challenge, we propose an ensemble transfer learning framework for gastric cancer prediction using structured EHRs in a data-scarce single-hospital setting. Three base models, Support Vector Machine (SVM), Random Forest, and Deep Neural Network (DNN), were pretrained on a large-scale national dataset from the Republic of Korean National Health Insurance Service (NHIS) and fine-tuned on a smaller institutional dataset from Kangdong Sacred Heart Hospital (KSHH). These fine-tuned models were combined via stacking ensemble learning with logistic regression as a meta-learner. The proposed model achieved strong performance with precision 0.78, recall 0.92, F1-score 0.83, accuracy 0.91, and AUC 0.93. For interpretability, permutation feature importance and Shapley Additive Explanations (SHAP) were applied. Smoking status, gender, and hypertensive disorder were identified as key predictors consistent with previous studies. This study demonstrates the successful application of transfer learning to overcome data scarcity in single-hospital structured EHRs. Furthermore, our stacking ensemble strategy outperformed the individual fine-tuned models, offering a generalizable framework for gastric cancer prediction in data-scarce clinical settings. Full article

Background: Social determinants of health critically impact outcomes along the care continuum of patients with hepatocellular carcinoma (HCC). This systematic review summarizes the effect of socioeconomic status (SES) factors on HCC outcomes in the United States. Methods: Electronic databases were queried for the concepts of “liver cancer”, “health disparities”, and “socioeconomic factors” on 1 March 2021. Eligible studies included an individual- or area-level SES measure such as income, education, employment, and insurance and one of the following outcomes across the clinical continuum of HCC care: incidence, screening/surveillance, diagnosis, treatment, survival, and end-of-life. Results: Of 3331 studies screened, a total of 63 studies encompassing 179 separate analyses were included in our narrative synthesis: 13 on incidence, 5 on surveillance, 19 on diagnosis, 79 on treatment, 61 on survival, and 2 on end-of-life. Insurance was the most frequent SES measure represented (50%), followed by mostly area-level income (39%), education (9%), and employment (2%). The included studies were heterogeneous regarding both SES definitions (e.g., individual vs. area-level measures) and outcome reporting. Trends of worse outcomes were generally observed with lower indicators across all SES domains and HCC outcomes, particularly in analyses using national cancer registry data (e.g., SEER and NCDB). Unadjusted racial and ethnic disparities in outcome were attenuated in six out of 23 analyses that adjusted for an SES measure. Conclusions: Our findings highlight the need for social risk screening and interventions early in the HCC care pathway. Future research should focus on HCC surveillance and end-of-life/survivorship, with greater emphasis on examination of modifiable individual-level social determinants. Full article

Livestock farm biosecurity is crucial for animal health and economic sustainability, however uneven adoption/implementation across diverse livestock species and production systems persists. To improve uptake of biosecurity, it is necessary to identify critical economic behavioural, and systematic barriers, and to outline practical drivers. Perceived high costs, labour/time burdens, and uncertain benefits can suppress private investment, while poorly designed indemnities can create moral hazard. Conversely, targeted subsidies, risk-based insurance, and market standards (e.g., certification and procurement) can incentivise implementation. Knowledge and trust gaps, especially in smallholder and backyard settings, further limit compliance. Participatory, and context-specific training led by field veterinarians consistently outperforms top–down messaging, with effective element including: simple, low-cost “easy wins”, tiered checklists, and decision-support tools to help embed routines and demonstrate the value of biosecurity. Integrating clear cost–benefit evidence, incentive-based tools, and co-designed training can transform biosecurity from a perceived practical and cost burden into a resilient, profitable practice that delivers public-good benefits for animal health, trade, and One Health across Europe and beyond. Full article

