Search Results (188)

Taiwan’s strategic focus in digital healthcare has been officially integrated into national industrial policy and identified as a crucial application area for artificial intelligence (AI) and next-generation communication technologies. As the healthcare sector undergoes rapid digital transformation, digital healthcare technologies have emerged as essential tools for improving medical quality and efficiency. Leveraging the extensive coverage of its National Health Insurance (NHI) system and its strengths in Information and Communications Technology (ICT), Taiwan also benefits from the robust research capacity of universities and hospitals. Government-driven regulatory reforms and infrastructure initiatives are further accelerating the advancement of the NHI MediCloud system and the broader digital healthcare ecosystem. This article provides a comprehensive overview of smart healthcare development, highlighting government policy support and the R&D capabilities of universities, research institutes, and hospitals. It also examines the ICT industry’s participation in the development of smart healthcare ecosystems, such as Foxconn, Quanta, Acer, ASUS, Wistron, Qisda, etc. With strong data assets, technological expertise, and policy backing, Taiwan demonstrates significant potential in both AI innovation and smart healthcare applications, steadily positioning itself as a key player in the global healthcare market. Full article

Despite seven decades of international commitment—from the 1948 Universal Declaration of Human Rights through SDG 3.8—universal health coverage remains stubbornly out of reach. Two billion people, predominantly informal sector workers, lack access to sustainable health insurance. This entry explains the underlying cause: sustainable health insurance requires specific behavioral and institutional conditions for collective action—conditions that existing health insurance models systematically fail to satisfy, thereby structurally excluding informal populations. The Trinity Law framework formalizes these conditions as three multiplicatively interacting requirements—Trust (T), Consensus (C), and Dual Benefit (DB)—expressed as S = T × C × DB. Empirical analysis of community-based health insurance schemes across 24 countries identifies a robust trust threshold (τ* ≈ 0.68) operating as a behavioral phase transition: below this level, cooperation collapses; above it, participation becomes self-sustaining. Cross-country evidence from 274 organizations across 155 countries confirms consensus thresholds (C* ≈ 0.59), while analysis of 158,763 observations validates dual benefit mechanisms. The multiplicative structure explains why partial reforms fail: weakness in any single component drives overall sustainability toward zero. Applied to health insurance, this framework distinguishes conventional systems—Bismarckian employment-based, Beveridgean tax-financed, and commercial health insurance from sustainable systems like participatory community-based microinsurance that satisfy all three Trinity Law conditions through participatory design, transparent governance, and aligned incentives. The persistent UHC gap reflects not implementation failures but fundamental design incompatibilities that the Trinity Law makes explicit. This entry has three objectives: first, it states the Trinity Law conditions; second, it summarizes the empirical evidence for each component; third, it applies the framework to classify major health insurance models. Supporting datasets and code are available in the referenced Zenodo repositories. The term ‘law’ follows the tradition of social science regularities like the ‘law of demand’: a robust empirical pattern with strong predictive validity, not a claim to physical certainty. 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

Guangdong south-pearl aquaculture, a cornerstone of China’s marine industry under the Rural Revitalization Strategy, contributes over 70% of national output but faces escalating marine disasters that expose systemic barriers to resilience. This study develops a diagnostic multidimensional framework for post-disaster resilience using a Grounded Theory design. We conducted 32 semi-structured interviews with participants from five key enterprises and cooperatives in the core Leizhou production region. Interview transcripts were analyzed in NVivo through open, axial, and selective coding with constant comparison. Open coding generated 136 initial concepts, axial coding consolidated them into 25 categories, and selective coding integrated these into four core dimensions: technological adaptation gaps, institutional trust deficits, human-resource succession ruptures, and ecological path dependence. These dimensions constitute the core phenomenon, termed the four-dimensional synergistic dilemma. Building on this empirically grounded diagnosis, we propose a multidimensional collaborative recovery framework that links each dimension to actionable levers, including stress-tolerant breeding and ecological aquaculture models, targeted policy instruments and adaptive insurance, industry-education pipelines to preserve craftsmanship, and spatial planning with coordinated pollution control. The study provides a theoretically informed and empirically validated model for enhancing industrial resilience, offering actionable insights for the sustainable revitalization of coastal specialty industries. Full article

