Search Results (410)

China’s healthcare expenditure tripled during 2010–2019, prompting the nationwide implementation of centralized volume-based procurement (CVBP). While effective in reducing drug prices, CVBP introduces sustainability challenges including supply chain vulnerabilities and welfare trade-offs. This study develops a pharmaceutical sector-embedded computable general equilibrium (CGE) model to quantify CVBP’s multidimensional sustainability impacts. Using China’s 2020 Social Accounting Matrix (SAM) with simulated 10–50% price reductions, key findings reveal that (1) >40% price reductions trigger sectoral output reversal; (2) GDP exhibits an inverted U-shape; (3) household income declines despite corporate/government gains; and (4) industrial contraction impairs innovation capacity and employment stability. Our analysis identifies potential sustainability risks, emphasizing the need for rigorous empirical validation prior to implementing aggressive price reduction policies, and underscores the importance of integrating supply chain considerations into procurement policy design. This approach maximizes resource allocation efficiency while advancing socioeconomic resilience in healthcare systems. Full article

This paper presents a cross-layer intrusion detection framework leveraging explainable artificial intelligence (XAI) and interpretability methods to enhance transparency and robustness in attack detection within the Internet of Medical Things (IoMT) domain. By addressing the dual challenges of compromised data integrity, which span both biosensor and network-layer data, this study combines advanced techniques to enhance interpretability, accuracy, and trust. Unlike conventional flow-based intrusion detection systems that primarily rely on transport-layer statistics, the proposed framework operates directly on raw packet-level features and application-layer semantics, including MQTT message types, payload entropy, and topic structures. The key contributions of this research include the application of K-Means clustering combined with the principal component analysis (PCA) algorthim for initial categorization of attack types, the use of SHapley Additive exPlanations (SHAP) for feature prioritization to identify the most influential factors in model predictions, and the employment of Partial Dependence Plots (PDP) and Accumulated Local Effects (ALE) to elucidate feature interactions across layers. These methods enhance the system’s interpretability, making data-driven decisions more accessible to nontechnical stakeholders. Evaluation on a realistic healthcare IoMT testbed demonstrates significant improvements in detection accuracy and decision-making transparency. Furthermore, the proposed approach highlights the effectiveness of explainable and cross-layer intrusion detection for secure and trustworthy medical IoT environments that are tailored for cybersecurity analysts and healthcare stakeholders. Full article

Moral injury is a discrete form of harm affecting individuals as a potentially avoidable consequence of exposure to a morally injurious event. That injury (independent of psychological injury or illness) has been identified as a cause of physical symptoms, suicide and suicidality. Originally identified within military and veteran cohorts, it is observable in emergency responders, healthcare providers, human rights advocates and others. Its aetiology suggests that other groups where the potential for tensions between personal morals, professional ethics and occupational activities arises (such as whistleblowers, law enforcement personnel and lawyers) may be at risk. Despite increasingly diverse evidence identifying moral injury as a substantive harm with significant consequences, the legal options for redress are unclear. This article explores whether requirements for establishing a duty of care as a precursor to a negligence claim are likely to pose an insurmountable obstacle for plaintiffs, including in the context of employer–employee duty relationships. It concludes that despite popular perceptions that negligence law is unlikely to be able to accommodate moral injury claims, a closer reading of key judgments indicates that there are opportunities for it to potentially be recognised as a harm on a principled basis—consistent with existing jurisprudence and legislation—for the purposes of establishing a duty of care. In the event that normative claims for its recognition are resisted, the justification for that resistance must be found outside historical development of legal principles from case law. Full article

Primary healthcare is vital to achieving universal health coverage, as emphasized by Sustainable Development Goal 3 (SDG 3). However, energy poverty remains a critical yet overlooked barrier to the efficiency of primary healthcare services in rural China—precisely the focus of this study. It employs panel regression models and threshold analysis methods using data from 31 Chinese provinces for the period 2014–2021, sourced from the EPSDATA data platform. Robustness checks are performed using bootstrap procedures, accompanied by detailed mechanism analyses. The empirical results demonstrate that rural energy poverty significantly reduces primary healthcare efficiency, particularly in provinces initially characterized by lower healthcare performance. The mechanism analysis identifies four critical transmission channels—off-farm employment, internet intensity, food safety, and health education—through which rural energy poverty undermines healthcare outcomes. Furthermore, threshold regressions uncover nonlinear relationships, indicating that the negative impacts of rural energy poverty intensify when household medical expenditures exceed 10.9%, the old-age dependency ratio surpasses 22.61%, and the rural energy poverty index is higher than 0.641. In theoretical terms, this study identifies rural energy poverty as a critical determinant of primary healthcare efficiency, thereby addressing an important gap in the existing literature. At the policy level, the findings emphasize the necessity for integrated measures targeting both rural energy poverty and primary healthcare inefficiencies to achieve SDG 3 and sustainably promote equitable, high-quality healthcare access in rural China. Full article