Background: Preventing and reducing acute exacerbations is a key objective in chronic obstructive pulmonary disease (COPD) management. Therefore, vaccination against influenza and pneumococcal disease is particularly important for this population. Under self-funded vaccination policies, the coverage rates for both vaccines among COPD patients in China are critically low. Since 2013, Shanghai has implemented a program providing one free dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23) to residents aged 60 and above, whereas influenza vaccination remains self-funded. Few studies have compared influenza and pneumococcal vaccination coverage among COPD patients in China under these distinct funding strategies. Methods: This study used a stratified cluster sampling method to select COPD patients registered in the “Shanghai Community Chronic Disease Health Management System” from both urban (Xuhui) and suburban (Fengxian) districts of Shanghai. Data on demographic characteristics, medical history, physical examination results, behavioral risk factors, and vaccination records were extracted from the system. Vaccination records were verified using the “Shanghai Immunization Information System”. Descriptive analysis was conducted to assess influenza vaccine (self-funded, InfV) coverage during the 2023/2024 influenza season and cumulative PPV23 (government-funded) vaccination coverage among COPD patients. Logistic regression analysis was further employed to identify potential factors associated with InfV and PPV23 vaccination uptake in this population. Results: During the 2023/2024 influenza season, the influenza vaccination coverage under a self-funded policy was 5.87% among 1601 COPD patients in Shanghai, while the cumulative coverage of PPV23 under the government-funded program reached 52.15%. The willingness to receive PPV23 (60.40% vs. 27.55%; χ² = 350.73, p < 0.001) and the uptake among willing individuals (86.35% vs. 21.32%; χ² = 570.69, p < 0.001) were significantly higher under the free strategy compared to the self-funded InfV. For both vaccines, the primary reason for vaccine hesitancy was concern about adverse reactions, cited by over 50% of unwilling COPD patients. Multivariate analysis identified urban residence (aOR = 4.47, 95%CI: 2.86–6.98), prior PPV23 vaccination (aOR = 6.00, 95%CI: 3.43–10.49) and prior COVID-19 vaccination (aOR = 3.18, 95%CI: 1.79–5.66) as positive predictors of self-funded influenza vaccination. For PPV23 vaccination under the government-funded policy, significant factors included prior influenza vaccination (aOR = 6.89, 95%CI: 4.68–10.12), advanced age (aOR = 4.73, 95%CI: 3.68–6.09), and suburban residence (aOR = 0.37, 95%CI: 0.29–0.47). Conclusions: Influenza vaccination coverage among COPD patients in Shanghai remains critically low compared to the government-funded PPV23, highlighting the pivotal role of public funding. To address this disparity, urgent policy measures, including incorporating the influenza vaccine into publicly funded or health insurance reimbursement schemes, are essential. Full article

This study examines how individuals’ perceptions of the importance of their health insurance benefits (Insurance Importance) influence their overall job satisfaction (Job Satisfaction), with health insurance satisfaction (Insurance Satisfaction) serving as a mediator and time spent on insurance administrative tasks or burdens (Time Spent) acting as a moderator. Using survey data from a final analytic sample of 296 participants in the United States, we found that Insurance Satisfaction mediates the relationship between perceived Insurance Importance and Job Satisfaction. Moreover, the positive association between Insurance Importance and Insurance Satisfaction weakens when individuals spend more time managing insurance administrative burdens. Our findings highlight the critical need for organizations to strategically prioritize employee benefits, with a particular emphasis on streamlining and enhancing the efficiency of health insurance administrative process to reduce administrative burdens. By implementing such strategies, organizations can improve employees’ satisfaction with health insurance, thereby boosting their job satisfaction. Full article

