Search Results (1,237)

Although organizational resilience is well established, refining the systematic quantitative evaluation of health systems resilience (HSR) remains an ongoing opportunity for advancement. Research either focuses on individual HSR indicators, such as social welfare policy, public expenditure, health insurance, healthcare quality, and technology, or broadly examines socio-economic factors, highlighting the need for a more comprehensive methodological approach. This study employed the Slacks-Based Measure (SBM) within Data Envelopment Analysis (DEA) to analyze efficiency by maximizing outputs. It systematically examined key HSR factors across countries, providing insights for improved policymaking and resource allocation. Taking a five-year (2016–2020) dataset that covered 55 to 56 countries and evaluating 17 indicators across governance, health systems, and economic aspects, the paper presents that all sixteen top-ranked countries with a perfect efficiency score of 1 belonged to the high-income group, with ten in Europe, highlighting regional HSR differences. This paper concludes that adequate economic resources form the foundation of HSR and ensure stability and sustained progress. A properly supported healthcare workforce is essential for significantly enhancing health systems and delivering quality care. Last, effective governance and the equitable allocation of resources are crucial for fostering sustainable development and strengthening HSR. Full article

Invasive fungal infections (IFIs) represent a growing global health threat, particularly for immunocompromised populations, with mortality exceeding 1.5 million deaths annually. Despite their clinical and economic burden—costing billions in healthcare expenditures—fungal infections remain underprioritized in public health agendas. This review examines the current landscape of antifungal therapy, focusing on advances, challenges, and future directions. Key drug classes (polyenes, azoles, echinocandins, and novel agents) are analyzed for their mechanisms of action, pharmacokinetics, and clinical applications, alongside emerging resistance patterns in pathogens like Candida auris and azole-resistant Aspergillus fumigatus. The rise of resistance, driven by agricultural fungicide use and nosocomial transmission, underscores the need for innovative antifungals, rapid diagnostics, and stewardship programs. Promising developments include next-generation echinocandins (e.g., rezafungin), triterpenoids (ibrexafungerp), and orotomides (olorofim), which target resistant strains and offer improved safety profiles. The review also highlights the critical role of “One Health” strategies to mitigate environmental and clinical resistance. Future success hinges on multidisciplinary collaboration, enhanced surveillance, and accelerated drug development to address unmet needs in antifungal therapy. Full article

This study assesses the effects of the COVID-19 pandemic on catastrophic health expenditures and income inequality in Benin. A microsimulation was calibrated to estimate the impact of the pandemic under three different shock scenarios: low, moderate, and severe. The analysis relies on secondary data from household living condition surveys. The results indicate that the COVID-19 crisis would lead to a significant average income loss of up to 20% and income inequality, while the number of households with catastrophic health expenditures would increase by 4%. More importantly, the findings reveal heterogeneous impacts across households, with urban residents, younger individuals, more educated households, and male-headed households experiencing the greatest income decline. These findings underscore the need for targeted health coverage and employment policies to better protect vulnerable populations in Benin in the face of future shocks. Full article

The continued migration of physicians from independent practice to affiliation with larger entities has garnered significant scrutiny. These affiliation models include hospitals and health systems, payers and corporate entities, and management services organizations, which may or may not be private equity (PE)-backed. Data on the impact of different physician affiliation models on cost of care is limited. We examined the relationship between provider affiliation model, site of care (SOC), and cost of care for certain high-volume procedures in procedure-intensive specialties for both Medicare and commercial insurance. We found that hospital-affiliated physicians are least likely—and PE-affiliated physicians are most likely—to provide care in lower-cost settings. For both Medicare and commercial insurance, SOC contributes meaningfully to procedure unit price, which is consistently greater in hospital-based settings. These findings suggest that the physician affiliation model and associated SOC cost differentials contribute materially to healthcare expenditures. As the Medicare cost differentials are set by statute and regulations, strategies such as site-neutral payments are needed to mitigate the monetary impact of historical and future physician practice migration. Full article