This article investigates the macroeconomic and labor market conditions that shape the adoption of artificial intelligence (AI) technologies among large firms in Europe. Based on panel data econometrics and supervised machine learning techniques, we estimate how public health spending, access to credit, export activity, gross capital formation, inflation, openness to trade, and labor market structure influence the share of firms that adopt at least one AI technology. The research covers all 28 EU members between 2018 and 2023. We employ a set of robustness checks using a combination of fixed-effects, random-effects, and dynamic panel data specifications supported by Clustering and supervised learning techniques. We find that AI adoption is linked to higher GDP per capita, healthcare spending, inflation, and openness to trade but lower levels of credit, exports, and capital formation. Labor markets with higher proportions of salaried work, service occupations, and self-employment are linked to AI diffusion, while unemployment and vulnerable work are detractors. Cluster analysis identifies groups of EU members with similar adoption patterns that are usually underpinned by stronger economic and institutional fundamentals. The results collectively suggest that AI diffusion is shaped not only by technological preparedness and capabilities to invest but by inclusive macroeconomic conditions and equitable labor institutions. Targeted policy measures can accelerate the equitable adoption of AI technologies within the European industrial economy. Full article

The right to development, an inherent human right for all, emphasizes that all individuals and communities have the right to participate in, contribute to, and benefit from development that ensures the full realization of human rights. In Kenya, where a significant portion of the population faces poverty and vulnerability to climate change, access to rights-based needs such as clean water, healthcare, and education still remains a critical challenge. This study explored the implementation of a Human Rights-Based approach to community development through a Public–Private Development Partnership model (PPDP), with a focus on alleviating poverty and improving access to rights-based services at the community level in Narok and Nakuru counties. The research aimed to identify critical success factors for scaling the PPDP model and explore its effects on socio-economic empowerment. The study employed a mixed-methods approach for data collection, using questionnaires to obtain quantitative data, focus group discussions, and key informant interviews with community members, local leaders, and stakeholders to gather qualitative data. We cleaned and analyzed all our data in R (version 4.4.3) and used the chi-square to establish the significance of differences between areas where the PPDP model was implemented and control areas where it was not. Results reveal that communities with the PPDP model experienced statistically significant improvements in employment, income levels, and access to rights-based services compared to control areas. The outcomes underscore the potential of the PPDP model to address inclusive and sustainable development. This study therefore proposes a scalable pathway beginning with access to rights-based needs, followed by improved service delivery, and culminating in economic empowerment. These findings offer valuable insights for governments, development practitioners, investment agencies, and researchers seeking community-driven developments in similar socio-economic contexts across Africa. For the first time, it can be adopted in the design and implementation of development projects in rural and local communities across Africa bringing into focus the need to integrate rights-based needs at the core of the project. Full article

Urban health planning requires a multi-scalar understanding of the territory, capable of capturing socio-economic inequalities and health needs at the local level. In the case of Rome, current administrative subdivisions—Urban Zones (Zone Urbanistiche)—are too large and internally heterogeneous to serve as effective units for equitable health planning. This study presents a methodology for the territorial redefinition of Rome’s Municipality III, aimed at supporting healthcare planning through an integrated analysis of census sections. These were grouped using a combination of census-based socio-demographic indicators (educational attainment, employment status, single-person households) and real estate values (OMI data), alongside administrative and road network data. The resulting territorial units—21 newly defined Mesoareas—are smaller than Urban Zones but larger than individual census sections and correspond to socio-territorially homogeneous neighborhoods; this structure enables a more nuanced spatial understanding of health-related inequalities. The proposed model is replicable, adaptable to other urban contexts, and offers a solid analytical basis for more equitable and targeted health planning, as well as for broader urban policy interventions aimed at promoting spatial justice. Full article