Stigmatized views of emotionality form within familial, cultural, and societal contexts and serve as a mechanism impacting youth mental health and substance misuse with notable ties to health equity. Yet critical questions remain regarding the impact of racial identity on emotionality stigma in urban groups and the moderating relationship between race and emotionality stigma on youth mental health and substance misuse. The current study aimed to investigate emotionality stigma as a mechanism of health inequity by exploring the relationships between racial identity, emotionality stigma, and adolescent mental health and substance misuse. Urban adolescents (n = 85) recruited from a combined mental health and substance use treatment program reported on their stigmatized views of emotionality, mental health, and substance use. Participants primarily identified as multicultural (60.3%) and socioeconomically disadvantaged, with 55.2% requiring transportation assistance and 63.8% being either insured through Medicaid or uninsured. Findings suggest a link between racial identity and emotionality stigma that was associated with attachment (β = −3.43, p < 0.001) as well as substance misuse type (β = 5.36, p < 0.001) and polysubstance use (β = −6.53, p < 0.001) for urban adolescents in combined treatment. This study is the first to provide empirical support for the interconnected role of sociocultural factors and emotionality stigma and calls for systems-level change to address emotionality stigma individually, communally, and socially. Full article

Background/Objectives: Health insurance coverage is critical for children’s health, yet underinsurance remains a significant issue in the United States. This study aims to estimate the prevalence and correlates of childhood underinsurance in southwestern Ohio during a portion of the COVID-19 pandemic. Methods: This is a cross-sectional study of a convenience sample of children, ages 6 months to <18 years, seen in primary care pediatric practices. Recruitment of children’s primary caregivers (PCGs) occurred in practice waiting rooms from June 2021 to April 2023. Respondents completed the Medical Expenses of Children Survey (MEoCS). Index children were considered underinsured if their PCG responded “yes” to any of six questions regarding the inability to pay for a child health clinician’s recommendation despite the child having health insurance. Chi-squared tests and logistic regression were employed in data analysis. Results: 1252 PCGs completed the MEoCS with a response rate of about 90%. 11.3% of index children were underinsured. 41.5% of PCGs raising underinsured children found it harder to access care for their child compared to 3 years ago, while only 9.5% of PCGs raising adequately insured children reported it was harder (p < 0.001). PCGs of underinsured children were more likely to report that COVID-19 had a negative effect on their household income (49.2%) and their child’s school performance (52.0%) and mental health (47.7%) compared to adequately insured children (27.0%, 27.0%, 25.0%; p < 0.001). Conclusions: About 1 in 9 index children were underinsured. Lower parental education and private health insurance were associated with underinsurance across several study cohorts, documenting the stability of these drivers of underinsurance. Full article

Background: Burn patients with severe inhalation injury and refractory hypoxemia are at high risk for cardiorespiratory failure and mortality. Extracorporeal membrane oxygenation (ECMO) has emerged as a potential rescue therapy, but its survival benefits in this population remain uncertain. This study aimed to evaluate the impact of ECMO on mortality in burn patients with severe lung injury, to identify risk factors associated with death, and to analyze causes of rehospitalization among survivors. Methods: We conducted a population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD). Burn patients with severe hypoxia requiring mechanical ventilation between 2000 and 2015 were identified. A 0.25-fold propensity score matching was applied based on age, gender, and burn severity. Mortality rates, survival risk factors, and rehospitalization causes were analyzed between ECMO and non-ECMO groups. Results: Among 6493 eligible patients, ECMO-treated patients had a hospital mortality rate of 47.09%, compared to 38.71% in the non-ECMO group. Early-phase mortality was higher among ECMO patients (adjusted 1-year mortality HR: 3.19), but survivors demonstrated stable long-term outcomes. Pulmonary complications, cardiac dysfunction, and sepsis were the leading causes of death. Kidney failure and infections were the most common reasons for rehospitalization among survivors. Conclusions: This research offers a comprehensive real-world analysis of the effectiveness of ECMO in burn patients. While ECMO does not eliminate early mortality risk, it may provide critical support during acute phase in carefully selected burn patients with severe hypoxemia. Multidisciplinary care and early rehabilitation planning are essential to improve long-term outcomes. Further research is needed to refine patient selection and optimize ECMO strategies in this high-risk population. Full article