Objective: The objective of the study was to investigate the relationship between the level of physical activity and body composition, and the levels of motor skills and strength in overweight and obese men. Methods: The research involved 64 men. Body composition, physical activity, motor control, Motor Control Test (MCT), and strength variables were evaluated. Body composition was assessed by DXA, and the participants were classified into two groups according to the percentage of total fat mass: greater and less than 27.65%. Physical activity was assessed using accelerometry, and motor control was measured with posturography, which provided a composite score of motor performance and postural control effectiveness. Strength was assessed using hand, leg, and back dynamometers. Results: The participants with a higher percentage of body fat had a lower DSI (Dynamic Strength Index) (p < 0.001) and significantly reduced PAL (physical activity level) and energy expenditure (p < 0.001). No significant differences were found in the muscle strength of the upper limbs (p = 0.06) and lower limbs (p = 0.419). With regard to MCT, there was a significant difference between groups in the backward direction (p = 0.041), with the group with the highest percentage of body fat showing lower values. Conclusions: Individuals with a higher percentage of body fat tend to have lower levels of strength, physical activity, and energy expenditure, which can lead to impaired balance. The findings highlight the need for targeted interventions to improve body composition and levels of strength and physical activity, with a positive impact on general health and quality of life. Emphasis should be placed on improving physical activity levels in male individuals with a higher percentage of fat mass to improve their body composition and dynamic strength levels, which are beneficial to life, particularly to help improve postural control. Full article

This study aimed to investigate the effects of augmented reality (AR) treadmill walking training on cognitive function, body composition, physiological responses, and acceptance among older adults. Additionally, it analyzed the relationships between body composition, physiological responses, and the acceptance of AR technology. A randomized controlled trial was conducted, recruiting 60 healthy older adults, who were assigned to either the experimental group (AR treadmill walking training) or the control group (traditional treadmill walking training). The assessments included cognitive function evaluation (stride length, walking speed, and balance test), body composition (BMI, skeletal muscle mass, fat mass, and body fat percentage), and physiological responses (heart rate, calorie expenditure, exercise duration, and distance covered). Furthermore, the AR Acceptance Scale was used to assess perceived ease of use, perceived usefulness, attitudes, and behavioral intentions. The results indicated that AR treadmill walking training had significant positive effects on improving cognitive function, optimizing body composition, and enhancing physiological responses among older adults. Compared with the traditional training group, the experimental group demonstrated better performance in stride length, walking speed, and balance tests, with increased skeletal muscle mass and reduced body fat percentage. Additionally, improvements were observed in heart rate regulation, calorie expenditure, exercise duration, and distance covered, reflecting enhanced exercise tolerance. Moreover, older adults exhibited a high level of acceptance toward AR technology, particularly in terms of attitudes and behavioral intentions, as well as perceived usefulness. This study provides empirical support for the application of AR technology in promoting elderly health and suggests that future research should explore personalized adaptation strategies and long-term effects to further expand the potential value of AR technology in elderly exercise. Full article

In modern society, obesity and its associated complications have emerged as serious public health concerns, primarily stemming from sedentary lifestyles and carbohydrate-rich diets. Due to the severe side effects often associated with pharmacological anti-obesity agents, emerging global efforts focus on preventive strategies, e.g., dietary modifications and weight gain-suppressing functional foods. In this context, plant-derived metabolites are extensively investigated for their beneficial anti-obesity effects. In this study, we evaluated how Rosa rugosa Thunb. flower bud extract affects fat metabolism in 3T3-L1 preadipocyte cells. The extract significantly inhibited adipocyte differentiation and intracellular triglyceride accumulation in 3T3-L1 cells, enhanced lipolysis, suppressed lipogenesis, and promoted energy metabolism in differentiated adipocytes. In vivo, it reduced body and organ weights and fat mass in high-fat diet-induced obese rats, along with marked adipocyte size and hepatic lipid accumulation reductions. In the epididymal adipose tissue, the extract similarly enhanced lipolytic activity, suppressed lipogenic enzyme expression, and stimulated energy expenditure. Taken together, our results demonstrate the potential of R. rugosa Thunb. flower bud extract in reducing fat accumulation through lipid metabolism modulation both in cellular and animal models. Further studies are warranted to identify the active constituents and evaluate the safety and efficacy of the extract in clinical applications. Full article