Despite growing recognition of the role that social determinants of health (SDOHs) and health-related social needs (HRSNs) play in chronic disease, limited research has examined their associations with Chronic Obstructive Pulmonary Disease (COPD) in population-based studies. This cross-sectional study analyzed 2022 Behavioral Risk Factor Surveillance System (BRFSS) data from 37 U.S. states and territories to determine how financial hardship, food insecurity, employment loss, healthcare access barriers, and psychosocial stressors influence the prevalence of COPD. Weighted logistic regression models were used to assess the associations between COPD and specific SDOHs and HRSNs. Several individual SDOH and HRSN factors were significantly associated with COPD prevalence, with financial strain emerging as a particularly strong predictor. In models examining specific SDOH factors, economic hardships like inability to afford medical care were strongly linked to higher COPD odds. Psychosocial HRSN risks, such as experiencing mental stress, also showed moderate associations with increased COPD prevalence. These findings suggest that addressing both structural and individual-level social risks may be critical for reducing the prevalence of COPD in populations experiencing financial challenges. Full article

Grounded in health behavior theory, this study examined patterns of preventive health behavior in a culturally diverse, multilingual region of northern Italy using data from a representative population survey (n = 2090). Preventive behaviors were assessed using the 16-item Good Health Practices (GHP-16) scale. Latent profile analysis (LPA) identified five behavioral profiles, ranging from ‘Globally Low Engagers’ to ‘Comprehensive High Engagers’. Binary logistic regression compared ‘Globally Low Engagers’ to ‘Broadly Moderate Preventers’, examining predictors including gender, age, education, language, chronic disease status, health literacy (HLS-EU-Q16), patient activation (PAM-10), mistrust of health information, living situation, and healthcare employment. The results showed that men, younger adults, individuals with low patient activation, those living alone, and respondents with high mistrust of health information had higher odds of belonging to the low engagement group. Health literacy and language group membership were not significantly associated with the profile membership. Item-level comparisons revealed gender differences in information-seeking, oral hygiene, and dietary behaviors, with men reporting lower engagement. These findings support a segmentation-based understanding of preventive health behavior and highlight the need to address personal capacities and contextual barriers in interventions while challenging assumptions of uniformly higher female health vigilance. Full article

Background/Objectives: Sudden cardiac arrest (SCA) is a major global health concern with high mortality despite advances in resuscitation techniques. Achieving return of spontaneous circulation (ROSC) represents merely the initial step in the extensive rehabilitation journey. This review highlights the critical role of structured, multidisciplinary rehabilitation following ROSC, emphasizing the necessity of integrated physiotherapy, neurocognitive therapy, and psychosocial support to enhance quality of life and societal reintegration in survivors. Methods: This narrative review analyzed peer-reviewed literature from 2020–2025, sourced from databases such as PubMed, Scopus, Web of Science, and Google Scholar. Emphasis was on clinical trials, expert guidelines (e.g., European Resuscitation Council 2021, American Heart Association 2020), and high-impact journals, with systematic thematic analysis across rehabilitation phases. Results: The review confirms rehabilitation as essential in addressing Intensive Care Unit–acquired weakness, cognitive impairment, and post-intensive care syndrome. Early rehabilitation (0–7 days post-ROSC), focusing on parameter-guided mobilization and cognitive stimulation, significantly improves functional outcomes. Structured interdisciplinary interventions encompassing cardiopulmonary, neuromuscular, and cognitive domains effectively mitigate long-term disability, facilitating return to daily activities and employment. However, access disparities and insufficient randomized controlled trials limit evidence-based standardization. Discussion: Optimal recovery after SCA necessitates early and continuous interdisciplinary engagement, tailored to individual physiological and cognitive profiles. Persistent cognitive fatigue, executive dysfunction, and emotional instability remain significant barriers, underscoring the need for holistic and sustained rehabilitative approaches. Conclusions: Comprehensive, individualized rehabilitation following cardiac arrest is not supplementary but fundamental to meaningful recovery. Emphasizing early mobilization, neurocognitive therapy, family involvement, and structured social reintegration pathways is crucial. Addressing healthcare disparities and investing in rigorous randomized trials are imperative to achieving standardized, equitable, and outcome-oriented rehabilitation services globally. Full article

