Search Results (693)

Background: Climate change is a serious threat to global health. The healthcare sector contributes substantially to greenhouse gas (GHG) emissions, with anaesthetic gases being a major source of Scope 1 emissions. We aimed to evaluate the 2024 impact of the Sustainable Anesthesia Project, designed to reduce the environmental footprint of anaesthetic gases by eliminating and/or replacing the most polluting agents (nitrous oxide and desflurane) with more sustainable alternatives (sevoflurane, total intravenous anaesthesia, and regional/local anaesthesia). Methods: We conducted a descriptive analysis of anaesthetic gas consumption in 2023 and 2024, as well as a comparison of emissions in tons of CO₂, the impact on the carbon footprint, and the potential future emissions savings that full implementation of the project would entail. Results: In the first year, nitrous oxide consumption decreased by 64% and desflurane by 63%. Overall anaesthetic-gas emissions fell by 8386 tCO₂e versus 2023, a 54% relative reduction. Furthermore, the contribution of these gases to the total Scope 1 emissions markedly declined from 35.18% in 2023 to 21.22% in 2024. An additional reduction potential of around 4800 tCO₂e was identified for consolidation by 2025 with full implementation. Conclusions: The results observed in this study demonstrate the success of the Sustainable Anesthesia Project, whose strategy represents an extensible and applicable option to other centers and companies in the health sector to reduce their environmental impact. Full article

This article presents a modular and replicable framework to assess spatial accessibility to essential public services in the Lazio Region (Italy). Current policies, framed within the EU Urban Agenda and the UN Sustainable Development Goals, emphasize improving accessibility rather than mobility, integrating land-use and transport planning, and supporting sustainable modes. The study adopts urban centres, densely populated sub-municipal units, as the main spatial unit to capture intra-municipal variability. Accessibility is measured as distance and travel time to the nearest education and healthcare facilities, for both private car and public transport, considering traffic conditions. Distances and times are computed using routing APIs and aggregated into service-specific indicators at urban-centre and municipal levels. Due to GTFS availability, the public transport analysis is restricted to the Province of Rome. Indicators are published as Linked Open Data following DCAT-AP, exposed via a SPARQL endpoint, and visualized through an interactive web map viewer. Results highlight pronounced disparities: car accessibility is relatively uniform, while public transport shows critical gaps in peripheral and mountainous areas. The framework enables transparent benchmarking and supports evidence-based, place-sensitive planning across different European contexts. Full article

The COVID-19 pandemic highlighted critical issues in health services and public policy, particularly in long-term care facilities across Canada. Failures in these facilities revolving around chronic underfunding, staffing shortages, inadequate infection control, and inconsistent regulatory oversight, underscore the need to rethink health service interventions, especially considering varying implementation contexts among provinces. The Ontario Long-Term Care COVID-19 Commission Final Report pointed to long-standing systemic issues as the primary causes of the sector’s failures. To explore this issue, a narrative review was conducted with findings indicating that the long-term care crisis in Canada cannot be solved by more privatization, regulation or efficiency measures, as these have contributed to the problem’s root causes. Ontario’s long-term care crisis stems from systemic misalignments in policy, structure and stakeholder dynamics, requiring a shift toward systems thinking and resident-centered care to build an equitable and sustainable long-term care sector. Ultimately, governments must lead a policy redesign that reflects shared responsibility, stakeholder interdependence, and public involvement, offering a model for broader healthcare reform. Full article

Objective: This study assessed sociodemographic, health-seeking and social services related factors associated with first-trimester prenatal care. Study Design: This cross-sectional study used Phase 8 pooled data from the Kentucky Pregnancy Risk Assessment Monitoring System (PRAMS) for 2017 to 2020 and 2022. A logistic regression model was used to estimate unadjusted and adjusted odds ratios and 95% confidence intervals. Results: Among the 3502 women in the analytic sample, 89.3% had first-trimester prenatal care. Most respondents were White (weighted percentage, 83.3%), between the ages of 25 and 29 (31.2%), had more than a high school education (59.5%), were married (59.8%), lived in an urban area (59.4%), and had public insurance (53.9%). Maternal education was associated with the highest odds of first-trimester prenatal care, relative to other covariates, and was highest among those who completed more than high school (aOR 4.23, 95% CI 2.72–6.59) and high school (aOR 3.09, 95% CI 2.06–4.64) relative to less than high school. Private insurance, having a healthcare visit one year prior to pregnancy, and WIC receipt during pregnancy were associated with higher odds of first-trimester prenatal care. Conclusions: The findings of this study suggest that sociodemographic factors and access to healthcare and social services are important factors in first-trimester prenatal care. Full article

