Search Results (236)

A large and growing empirical literature documents that privatization, deregulation, financialization, and under-regulation of harmful industries are associated with adverse health outcomes in the United States. However, this evidence remains fragmented across sectors and rarely articulates a unifying causal framework. This paper advances the literature by integrating findings across health care, harmful-product industries, and economic and social policy to demonstrate that corporate profit maximization functions as a cross-cutting driver of health disparities and premature mortality in the United States. We synthesize evidence showing that profit-driven incentives shape insurance markets, hospital and physician practice ownership, pharmaceutical marketing, and the aggressive promotion of tobacco, alcohol, ultra-processed foods, opioids, firearms, and fossil fuels—together contributing to more than one million deaths annually. We further document how corporate influence over public policy has increased poverty, economic inequality, and discrimination, all of which are powerful social determinants of health. In contrast to sector-specific analyses, this paper presents a unified, systems-level account of how profit-first governance undermines population health. We conclude by describing how a social movement to achieve a single payer system that provides Medicare for All would not only vastly improve public health, it would be a catalyst for numerous other reforms that enhance the general wellbeing. Full article

Background: Hypertension-preventable hospitalizations are used internationally as indicators of primary healthcare centers (PHCs) performance. The Ministry of Health (MoH) in Saudi Arabia has recently implemented several programs to strengthen PHCs and reduce avoidable admissions. This study aimed to observe recent trends in healthcare utilization among hypertensive patients in Makkah City. Methods: A retrospective comparative time-trend analysis was conducted using aggregated monthly counts from individual-level records collected by the Makkah Health Cluster between January 2023 and May 2024. Data from 43 PHCs and all public hospitals were analyzed using segmented Poisson regression based on the AHRQ Prevention Quality Indicator #07 (PQI-07) for hypertension. Models included demographic covariates (age, sex, nationality) and a dummy variable to adjust for the Eid holiday period. Rates were calculated per 100,000 adults. Results: A total of 42,743 hypertension-related encounters were identified, including 2895 preventable hospitalizations and 39,848 PHC visits. Monthly analyses showed a 5.7% decline in preventable hospitalizations (IRR = 0.943; p < 0.001) and a 1.5% increase in PHC visits (IRR = 1.015; p < 0.001). Reductions were most pronounced among adults ≥ 65 years. Non-Saudis were significantly less likely to attend PHCs, reflecting public-sector eligibility differences. Conclusions: After controlling for Eid-related seasonal variation, the results indicate a favorable shift toward outpatient hypertension management in Makkah City. These findings align with Saudi Vision 2030 objectives of strengthening PHC and reducing preventable hospital burden. Further multi-regional studies integrating private-sector data are warranted to confirm national trends. Full article

Background: As part of Vision 2030, the Saudi Health Sector Transformation Program (SHSTP) introduced hospital clustering and digital health to strengthen patient-centered care. However, limited empirical evidence exists on its real-world impact. SHSTP represents one of the first large-scale digital integration reforms in the Gulf region, aligning with international frameworks such as the WHO Integrated People-Centred Health Services (IPCHS) and the Wagner Chronic Care Model. This study therefore contributes policy-relevant evidence on how national digital health reforms translate into measurable improvements in care coordination and patient experience. Methods: A convergent mixed-methods study was conducted across two regions (Mecca and Eastern Province) and four public hospitals (two clustered, two non-clustered) from 2016 to 2024. Quantitative indicators included patient satisfaction, Patient-Centered Care Index (PCCI), follow-up compliance, digital engagement (telemedicine, Sehat app/EMR), operational efficiency, and readmissions. Analyses used t-tests, ANOVA, and multivariable regression. Qualitative data from 53 semi-structured interviews (patients and physicians) were thematically analyzed and integrated with quantitative results through triangulation. Results: Clustered hospitals showed higher patient satisfaction (87.6% vs. 75.0%), stronger care coordination (PCCI: 89.4 vs. 69.7; p < 0.001), and better follow-up compliance (83.6% vs. 71.2%; p = 0.006). Digital engagement was greater (telemedicine 0.53 vs. 0.30; Sehat app 0.55 vs. 0.26; both p < 0.05). Regression identified hospital clustering (β = 12.49; p = 0.022), physician role (β = 19.92; p < 0.001), and digital literacy (β = 4.03; p = 0.047) as significant predictors of care coordination. Qualitative findings supported these results but highlighted challenges with digital literacy and workforce stability. Conclusions: SHSTP clustering improves patient experiences, digital engagement, and operational performance in chronic care. Sustained progress requires investment in digital literacy, workforce development, and change management. Broader longitudinal evaluation is warranted to confirm scalability and system-wide effects. These results extend the global evidence base on health system transformation by illustrating how digital and structural integration can operationalize patient-centered care in emerging-economy settings. Full article