Background: Female collegiate runners may be at high risk for disordered eating and poor bone health, which are characteristics of the female athlete triad. Intuitive eating can promote healthy eating behavior and adequate calorie intake, central variables in calculating energy availability, an underlying cause of low bone mass in athletes. Poor bone health can contribute to injury, preventing optimal performance for athletes. The purpose of this study was to assess intuitive eating, energy availability, and bone mineral density in female college runners with comparison to non-athletes. Methods: Female college athletes (n = 13, 19.5 ± 1.4 yrs) and non-athletes (n = 12, 19.9 ± 1.3 yrs) completed the Intuitive Eating Scale, Eating Disorder Examination Questionnaire, and menstrual history survey. Bone mineral density and body composition were measured using a dual-energy X-ray absorptiometer (DEXA). A 3-day diet record and exercise log were used to assess dietary intake, estimate energy expenditure, and calculate energy availability. Results: Intuitive eating was inversely correlated with disordered eating (r = −0.596, p = 0.002). Intuitive eating scores were not correlated to calorie intake, energy availability, bone mass, or percent body fat. Runners consumed significantly more calories, calcium, magnesium, phosphorus, and protein (g/kg) than non-athletes. Energy availability and bone mineral density were not significantly different between runners and non-athletes. Conclusions: Intuitive eating is associated with healthy eating behaviors in college-age females and was not related to energy availability, bone density, or body composition in this population. Future research could explore the use of intuitive eating principles in reducing disordered eating and addressing low energy availability in female runners and non-athletes. Full article

Background and Objectives: The worldwide shift toward psychiatric deinstitutionalization has aimed to enhance patient autonomy, social integration, and overall quality of life. However, limited studies have examined how concurrent substance use—particularly alcohol, marijuana, and inhalable drugs—affects clinical outcomes in these populations. This study aimed to evaluate psychiatric patients with varying degrees of institutionalization and investigate whether substance use complicates or exacerbates treatment outcomes. We hypothesized that individuals using substances would demonstrate worse psychosocial functioning, higher healthcare costs, and increased readmission rates. Methods: We performed a cross-sectional study of 95 participants recruited from long-term care facilities. Participants completed the SF-36 survey validated in Romanian. Financial data were collected to gauge direct and indirect healthcare expenditures. Results: Results indicated that 34.7% of participants reported alcohol use, 12.6% used marijuana, and 9.5% used inhalable substances. Substance-using patients experienced higher mean hospitalization costs of approximately USD 3251.8, compared to non-users (USD 2743.6, p = 0.032). Quality-of-life scores were significantly lower among substance users (mean SF-36 score 58.4 vs. 66.7, p = 0.027). Rates of relapse and readmission were also notably higher in the substance-using cohort (42.1%) relative to non-users (29.8%, p = 0.041). Conclusions: To our knowledge, this is the first Romanian study—and one of only a handful in Europe—to quantify how specific substance-use profiles simultaneously alter quality of life and direct healthcare costs in a deinstitutionalized psychiatric population. Our findings highlight the need for integrated interventions targeting both mental health and substance abuse. Full article

Background: Pain is a common, often debilitating ailment that may necessitate considerable health service utilization. However, there is a need to assess the associations of pain intensity and other variables with health service utilization among United States adults who have pain. Methods: This cross-sectional database analysis made use of the Medical Expenditure Panel Survey full-year consolidated data file and included United States adults (≥18 years) who have pain. The dependent variables consisted of four health service utilization variables, which included the number of emergency room visits, inpatient discharges, office visits, and outpatient visits in 2021. The number of visits or discharges were categorized as either ≥1 or 0. The independent variable was pain intensity (extreme, quite a bit, moderate, or little pain). Other variables analyzed included age, race, ethnicity, sex, marriage, education, employment, income, insurance, chronic conditions, limitations, exercise, smoking, physical health, and mental health. Chi-squared tests compared differences between pain intensity groups, and multivariable logistic regression models assessed the associations of pain intensity and other variables with each of the four health service utilization variables. The analysis was weighted for national estimates. The significance (alpha) level was 0.05. Results: This analysis included 6280 adults, representing 89,314,769 United States adults with pain. In the multivariable analyses, there were statistically significant associations for extreme pain (odds ratio = 1.72, 95% confidence interval = 1.27–2.33), quite a bit of pain (odds ratio = 1.75, 95% confidence interval=1.37–2.24), and moderate pain (odds ratio = 1.28, 95% confidence interval = 1.02–1.60) versus little pain with emergency room visits, extreme pain (odds ratio = 2.10, 95% confidence interval = 1.44–3.08) and quite a bit of pain (odds ratio = 1.66, 95% confidence interval = 1.21–2.28) versus little pain with inpatient discharges, and quite a bit of pain (odds ratio = 1.47, 95% confidence interval = 1.03–2.11) versus little pain with office visits. There was no correlation between pain intensity levels and outpatient visits. In addition, several other variables were associated with various health service utilization variables. Conclusions: This database analysis discovered greater pain intensity levels were often correlated with increased health service utilization, including more emergency room, inpatient, and office visits. These findings may inform the development of targeted interventions for people with specific characteristics. Further work is needed to implement initiatives that optimize health service utilization and ultimately improve health outcomes for United States adults who have pain. Full article