As treatments for multiple myeloma (MM) evolve, there is a need for real-world insights into treatment patterns and outcomes. The treatment practices and clinical outcomes in patients with MM (TOTEMM) was a database study (2018–2024) of newly diagnosed transplant-ineligible patients with MM in Argentina (TOTEMM-A) and Brazil (TOTEMM-B) in a private healthcare setting. In TOTEMM-A (n = 72) and TOTEMM-B (n = 892), 37 and 92 different drug regimens were reported, respectively. In each country, treatment duration reduced across lines of therapy (LOT) (TOTEMM-A: range, 6.2–3.4 months; TOTEMM-B: range, 4.4–3.5 months); attrition rates increased across LOT (TOTEMM-A: range, 52.8–86.1%; TOTEMM-B: range, 41.9–88.0%); triplet regimens (mainly bortezomib based) were used most frequently in first-line (1L); >75% relapsed within 12 months, regardless of the drug prescribed; over 90% of relapses occurred between 1L and second-line, and up to half of patients were rechallenged with the same drug; >65% of patients experienced disease progression after 1L; and the 1- to 5-year adjusted cumulative risk of progression or death increased across LOT (TOTEMM-A: range, 47.1–88.5%; TOTEMM-B: range, 40.4–91.7%). The rapid and marked progression underscores the urgent need for novel treatments and regimens. Full article

Background: Prostate cancer (PrCa) outcomes are inferior in regional and rural areas compared to metropolitan centres. We evaluated patterns of care in PrCa patients treated in public and private healthcare facilities in regional Tasmania. Methods: This retrospective study used clinicopathological data for 2180 PrCa patients diagnosed between 2015–2022. Descriptive statistics and regression analyses determined associations between treatment facility (public vs. private) and diagnostic and treatment factors. Results: A significantly greater proportion of public patients were from outer regional/remote areas (prevalence ratio (PR) = 1.25, 95% CI: 1.19–1.31), presented with higher-risk disease (PR = 1.56, 95% CI: 1.22–2.00) and underwent active treatment compared to private patients (PR = 1.07, 95% CI: 1.03–1.11). Men treated privately were most likely to have low-risk PrCa (p < 0.001) and be managed with active surveillance (AS, 52.9%). When stratified by disease risk, public patients with intermediate (p < 0.001) or very high-risk/metastatic disease (p = 0.003) were still significantly more likely to receive active treatment than private patients. Furthermore, except for very high-risk/metastatic patients, public patients took significantly longer to commence treatment, ranging between a mean difference of 40 to 59 days depending on risk category. Conclusions: In Tasmania, treatment pathways for PrCa patients differ significantly between public and private healthcare sectors and may contribute to poorer outcomes in regional and remote areas. Full article

The increasing volume of digital medical data offers substantial research opportunities, though its complete utilization is hindered by ongoing privacy and security obstacles. This proof-of-concept study explores and confirms the viability of using Secure Multi-Party Computation (SMPC) to ensure protection and integrity of sensitive patient data, allowing the construction of clinical trial cohorts. Our findings reveal that SMPC facilitates collaborative data analysis on distributed, private datasets with negligible computational costs and optimized data partition sizes. The established architecture incorporates patient information via a blockchain-based decentralized healthcare platform and employs the MPyC library in Python for secure computations on Fast Healthcare Interoperability Resources (FHIR)-format data. The outcomes affirm SMPC’s capacity to maintain patient privacy during cohort formation, with minimal overhead. It illustrates the potential of SMPC-based methodologies to expand access to medical research data. A key contribution of this work is eliminating the need for complex cryptographic key management while maintaining patient privacy, illustrating the potential of SMPC-based methodologies to expand access to medical research data by reducing implementation barriers. Full article