Background: Diabetes disproportionately affects U.S. subgroups, yet non-Hispanic multiracial adults are underrepresented in epidemiologic studies. This study aimed to examine behavioral and sociodemographic predictors of diabetes in this population. Methods: We analyzed data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) using a cross-sectional design that incorporated survey weights, strata, and primary sampling units. Binary logistic regression was employed to identify predictors of diabetes, including variables with p ≤ 0.20 from bivariate models in the multivariable analysis. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: The study included a total of 6429 participants. Obesity (AOR = 4.16; 95% CI: 3.33, 33.23), being overweight (AOR = 2.05; 1.62, 2.60), poor general health (AOR = 2.82; 2.38, 38.35), age ≥ 65 years (AOR = 3.08; 2.60, 3.65), male sex (AOR = 1.34; 1.15, 1.58), and health insurance (AOR = 2.14; 1.35, 3.61) were associated with higher odds of diabetes. Physical activity (AOR = 0.76; 0.64, 0.90) and alcohol consumption (AOR = 0.55; 0.47, 47.65) were linked to lower odds of diabetes. Smoking status showed no significant association after adjustment. Conclusions: In non-Hispanic multiracial adults, factors such as adiposity and older age increased the risk of diabetes, while physical activity and alcohol consumption offered protective benefits. These findings indicate that current diabetes prevention strategies are applicable to this subgroup, and public health initiatives should prioritize their inclusion in outreach, screening, and intervention efforts. Full article

Objective: Antimicrobial resistance (AMR) is a top ten threat to global public health, and Malta remains among the highest antibiotic-consuming countries in the European Union. This systematic review aimed to identify barriers and facilitators influencing antimicrobial stewardship in Malta, focusing on general practitioners (GPs) and pharmacists. Methods and Measures: Eligible studies included GPs and/or pharmacists practising in Malta and explored influences on prescribing and/or dispensing. Systematic searches were performed in June 2025 and September 2025 using the following databases MEDLINE, PsycINFO, PsycArticles PubMed, and Google Scholar. Data were extracted using a modified Cochrane template, and quality was assessed using Joanna Briggs Institute tools. Findings were synthesised using the socio-ecological model and mapped to the COM-B framework. Results: Seven studies met inclusion criteria, with a total sample size of 495 participants. Barriers included diagnostic uncertainty, knowledge gaps, misconceptions about AMR, patient expectations, commercial pressures, limited diagnostic and IT infrastructure, and defensive prescribing linked to indemnity insurance. Facilitators included stewardship values, stronger guideline adherence among younger GPs, trust-based GP–patient relationships, GP–pharmacist collaboration, and intervention effects from a social marketing programme. Mapping to COM-B showed barriers and facilitators interacting across capability, opportunity, and motivation. Conclusions: Prescribing in Malta is shaped by diagnostic uncertainty, entrenched habits, patient expectations, and structural gaps. Although the evidence base was limited and partly overlapping, consistent findings across mixed method designs highlighted that effective stewardship will require rapid diagnostics, e-prescribing, over-the-counter enforcement, and GP–pharmacist collaboration, supported by policy reforms aligning indemnity and sick-leave systems with AMR goals. Full article