Healthcare cost acceleration and resource allocation issues have worsened across European health systems, where a small group of patients drives excessive healthcare spending. The prediction of high-cost utilization patterns is important for the sustainable management of healthcare and focused intervention measures. The aim of our study was to derive and validate machine learning algorithms for high-cost healthcare utilization prediction based on detailed administrative data and by comparing three algorithmic methods for the best risk stratification performance. The research analyzed extensive insurance beneficiary records which compile data from health group collective funds operated by non-life insurers across EU countries, across multiple service classes. The definition of high utilization was equivalent to the upper quintile of overall health expenditure using a moderate cost threshold. The research applied three machine learning algorithms, namely logistic regression using elastic net regularization, the random forest, and support vector machines. The models used a comprehensive set of predictor variables including demographics, policy profiles, and patterns of service utilization across multiple domains of healthcare. The performance of the models was evaluated using the standard train–test methodology and rigorous cross-validation procedures. All three models demonstrated outstanding discriminative ability by achieving area under the curve values at near-perfect levels. The random forest achieved the best test performance with exceptional metrics, closely followed by logistic regression with comparable exceptional performance. Service diversity proved to be the strongest predictor across all models, while dentistry services produced an extraordinarily high odds ratio with robust confidence intervals. The group of high utilizers comprised approximately one-fifth of the sample but demonstrated significantly higher utilization across all service classes. Machine learning algorithms are capable of classifying patients eligible for the high utilization of healthcare services with nearly perfect discriminative ability. The findings justify the application of predictive analytics for proactive case management, resource planning, and focused intervention measures across private group health insurance providers in EU countries. Full article

Over the past decades, bile acids have been recognized as important signaling molecules with significant roles in metabolic health and disease. Many of their beneficial effects are mediated through the activation of the Takeda G protein-coupled receptor 5 (TGR5), a G protein-coupled receptor ubiquitously expressed in both humans and animals. Upon activation, TGR5 stimulates adenylate cyclase, leading to increased cyclic adenosine monophosphate (cAMP) levels and subsequent activation of protein kinase A (PKA). PKA then phosphorylates and activates several downstream signaling pathways, including exchange protein directly activated by cAMP (EPAC), extracellular signal-regulated kinase 1/2 (ERK1/2), and protein kinase B (AKT). Through these pathways, TGR5 acts as a key molecular link between bile acid signaling and the regulation of energy metabolism. TGR5 activation has been associated with body weight loss in obese models, primarily by reducing food intake, enhancing thermogenesis in adipose tissue and muscle to increase energy expenditure, and improving insulin secretion. This review highlights recent advances in our understanding of TGR5 biology and critically examines its therapeutic potential, limitations, and controversies in the context of energy metabolism, offering new perspectives and opportunities for treating metabolic disorders. Full article