Workplace behaviors and employee outcomes, such as team functioning, job satisfaction, and intentions to leave, are crucial for healthcare quality and safety. It highlights the substantial productivity, societal, and economic costs of worker well-being. Against this backdrop, this study examines how two dimensions of organizational culture: ethical climate and perceived managerial competence, together with team support, relate to job satisfaction and turnover intention among healthcare professionals. A quantitative, cross-sectional survey was conducted with 430 physicians, nurses, and other clinical staff in public and private institutions across the Federation of Bosnia and Herzegovina. Using established scales and structural equation modeling (SEM) in AMOS, we first verified satisfactory reliability and construct validity via exploratory and confirmatory factor analyses. The structural model showed that ethical organizational culture and managerial competence are positively related to team support and, directly or indirectly, to higher job satisfaction and lower turnover intention. Team support was positively related to job satisfaction and negatively related to turnover intention and significantly mediated the effects of both ethical climate and managerial competence on these outcomes. In addition, job satisfaction was strongly and negatively correlated with turnover intention, underscoring its central role in retention. Full article

Poor diet is the leading preventable risk factor for death worldwide, associated with over 10 million premature deaths and USD 8 trillion related costs every year. Artificial intelligence or AI is rapidly emerging as the most historically disruptive, innovatively dynamic, rapidly scaled, cost-efficient, and economically productive technology (which is increasingly providing transformative countermeasures to these negative health trends, especially in low- and middle-income countries (LMICs) and underserved communities which bear the greatest burden from them). Yet widespread confusion persists among healthcare systems and policymakers on how to best identify, integrate, and evolve the safe, trusted, effective, affordable, and equitable AI solutions that are right for their communities, especially in public health nutrition. We therefore provide here the first known global, comprehensive, and actionable narrative review of the state of the art of AI-accelerated nutrition assessment and healthy eating for healthcare systems, generated by the first automated end-to-end empirical index for responsible health AI readiness and maturity: the Responsible Health AI readiness and Maturity Index (RHAMI). The index is built and the analysis and review conducted by a multi-national team spanning the Global North and South, consisting of front-line clinicians, ethicists, engineers, executives, administrators, public health practitioners, and policymakers. RHAMI analysis identified the top-performing healthcare systems and their nutrition AI, along with leading use cases including multimodal edge AI nutrition assessments as ambient intelligence, the strategic scaling of practical embedded precision nutrition platforms, and sovereign swarm agentic AI social networks for sustainable healthy diets. This index-based review is meant to facilitate standardized, continuous, automated, and real-time multi-disciplinary and multi-dimensional strategic planning, implementation, and optimization of AI capabilities and functionalities worldwide, aligned with healthcare systems’ strategic objectives, practical constraints, and local cultural values. The ultimate strategic objectives of the RHAMI’s application for AI-accelerated public health nutrition are to improve population health, financial efficiency, and societal equity through the global cooperation of the public and private sectors stretching across the Global North and South. Full article

Background/Objectives: Employee engagement is fundamental for the quality and sustainability of the Slovak healthcare sector. While the concept is critical, its operational challenges lie in the differentiated perception of its drivers across the highly heterogeneous workforce. This study aimed to empirically identify and structure the key antecedent factors of engagement and examine their perception based on structural and sociodemographic characteristics among healthcare workers in Slovakia. Methods: This research employed a quantitative, cross-sectional design, utilizing a self-administered questionnaire distributed widely among healthcare providers throughout Slovakia. To achieve the study’s objectives, several advanced mathematical and statistical methods were applied: the Kaiser-Meyer-Olkin (KMO) Measure and Bartlett’s Test for sample adequacy, Principal Component Analysis (PCA) for empirical factor structuring and Analysis of Variance (ANOVA). Results: Three common antecedent factors for healthcare workers’ engagement and well-being were identified: Factor 1—Organizational Commitment and Identity; Factor 2—Meaningful Involvement and Job Satisfaction; and Factor 3—Organizational Citizenship and Retention Intent. Factor 1 was evaluated positively in public (state-owned) and mixed organizations but negatively in private healthcare providers, confirming a statistically significant difference. Factor 2 also exhibited significant differences based on work position: it was negatively rated by management, physicians, and nurses, but positively by other staff categories. Conclusions: The contribution of this study lies in the empirical confirmation that a universal managerial approach to increasing employee engagement in Slovak healthcare is ineffective. A differentiated managerial approach based on organizational type and work position directly supports the transition from blanket, expensive, and ineffective HR policies to strategic and targeted engagement management, which is essential for the long-term sustainability and improvement of care quality in Slovak healthcare. Full article