Medication non-adherence remains a major challenge in healthcare systems worldwide, with significant implications for patient outcomes and healthcare costs. This study explored the perceptions and practices of Key Opinion Creators (KOCs) in Kosovo regarding medication adherence. Using a qualitative approach, 15 participants representing hospitals, pharmacies, academia, pharmaceutical companies, insurance, and professional associations were surveyed through open-ended questionnaires. Findings reveal the absence of clear national policies or guidelines dedicated to adherence, limited monitoring systems, and insufficient institutional support. While KOCs recognize healthcare professionals’ (HPs) role in patient education, counseling, and monitoring, they also stressed that their engagement is often fragmented and lacks standardized reporting mechanisms. Technology and innovation were identified as promising tools to improve adherence, but their application is limited by inadequate infrastructure and resources. Key barriers include a lack of guidelines, financial and human resource constraints, low patient education, and disparities across demographic groups. The study highlights the urgent need for coordinated policies, stronger inter-professional collaboration, targeted interventions, and integration of digital health solutions to strengthen medication adherence practices in Kosovo. Full article

Background/Objectives: Cancer remains a major public health concern in India, with the Northeast Region (NER) reporting the country’s highest incidence rates. In Meghalaya, a predominantly tribal state, cultural beliefs, financial hardship, and limited healthcare access significantly affect cancer diagnosis and treatment outcomes. This study explores the experiences and needs of cancer patients in Meghalaya, India, to inform culturally sensitive, patient-centred, and financially inclusive approaches to cancer care among tribal populations. Methods: A qualitative study was conducted among 19 participants (12 patients and 7 caregivers; in cases where patients were unable to communicate effectively due to physical weakness or treatment-related complications, their primary caregivers, those directly linked to the specific patients, were interviewed instead) receiving treatment at Civil Hospital, Shillong, between August and November 2023. In-depth interviews were conducted in Khasi, translated into English, and analysed thematically following COREQ guidelines. Results: Ten key themes emerged. Patients often attributed early symptoms to supernatural causes and sought traditional healers, delaying diagnosis. Many experienced fragmented care pathways, misinformation, and fear of treatment side effects. The financial burden was severe, with high out-of-pocket costs for travel, diagnostics, and medicines, despite partial relief through the Meghalaya Health Insurance Scheme. Communication about costs between patients and providers was limited, leaving families unprepared for the expenses. Emotional distress, loss of livelihood, and dependence on family support were common, while faith and spirituality served as major coping mechanisms. Conclusions: Cancer care in Meghalaya is shaped by intertwined cultural, economic, and systemic barriers. Strengthening culturally tailored health education, decentralised diagnostic services, structured financial counselling, and cost transparency can improve care delivery. Future research should adopt multi-centre, longitudinal approaches to guide equitable, patient-centred cancer policies in tribal and rural settings. Full article

On 25 April 2014, the municipal water source in Flint, Michigan, was switched to the Flint River. Failure to properly treat the water for corrosion resulted in lead contamination of the water system. Resident concerns were dismissed by local, state, and federal government agencies until community participatory and clinical pediatric research demonstrated the contamination, and the water was restored to the original source 18 months later. Recovery efforts established a public health registry, funded by the Centers for Disease Control and Prevention. A grant of public health authority and registry funding were awarded to Michigan State University in August 2017 to establish a health surveillance system and public health intervention to refer exposed individuals to community services. Community feedback requested tiered data-sharing consent options. Participants who consented to join the registry were presented with four consent questions: to be contacted about future research opportunities, to use survey data to make referrals to services on their behalf, to share with the registry their State of Michigan Department of Health and Human Services (MDHHS) program data, and to share Michigan Medicaid administrative data. This descriptive study found that most participants consented to being contacted for future research (88%), sharing data for referrals (84%), and sharing data from MDHHS programs (77%) with the registry. Among participants with Medicaid insurance, 74% consented to sharing Medicaid data. Consent increased with age and decreased with income and education. Consent was higher among participants reporting food insecurity in the last 12 months. Consent to share data was unexpectedly high in the context of environmental disaster, trauma, and government distrust. Further work is needed to explore whether participation in public health activities is positively impacted by the implementation of a tiered consent process to share data. Full article