Tackling climate change in the public–private partnership (PPP) infrastructure sector requires radical transformation of projects to make them resilient against climate risks and free from excessive carbon emissions. Types of PPP infrastructure such as transport, power plants, hospitals, schools and residential buildings experience more than 30% of global climate change risks. Therefore, this study aims to examine the interrelationships between the climate risk management strategies in PPP infrastructure projects. The first step in conducting this research was to identify the strategies through a comprehensive literature review. The second step was data collection from 147 PPP stakeholders with a questionnaire. The third step was analysing the interrelationships between the strategies using a partial least square–structural equation model approach. The findings include green procurement, defined climate-resilient contract award criteria, the identification of climate-conscious projects and feasible contract management strategies. The results provide understanding of actionable measures to counter climate risks and they encourage PPP stakeholders to develop and promote climate-friendly strategies to mitigate climate crises in the PPP sector. The results also serve as foundational information for future studies to investigate climate change risk management strategies in PPP research. Full article

Safeguarding patient and personnel safety and improving care quality has emerged as a critical priority for healthcare systems globally. In response to persistent challenges in healthcare delivery, many countries have adopted clinical governance frameworks and organisational learning processes to strengthen accountability and promote continuous improvement. Robust clinical governance frameworks provide the processes and accountability measures necessary to foster a culture of knowledge-sharing and evidence-based decision-making, all of which are key characteristics of a learning organisation. This study seeks to investigate the role of clinical governance in improving hospital performance through three interconnected sub-studies. The first sub-study will explore how non-clinical managers in selected public sector hospitals leverage clinical governance to improve hospital performance. The second sub-study will evaluate the impact of clinical governance interventions on clinical outcomes and identify opportunities for organisational learning within these hospitals. The third sub-study will serve as an embedded experimental component, monitoring changes in complaint resolution indicators before and after interventions to assess improvements in clinical governance through both intra- and inter-hospital comparisons. Qualitative data will be analysed using NVivo version 15, with inductive thematic analysis employed to uncover emergent patterns and interpretive themes. Full article

Background: Artificial intelligence (AI) is increasingly integrated into healthcare, offering transformative potential across diagnostics, treatment, and clinical decision-making. As its adoption grows, understanding how medical doctors perceive and respond to AI, particularly in relation to their specialty, experience, and job security, is critical for effective implementation and acceptance. This study investigates the confidence of medical doctors in AI technologies and their role in healthcare, focusing on the impact of specialty, experience, and perceived job security. Method: A cross-sectional survey was conducted among 187 medical doctors across various specialties in Riyadh, Saudi Arabia, with a final sample of 176 participants. The survey assessed awareness, confidence, and concerns regarding AI integration into clinical practice. The survey was conducted across multiple healthcare hospitals in Riyadh, Saudi Arabia. Hospitals from both public and private sectors were included to ensure a diverse sample of healthcare professionals from different organizational structures. Results: A statistically significant association was found between specialty and confidence level (χ² = 14.5, p = 0.001). Among specialists, the majority (80%) reported high confidence in AI use compared to 45% of general practitioners and 38% of surgeons. Conversely, moderate confidence was most common among surgeons (46%), followed by general practitioners (35%) and specialists (13%). Additionally, participants with 11–20 years of experience reported the highest confidence, whereas those aged 55+ years showed the lowest perceived impact of AI on patient outcomes. Multivariate regression analysis identified specialty as the strongest predictor of AI confidence, with specialists being four times more likely to express high confidence in AI use (β = 0.89, p = 0.001) compared to general practitioners. Job displacement concerns negatively influenced confidence in AI, while age and years of experience had less impactful effects. Conclusions: The study concludes that addressing barriers to AI adoption will be crucial for enhancing its integration into healthcare and improving patient care. These findings underscore the importance of specialty-specific training and highlight the need for targeted educational programs, particularly for lower confidence groups such as general practitioners and surgeons. Lower confidence levels in these groups may result in a hesitant or incorrect use of AI tools, potentially compromising patient safety. Therefore, equipping all healthcare professionals with the necessary knowledge and confidence is essential for the safe and effective use of AI in clinical practice. Full article