Background/Objectives: Financial toxicity (FT) refers to the financial burden directly or indirectly caused by a patient’s medical care. Patients with head and neck cancer (HNC) are particularly vulnerable to FT due to lower rates of return to work and higher out-of-pocket payments (OOPP). In this cross-sectional study, we assessed the amount and types of OOPP, as well as the prevalence of FT, in HNC patients who had completed curative radiotherapy. Methods: We included HNC patients who underwent curative-intent radiotherapy at four private clinics in Romania, within 12 months of completing treatment. Participants completed a 25-item questionnaire capturing sociodemographic information, insurance status, income, and OOPP. To assess subjective FT, we used the validated nine-item Financial Index of Toxicity (FIT), which measures three FT domains: financial stress, financial strain, and lost productivity. Each domain and the total score range from 0 to 100, with higher scores indicating greater financial toxicity. Descriptive statistics were used to summarize patient characteristics. Pearson’s chi-square, t-tests, and one-way ANOVA were used to assess statistical associations, with a significance threshold of p < 0.05. Results: Among 113 patients (mean age: 59), the majority were male (74.3%) and married (74.3%), with 40% having completed university or higher education. The most frequent tumor sites were the oropharynx (29 cases), larynx (22), and oral cavity (21). Concurrent chemoradiation was the most common treatment modality (47%). The mean total FT score was 18.8. Overall, 39.8% of patients experienced financial toxicity, and 29.2% scored above the mean in financial stress. Moderate financial strain (score > 21) was reported by 39.8% of participants, and approximately one-third reported loss of productivity. Transportation and nutritional supplements were the most common OOPP categories. Notably, 42% of patients spent at least 400 euros—equivalent to Romania’s monthly minimum income—on transportation during radiotherapy. FT was significantly associated with employment and marital status, but not with tumor site or treatment type. Conclusions: Among Romanian HNC patients treated with curative radiotherapy, we found substantial OOPP, particularly for transportation and nutritional supplements. While overall FT levels were moderate, divorced patients and those retired due to other chronic conditions were the most vulnerable to financial distress. Financial toxicity can directly affect treatment adherence, survival, and quality of life. By integrating financial counseling, social support, and broader coverage of treatment-related expenses, healthcare systems can mitigate FT for these patients. Full article

Background: Adolescents and young adults (AYAs) with cancer have unique needs as they transition from childhood to adulthood. This study explored the patterns of health service use and the related costs incurred by the health care system and out-of-pocket (OOP) costs for AYAs diagnosed with cancer in Queensland, Australia. Methods: A linked administrative dataset (CancerCostMod) containing all AYA cancer survivors (n = 871; aged 15–24) diagnosed between July 2011 and June 2015 from the Queensland Cancer Registry (QCR) linked these records to Queensland Health Admitted Patient Data Collection (QHAPDC), Emergency Department Information System (EDIS), Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records from July 2011 to June 2018. We quantified total and average health service use, associated costs, OOP costs, and costs variations across sociodemographic characteristics. Results: The public hospital costs incurred for AYAs diagnosed with cancer were higher (AUD 33.7 M) compared to private hospitals (AUD 12.6 M). The median cost per person for public admissions (AUD 9759, IQR = AUD 0–37,245). AYAs claimed 215,900 MBS items and 58,321 PBS items over a five-year period. First Nations Australians and individuals living in regional and mostly disadvantaged areas had higher public hospital admissions, associated costs, and ED admissions compared to their counterparts. Conclusions: This study revealed significant variations in healthcare costs for AYAs diagnosed with cancer. Public hospital costs were higher, with notable differences observed across sociodemographic characteristics. Full article