Background: The continuous expansion of the National Reimbursement Drug List has led to an increasing cost disparity among alternative drugs for the same indications. Under the current proportional reimbursement mechanism, choosing higher-cost treatments often results in higher compensation. Given the lack of empirical evidence on whether income affects the medication choices of insured individuals in the Chinese context, this study aims to evaluate the impact of income levels on drug selection, providing a basis for optimizing the medical insurance reimbursement policy. Methods: This study extracts data from hospitalized patients enrolled in basic medical insurance from the China Health and Retirement Longitudinal Study (CHARLS) database and preprocesses it in Excel. Subsequently, SPSS is used to conduct descriptive statistics, difference analysis, correlation analysis, and regression analysis on the processed data to explore the impact of income levels on drug selection. Results: After controlling for length of hospitalization and hospitalization costs, the regression coefficient for urban employee basic medical insurance participants is β = 0.505 (p < 0.01), and the regression coefficient for new rural cooperative medical insurance participants is β = 0.195 (p < 0.01). This means that, regardless of whether participants are enrolled in urban employee basic medical insurance or new rural cooperative medical insurance, an increase in income will lead to higher hospitalization drug costs. Conclusions: Compared to low-income insured individuals, high-income participants in the basic medical insurance are more likely to choose higher-cost drugs among alternatives, which leads to unfair reimbursement under the current proportional reimbursement system. Full article

Background and Objectives: Clinical ethical judgments are often elicited through scenario-based (vignette-based) dilemmas that guide interpretation, reasoning, and moral judgment. Despite its importance, little is known about how healthcare professionals and students respond to such scenario-based dilemmas in Eastern European settings. This study explored differences in ethical decision-making between senior medical/dental students and practicing clinicians in Romania, focusing on how scenarios-based dilemmas influence conditional versus categorical responses. Materials and Methods: A cross-sectional survey was conducted with 244 participants (51 senior students; 193 practitioners). Respondents completed a validated 35-item questionnaire presenting hypothetical ethical scenarios across seven domains: informed consent, confidentiality, medical errors, public health duties, end-of-life decisions, professional boundaries, and crisis ethics. Each scenario used a Yes/No/It depends response structure. Group comparisons were analyzed using chi-square and non-parametric tests (α = 0.05). Results: Scenario-based dilemmas elicited frequent conditional reasoning, with “It depends” emerging as the most common response (47.8%). Strong consensus appeared in rejecting concealment of harmful errors and in treating unvaccinated families, reflecting robust professional norms. Divergences arose in areas where scenario-based dilemmas emphasized system-level duties: students more often supported annual influenza vaccination (52.9% vs. 32.6%, p = 0.028) and organ purchase authorization (76.47% vs. 62. 18%, p = 0.043), while practitioners more frequently endorsed higher insurance contributions for unhealthy lifestyles (48.7% vs. 23.5%, p = 0.003). Conclusions: Scenario-based dilemmas strongly shape moral decision-making in healthcare. While students tended toward principle-driven transparency, practitioners showed pragmatic orientations linked to experience and system stewardship. To promote high-quality clinical work and align decision-making with best practice and health policy, our findings support institutional protocols for transparent error disclosure, continuing professional development in ethical communication, the possible adoption of annual influenza vaccination policies for healthcare personnel as policy options rather than categorical imperatives, and structured triage frameworks during crisis situations. These proposals highlight how scenario-based ethics training can strengthen both individual reasoning and systemic resilience. Full article