Background: Occupational or work-related stress remains a persistent challenge in nursing, often intensified by sociodemographic factors. In Brazil’s Northeast, particularly in Aracaju, Sergipe, public hospital nurses face unique stressors shaped by regional socioeconomic conditions. Objective: This cross-sectional exploratory study aimed to examine the relationship between perceived work-related stress and the sociodemographic profiles of nursing professionals in three public hospitals in Aracaju. Methods: Data were collected via an online questionnaire incorporating the Perceived Stress Scale (PSS-10) and sociodemographic items. Results: Among 440 participants—comprising nurses (42%), nursing technicians (38.2%), nursing assistants (8.9%), and specialists (10.9%)—moderate to high stress levels were most prevalent among nursing technicians and assistants. Elevated stress was notably associated with adult women working in high-complexity sectors (e.g., pediatrics, obstetrics, ICU), particularly those without partners, earning low incomes, and with over ten years of professional experience. Conclusions: The findings highlight a vulnerable subgroup within the nursing workforce and underscore the need for targeted interventions to mitigate occupational stress in public healthcare settings. This study contributes region-specific insights into the intersection of stress and sociodemographic factors, offering a foundation for future policy and support strategies. Full article

Person-centred cultures are increasingly recognised as essential to the delivery of compassionate, safe, and effective healthcare. While Lean Six Sigma (LSS) is widely adopted as a process improvement methodology, its application is often critiqued for lacking alignment with relational or values-based care. This study aimed to test the transferability of three previously developed Programme Theories (PTs), generated through realist inquiry in a public hospital setting, within a large private acute hospital. Realist-informed adjudication workshops were conducted with interdisciplinary staff who had completed university-accredited training in LSS. Structured workbooks, visual artefacts, and thematic synthesis were used to identify how context–mechanism–outcome configurations (CMOCs) held, shifted, or evolved in the new setting. All three PTs were confirmed, with six CMOCs refined, and eight new configurations generated. Key refinements included the role of strategic intent, informal improvement communities, and intrinsic motivation. These findings suggest that values-based mechanisms underpinning person-centred LSS are not confined to public systems and may be equally active in private settings. The study confirms the explanatory strength of the original PTs while contributing new insights into their adaptability. It offers practical guidance for healthcare leaders seeking to embed person-centred improvement approaches across diverse systems, regardless of sectoral funding or governance structures. Full article

Public healthcare infrastructure is among the most energy-intensive of public facilities; therefore, it needs to become more environmentally and economically sustainable by increasing energy efficiency and improving service reliability. Achieving these goals requires modernizing hospital energy systems with renewable energy sources (RESs). This process often involves Energy Service Companies (ESCOs), which propose integrated RES technologies with tailored contractual schemes. However, comparing ESCO offers is challenging due to their heterogeneous technologies, contractual structures, and long-term performance commitments, which make simple cost-based assessments inadequate. This study develops a structured Multi-Criteria Decision-Making (MCDM) methodology to evaluate energy projects in public healthcare facilities. The framework, based on the Analytic Hierarchy Process (AHP), combines both quantitative (net present value, stochastic simulations of energy cost savings, and CO₂ emission reductions) with qualitative assessments (redundancy, flexibility, elasticity, and stakeholder image). It addresses the lack of standardized tools for ranking real-world ESCO proposals in public procurement. The approach, applied to a case study, involves three ESCO proposals for a large hospital in Southern Italy. The results show that integrating photovoltaic generation with trigeneration achieves the highest overall score. The proposed framework provides a transparent, replicable tool to support evidence-based energy investment decisions, extendable to other public-sector infrastructures. Full article

Background/Objectives: Workplace conflict and aggression pose significant psychosocial risks across diverse professional sectors. This protocol outlines a novel, university-based educational intervention. Developed by a multidisciplinary team from the University Hospital of Pisa, Italy, including occupational physicians and a psychiatrist specializing in work and organizational psychology, its primary purpose is to enhance conflict prevention and crisis management skills. While initially developed and tested within the veterinary sector due to its identified vulnerabilities, the intervention is inherently generalizable to any high-stress professional environment characterized by intense client, customer, or public interactions. Methods: The intervention integrates didactic instruction with active, immersive learning through tailored role-playing scenarios simulating real-world challenging encounters. This study protocol details the structured methodology for evaluating the immediate effectiveness of this training. We are using a specifically developed efficacy scale to assess outcomes. Results: The results demonstrate a significant improvement in all assessed skills from the pre-training to the post-training evaluation. For every item on the scale, the median scores increased, indicating a positive shift in overall group performance. The p-value for each item was <0.001, confirming that the observed improvements were statistically significant. These results demonstrate enhanced conflict resolution skills, improved communication, and an increased sense of self-efficacy among participants. Conclusions: This protocol offers a comprehensive and generalizable approach to addressing workplace psychosocial risks through an innovative educational intervention. A key future goal involves advancing this training methodology by integrating virtual reality (VR) environments with AI-driven avatars for role-playing, aiming to achieve a more realistic and impactful learning experience and sustained behavioral change. Full article