Background: The longitudinal RisCoin study investigated risk factors for COVID-19 vaccination failure among healthcare workers (HCWs) and patients with inflammatory bowel disease (IBD) at a University Hospital in Germany. Since the hospital served as the study sponsor and employer of the HCW, we implemented a custom mobile application. We aimed to evaluate the implementation, adherence, benefits, and limitations of this study’s app. Methods: The app allowed secure data collection through questionnaires, disseminated serological results, and managed bidirectional communication. Access was double-pseudonymized and irreversibly anonymized six months after enrollment. Download frequency, login events, and questionnaire submissions between October 2021 and December 2022 were analyzed. Multivariable logistic regression identified factors associated with app adherence. Results: Of the 3979 participants with app access, 3622 (91%) used the app; out of these, 1016 (28%) were “adherent users” (≥12 submitted questionnaires). App adherence significantly increased with age. Among HCW, adherent users were more likely to be non-smokers (p < 0.001), working as administrators or nursing staff vs. physicians (p < 0.001), vaccinated against influenza (p < 0.001), and had not travelled abroad in the past year (p < 0.001). IBD patients exposed to SARS-CoV-2 (p = 0.0133) and those with adverse events following the second COVID-19 vaccination (p = 0.0171) were more likely adherent app users. Despite technical issues causing dropout or non-adherence, the app served as a secure solution for cohort management and longitudinal data collection. Discussion: App-based cohort management enabled continuous data acquisition and individualized care while providing flexibility and anonymity for the study team and participants. App usability, technical issues, and cohort characteristics need to be thoroughly considered prior to implementation to optimize usage and adherence in clinical research. Full article

A vast majority of survivors of intimate partner violence (IPV) experience economic abuse, including but not limited to, employment sabotage. The purpose of this study is to further understand IPV by testing a technology-inclusive abuser-initiated workplace disruption measurement in an exploratory factor analysis (EFA) so that future researchers can better examine and address economic abuse. Using a sample of survivors (N = 312) employed in the nursing profession in the United States, who may be uniquely impacted by technology, we used complete data to examine experiences of abuser-initiated workplace disruptions, including those that utilized cellphones (e.g., excessive texting, harassment of coworkers, preventing educational advancement). The results revealed a two-factor structure: one containing a variety of direct and indirect workplace disruptions relevant to the nursing profession (73% of variance) and a second containing only cell-phone related harassment (9% of variance). Implications for healthcare employers seeking to protect employees from IPV, as well as policymakers, are included. Full article

Job satisfaction in sub-Saharan Africa is crucial as it directly impacts employee productivity, retention, and overall economic growth, fostering a motivated workforce that drives regional development. In sub–Saharan Africa, poor remuneration, limited professional development opportunities, and inadequate working conditions impact satisfaction. This study examined job-satisfaction predictors among health workers in primary healthcare settings across eight countries: Ethiopia, Kenya, Malawi, Senegal, South Sudan, Tanzania, Uganda, and Zambia. A cross-sectional study surveyed 1711 health workers, assessing five dimensions: employer–2employee relationships, remuneration and recognition, professional development, physical work environment, and supportive supervision. The study was conducted from October 2023 to March 2024. The job-satisfaction assessment tool was adopted from a validated tool originally developed for use in low-income healthcare settings. The tool was reviewed by staff from all the country offices to ensure contextual relevance and organization alignment. The responses were measured on a five-point Likert scale: 0: Not applicable, 1: Very dissatisfied, 2: Dissatisfied, 3: Neutral, 4: Satisfied, and 5: Very satisfied. The analysis employed descriptive and multivariable regression methods. Job satisfaction varied significantly by country. Satisfaction with the employer–employee relationship was highest in Zambia (80%) and lowest in Tanzania (16%). Remuneration satisfaction was highest in Senegal (63%) and Zambia (49%), while it was very low in Malawi (9.8%) and Ethiopia (2.3%). Overall, 44% of respondents were satisfied with their professional development, with Uganda leading (62%) and Ethiopia having the lowest satisfaction level (29%). Satisfaction with the physical environment was at 27%, with Uganda at 40% and Kenya at 12%. Satisfaction with supervisory support stood at 62%, with Zambia at 73% and Ethiopia at 30%. Key predictors of job satisfaction included a strong employer–employee relationships (OR = 2.20, p < 0.001), fair remuneration (OR = 1.59, p = 0.002), conducive work environments (OR = 1.71, p < 0.001), and supervisory support (OR = 3.58, p < 0.001. Improving the job satisfaction, retention, and performance of health workers in sub-Saharan Africa requires targeted interventions in employer–employee relationships, fair compensation, supportive supervision, and working conditions. Strategies must be tailored to each country’s unique challenges, as one-size-fits-all solutions may not be effective. Policymakers should prioritize these factors to build a motivated, resilient workforce, with ongoing research and monitoring essential to ensure sustained progress and improved healthcare delivery. Full article