Background/Objectives: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disease, but its relationship with gastric cancer (GC) remains unclear. This study aimed to investigate the association between AD and GC using a nationwide Korean database. Methods: Using the Korean National Health Insurance Service-National Sample Cohort, we conducted a nested case–control study including 10,174 GC patients and 40,696 matched controls (1:4 by age, sex, income, and region). Overlap propensity score weighting was used to control for confounders. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated via logistic regression. Results: AD was significantly associated with an increased risk of GC (adjusted OR = 1.08; 95% CI: 1.01–1.15). Subgroup analyses revealed stronger associations among individuals aged ≥ 65 years (OR = 1.12), men (OR = 1.10), rural residents (OR = 1.14), and those without comorbidities (CCI = 0, OR = 1.15). Higher risks were also observed in participants with non-allergic rhinitis (OR = 1.43) or no asthma (OR = 1.12). Conclusions: AD may be associated with an increased risk of GC in the Korean population. These findings may highlight the importance of considering dermatological conditions in the context of systemic cancer risk. 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: Although most amputations caused by diabetes and peripheral artery disease (PAD) are preventable, current limb preservation efforts in the United States remain poorly understood. This study aims to identify key barriers and facilitators to limb preservation from the primary care provider (PCP) perspective. We plan to use the insights from this work to promote targeted intervention strategies. Methods: Using a mixed-methods design, an online 5–10 min survey was distributed to Oklahoma primary care providers who could elect to participate further in a semi-structured, audio-recorded interview. Descriptive analysis was used to summarize survey results. Interviews were transcribed and qualitatively analyzed using grounded theory. Donabedian’s structure, process, and outcome framework was used to categorize how each identified barrier and facilitator increases or reduces the risk of limb loss for at-risk patients at the practice level. Finally, we compared and contrasted survey and interview findings. Results: Thirty surveys were completed (approximately 14% response rate), and seven interviews were conducted with PCPs geographically dispersed across Oklahoma. Most clinicians reported in the survey that they see at-risk limbs at least once every 1–2 months (n = 29, 96.7%). Half of clinicians were satisfied or very satisfied with access to vascular surgery (n = 15, 50.0%), interventional specialists (n = 13, 43.3%), and endocrinologists (n = 12, 40.0%). Finally, survey respondents reported that social needs most often affecting their patients with a limb at risk of amputation include income, health education, transportation, and health insurance. Interviews confirmed PCPs frequently see at-risk limbs. We identified thematic barriers to limb preservation that included limited access to specialty care, limited PCP and patient amputation prevention education, and patient social struggles surrounding transportation, finances, and insurance. Patient advocates (community, clinical, or personal), affordable medications, and more time with patients were reported as facilitators in amputation prevention. Conclusions: Oklahoma PCPs frequently see at-risk feet, realize poor access to care, and desire structural change to support excellent preventive care in diabetes and PAD. Limb preservation in Oklahoma is contingent upon shifting from disempowerment to engagement that requires systemic reform, clinical innovation, and community engagement. We identified several intervention strategies, including increasing education for PCPs to empower them to initiate early prevention, improving early identification and preventive therapy for patients at risk for limb loss, and cultivating specialty care access via networking and policy change. Full article

This study focuses on the Unified Health System (SUS) in five regions of the state of Rio de Janeiro, Brazil, one of Brazil’s most important states, as part of a comprehensive analysis of a research project, which has generated publications in earlier phases. The objective was to assess users’ perceptions of SUS in terms of access to and the quality of public health services, including primary care and pharmaceutical services. A cross-sectional study was conducted using a structured questionnaire comprising 66 questions, administered to a purposive sample of 1000 participants between August 2023 and August 2024. Data were analyzed using Pearson’s chi-square test with R software version 4.3. Among the participants, 54.5% were female, 62.5% were aged between 26 and 60 years, and 29% reported having private health insurance. Vaccination services were the most frequently used SUS service (25.1% of respondents). Participants who reported more frequent use of SUS services rated access more positively than those who used them less frequently (p = 0.002). The regions that evaluated SUS access and quality most favorably were Middle Paraíba and the metropolitan region, while the Coastal Lowlands region received the most negative assessments. Participants with lower socioeconomic status gave more favorable evaluations of access to public health services (p = 0.001). These findings highlight concerns about access to, and the quality of, SUS healthcare services and regional disparities in users’ perceptions of SUS services in Rio de Janeiro. The results underscore the importance of social participation as a key element in the evaluation and continuous improvement of responsive public healthcare. Full article