Background/Objectives: Reducing waiting times for elective surgeries remains a critical global healthcare challenge that negatively impacts patient outcomes and economic productivity. This study develops an adaptable cost-utility modeling framework for assessing the cost-effectiveness (CE) of reducing waiting time for elective surgeries in data-limited environments. Methods: We evaluated the economic and health impacts of Egypt’s recent initiative aimed at decreasing surgical waiting lists. The study conducts a CE analysis of the initiative by estimating incremental costs (expressed in Egyptian Pounds—EGP) and outcomes (expressed in quality-adjusted life years—QALYs) before and after its implementation, performs a benefit–cost analysis to quantify the initiative’s return on investment, and employs a budget share method to evaluate catastrophic health expenditure (CHE). The analysis included five elective surgical interventions: open-heart surgery, cardiac catheterization, cochlear implantation, ophthalmic surgery, and orthopedic (joint replacement) surgery. Results: The main research outcomes of the study are as follows. The initiative resulted in incremental cost-effectiveness ratios of EGP 46,795 (societal perspective) and EGP 56,094 (payer perspective) per QALY, both within acceptable CE thresholds. Most of the evaluated interventions demonstrated substantial returns on the investment. Without public funding, more than 90% of patients faced CHE, indicating considerable financial barriers to elective surgeries. Conclusions: Egypt’s initiative to reduce waiting times was deemed cost-effective. Our adaptable modeling framework could be practical for similar evaluations in low/middle-income countries, especially where data is limited. Scaling up the initiative to include additional curative and preventive services and integrating it with broader health system reforms in Egypt is strongly recommended. Full article

Suicide in children is a major global health crisis, with profound impacts on families, friends, and society. Understanding ways to ameliorate the rate of suicide attempt (SA) is critical given that it is a key factor in predicting future suicide risk. SA is the deliberate act of causing physical injury to oneself with the intent of death. The incidence of SA may be influenced by physical activity (PA). PA includes bodily movement via skeletal muscles that results in energy expenditure and physical fitness. While there is evidence to suggest that PA improves dysregulation of the parasympathetic nervous system which underpins the physiology of suicidal behaviour, evaluating the impact of PA on SA in children is required. Objectives: This systematic review aims to determine the relationship between PA and SA in children to inform alternative preventative and interventional strategies. Methods: This systematic review was registered with PROSPERO: CRD42023389415. Eight electronic databases were systematically searched. References were transferred to Covidence software for title and abstract screening and full text review were performed based on eligibility criteria: (1) children aged 6–18 years old; (2) participated in PA (individual, group exercise, or team sports); and (3) examined SA as a dependent variable. The JBI Checklist was used to measure the quality and level of bias of included studies. Results: Of the 2322 studies identified, 21 were included in the final analysis of the review. Twenty studies were cross-sectional in design, and one implemented a prospective study design. Thirteen studies (61.9%) yielded statistically significant results, indicating that increased PA, particularly team sport, may be associated with reduced odds of SA. There was some evidence to suggest that certain intensities and frequencies of PA may be beneficial to some and detrimental to other subgroups. Conclusions: The results suggest that PA may reduce the risk of suicide attempts. Although PA may be associated with reduced SA in children, future research is required, which (1) uses standardised outcome variables; (2) adopts longitudinal and experimental study designs; (3) explores qualitative research to determine distinctive factors that influence participation in PA not captured by quantitative research; and (4) examines different target populations such as children with a broad range of mental health issues. Full article

Background/Objectives: This cross-sectional study examined the association between diet quality, measured by the Korean Healthy Eating Index (KHEI), and medical expenditures among Korean adults. Methods: We used data from the Korea National Health and Nutrition Examination Survey (2016–2021). Adults aged ≥20 years with complete data on diet, sociodemographics, and healthcare use were included. Medical costs were estimated from self-reported service use and converted to USD. KHEI scores were categorized into quartiles. Multivariable linear regression was used to assess the association between KHEI quartiles and log-transformed costs. Subgroup analyses were conducted by age (<57 vs. ≥57 years), and sensitivity analyses treated KHEI as a continuous variable. A two-part model addressed skewed, zero-inflated cost data. Results: Compared to Q1, participants in Q4 had significantly lower inpatient (β = −0.080; 95% CI: −0.139 to −0.020) and total costs (β = −0.086; 95% CI: −0.144 to −0.027). In the younger group, Q4 was associated with lower total costs (β = −0.115; 95% CI: −0.198 to −0.031). Higher continuous KHEI scores were also linked to lower costs. In the two-part model, Q4 participants had a higher probability of incurring any cost but lower conditional costs (Q3 vs. Q1: β = −0.173; Q4 vs. Q1: β = −0.160; both p < 0.05). Conclusions: Higher diet quality was associated with reduced healthcare costs in Korean adults, especially among younger individuals. Promoting healthy eating may help lower economic burdens in aging societies. Full article