Federated learning (FL) enables collaborative model training without centralizing raw data, but its application to large-scale vision models remains constrained by high communication cost, data heterogeneity, and privacy risks. Furthermore, in real-world applications such as autonomous driving and healthcare, model updates can inadvertently expose sensitive information even without direct data sharing. This highlights the need for frameworks that balance privacy, efficiency, and accuracy. The current approach to addressing information exposure involves encrypting data by incorporating additional encoding. However, such approaches to encrypting data significantly increase communication costs. In this paper, we propose Federated Share-A Low-Rank Adaptation with Differential Privacy (FedSA-LoRA-DP), a parameter-efficient and privacy-preserving federated learning framework. The framework combines selective aggregation of low-rank parameters with Differential Privacy (DP), ensuring that only lightweight components are shared while formally bounding individual data influence. Since DP simply perturbs the numeric values of existing parameters without altering their dimensionality or structure, it does not increase communication cost. This design allows FedSA-LoRA-DP to provide strong privacy guarantees while maintaining communication efficiency and model accuracy. Experiments on CIFAR-100, MNIST, and SVHN datasets demonstrate that the proposed framework achieves accuracy comparable to non-private counterparts, even under heterogeneous non-independent and identically distributed data and partial client participation. These results demonstrate that integrating differential privacy into low-rank adaptation enables privacy-preserving and communication-efficient federated learning without sacrificing model performance across heterogeneous environments. Full article

Background: The 2022 Pakistan floods devastated healthcare access for pregnant women in already impoverished areas in Sindh province. This study examines how Cash for Health assistance (CH) of USD 112 alleviated financial burdens and improved maternal health outcomes and resilience, bridging a critical literature gap on cash effectiveness in humanitarian crises. Methodology: This study used a mixed-methods approach to assess the CH assistance intervention for families of pregnant/lactating women in flood-affected rural Sindh, Pakistan. A pre-post quantitative analysis of baseline (May–June 2024) and endline (August–November 2024) survey data in ~100 villages (Jamshoro/Sehwan) examined changes in healthcare access, expenditure, and preferences using t-tests, proportion tests, and multivariable regression. Concurrently, five qualitative case studies from key informant interviews provided thematic content analysis, triangulating findings on economic, health, and social impacts. Results: Respondents predominantly had low literacy rates and were from households of daily wage laborers in vulnerable, flood-affected areas. While income and education remained low, instances of forgone care due to financial barriers increased (68% to 97%, p < 0.001). CH significantly improved healthcare access (58% to 98%, p < 0.001). Access to regular physicians (20% to 69%) and private facilities (10% to 41%) notably expanded. Healthcare expenditure significantly increased from USD 9.3 to USD 25, with a shift in spending preference towards medication, consultations, and diagnostics. CH also significantly improved food security (21% to 97%), meal frequency, and overall household stability, including reducing domestic violence. Qualitative data emphasized pre-existing vulnerabilities and CH’s role in addressing health, nutrition, and psychosocial needs. Conclusions: CH significantly improved healthcare access and reduced financial burdens for vulnerable pregnant women post-disaster. However, a sustainable impact requires integrated “cash plus” models, combining financial aid with stronger health systems, psychosocial support, and literacy for long-term resilience. Full article

Each year, over 1 million people in the United States die from diabetes and cardiovascular diseases (CVDs). These largely preventable chronic conditions also create a financial burden on patients, payers, and healthcare systems. The popularity of GLP-1-based management of cardiometabolic conditions can escalate healthcare spending, while incentivizing digitization of semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro), and others using the “prescription drug use-related software” (PDURS) framework. In this article, we highlight opportunities to advance digital-first interventions and metformin-enhanced digital therapeutics (DTx) for the primary prevention of diabetes and CVDs. Metformin is a low-cost antidiabetic medication that is effective in preventing diabetes and cardiovascular adverse events. Concurrently, digital health technologies for managing chronic conditions, e.g., Dario Health, Omada Health, and WellDoc, enable digital-first and drug + digital combination therapies for prediabetes and those at risk for CVDs. We describe incentives for advancing Affordable Primary Prevention (APP), suggesting that nonprofit healthcare systems, such as Kaiser Permanente, Intermountain Health or Ascension Health, payers such as Cigna and Aetna/CVS Health, or private equity investors can leverage their venture funds to support development of metformin-enhanced DTx. In conclusion, (1) the PDURS framework can accelerate innovation of preventive medicine by bridging precision digital interventions with low-cost generic drugs, and (2) integrating healthy behaviors with pharmacotherapies is essential for the financially sustainable prevention of lifestyle-related chronic diseases. Full article