Background: Breastfeeding is essential for preventing non-communicable diseases. However, mothers with chronic illnesses tend to breastfeed less, increasing the likelihood of abandoning breastfeeding, especially if they experience gestational complications. Objective: To analyze the association between factors such as prepregnancy maternal characteristics, gestational complications, food security, barriers, and facilitators with the practice of exclusive breastfeeding. Methods: Cross-sectional study with 566 women who had prenatal care and gave birth at the National Institute of Perinatology (Mexico City) between 2021 and 2024. Surveys were administered on breastfeeding practices, food insecurity, barriers, and facilitators of exclusive breastfeeding in mothers. In addition, sociodemographic information, medical history (prepregnancy conditions and complications), gestational weight gain, and neonatal outcomes were recorded. Results: Of the 566 women, only 43.6% practiced exclusive breastfeeding, with a median duration of 4 months. Exclusive breastfeeding was more frequent in young, stay-at-home mothers with lower educational attainment and in those with food insecurity, who also tended to delay the introduction of complementary foods until after six months. Prepregnancy risk conditions (OR 1.56, 95% CI 1.06–2.30) and multiparity (OR 1.64, 95% CI 1.08–2.49) increased the risk of non-exclusive breastfeeding. Conversely, food insecurity (OR 0.40, 95% CI 0.20–0.78) and counseling from healthcare personnel (OR 0.09, 95% CI 0.01–0.51) showed a protective effect. The analysis also showed that paid employment (OR 4.68, 95% CI 1.65–13.21), the perception of low milk production (OR 6.45, 95% CI 2.95–14.10), maternal illness/medication (OR 3.91, 95% CI 1.36–11.28), and fatigue (OR 4.67, 95% CI 1.36–11.28) increased the probability of non-exclusive breastfeeding. Conclusions: In Mexico, the promotion of exclusive breastfeeding faces challenges, especially in mothers who begin pregnancy with significant chronic conditions such as diabetes, hypertension, obesity, advanced maternal age, and hypothyroidism, among others. Healthcare personnel should provide personalized advice to each woman from the prenatal stage on strategies to achieve and maintain exclusive breastfeeding. Full article

Burnout and work-related stress are extensively studied among mental health professionals (MHPs) in countries around the world, but there is a paucity of research emanating from Greece’s hybrid healthcare system. In Greece, MHPs may encounter unique challenges with economic obstacles and in putting ongoing community-oriented mental healthcare policies into practice. This study aims, first, to assess the prevalence of burnout, compassion fatigue, and compassion satisfaction among Greek MHPs; and second, to examine the sociodemographic and work-related factors influencing these dimensions of professional quality of life. A total of 287 Greek MHPs (25.4% male, 74.6% female; M = 39.85 years, SD = 9.52) completed the Maslach Burnout Inventory (MBI) and the Professional Quality of Life Scale-5 (ProQOL-5). Sociodemographic and occupational data were also collected. Findings revealed that 11.8% of participants reported high emotional exhaustion, 19.9% high depersonalization, and 35.9% a high risk of reduced personal accomplishment. Almost half of the participants (48.8%) reported high levels of compassion satisfaction, suggesting that many MHPs continue to find fulfillment in their work. Notably, none of the participants reported high levels of compassion fatigue. Sociodemographic characteristics, such as gender, ethnicity, and marital status, as well as work-related factors, including employment sector, specialization, and years of experience, were related to MHPs’ professional quality of life. These results highlight the need for targeted strategies to address burnout and promote positive professional experiences among MHPs in Greece. Interventions should support well-being and enhance the rewarding aspects of mental health practice. Full article