Background/Objectives: Uropathogenic Escherichia coli (UPEC) is the leading cause of urinary tract infections in both community and hospital settings worldwide. Antimicrobial-resistant UPEC strains pose a significant challenge for effective antibiotic therapy. In this study, 50 bacterial isolates recovered from urine samples of patients attended in different sectors of a public hospital in Rio de Janeiro over five months were analyzed to assess antimicrobial resistance and virulence profiles through broad gene screening. Methods: Biofilm production was assessed using a semi-quantitative adherence assay. PCR was employed to investigate 27 resistance genes, 6 virulence genes, sequence types (STs), and phylogroups. Susceptibility to 25 antimicrobial agents was determined by disk diffusion testing. Furthermore, the pathogenic potential was evaluated in vivo using the Tenebrio molitor larvae infection model. Results: Most UPEC isolates were moderate or strong biofilm producers (41/50; 82%). The sul1 and sul2 resistance genes were the most frequently detected (58%). Two virulence gene patterns were identified: fyuA, iutA, fimH, cnf1 and fyuA, iutA, fimH (13 isolates; 26%). ST131 and ST73 were the most common sequence types (16% each), and phylogroup B2 was the most prevalent (50%). Thirty isolates (60%) were multidrug-resistant, most of which belonged to phylogroup B2. UPEC exhibited dose-dependent lethality, causing 100% mortality at 2.6 × 10⁸ CFU/mL within 24 h. Conclusions: These findings reinforce the urgent need for surveillance strategies and effective antimicrobial stewardship in clinical practice. Full article

Background: Work-Related Quality of Life (WRQoL) is an essential aspect of the sustainability of the healthcare workforce, intimately connected to employee well-being, job fulfillment, and the standard of patient care. This research sought to evaluate WRQoL among healthcare employees in Greek public hospitals, concentrating on the influence of demographic and work-related factors in a healthcare system affected by prolonged economic and public health crises. Methods: A cross-sectional study was conducted with 1022 staff members from 23 hospitals in the 1st Health Region of Attica, utilizing the validated Work-Related Quality of Life Scale (WRQoL). Data were analyzed using non-parametric tests, including Chi-square and Linear-by-Linear Association analyses. Results: The findings showed that 44.3% of employees experienced low WRQoL, with the lowest ratings found among younger workers, those on temporary contracts, and individuals working in pediatric hospitals. Holding a leadership position, being over 40 years old, and having a permanent job were linked to notably greater well-being and job satisfaction. A significant portion of participants viewed the working conditions and autonomy as insufficient, particularly in demanding institutional environments. Conclusions: These results emphasize the necessity for focused policy measures to enhance working conditions, guarantee job stability, and reinforce organizational support structures. Tackling structural shortcomings in the healthcare system is crucial for protecting workforce stability and the standard of public health services. Full article

Background: The emergency medical services (EMS) sector, as a complex system, presents substantial hurdles in providing excellent treatment while operating within limited resources, prompting greater adoption of artificial intelligence (AI) as a tool for improving operational efficiency. While AI models have proved beneficial in healthcare operations, there is limited explainability and interpretability, as well as a lack of data used in their application and technological advancement. Methods: The scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews, using PubMed, IEEE Xplore, and Web of Science, with a procedure of double screening and extraction. The search included articles published from 2018 to the beginning of 2025. Studies were excluded if they did not explicitly identify an artificial intelligence (AI) component, lacked relevance to emergency department (ED) or prehospital contexts, failed to report measurable outcomes or evaluations, or did not exploit real-world data. We analyzed the data source used, clinical subclasses, AI domains, ML algorithms, their performance, as well as potential roles for large language models (LLMs) in future applications. Results: A comprehensive PRISMA-guided methodology was used to search academic databases, finding 1181 papers on prehospital emergency treatment from 2018 to 2025, with 65 articles identified after an extensive screening procedure. The results reveal a significant increase in AI publications. A notable technological advancement in the application of AI in EMS using different types of data was explored. Conclusions: These findings highlighted that AI and ML have emerged as revolutionary innovations with huge potential in the fields of healthcare and medicine. There are several promising AI interventions that can improve prehospital emergency care, particularly for out-of-hospital cardiac arrest and triage prioritization scenarios. Implications for EMS Practice: Integrating AI methods into prehospital care can optimize the use of available resources, as well as triage and dispatch efficiency. LLMs may have the potential to improve understanding and assist in decision-making under pressure in emergency situations by combining various forms of recorded data. However, there is a need to emphasize continued research and strong collaboration between AI experts and EMS physicians to ensure the safe, ethical, and effective integration of AI into EMS practice. Full article

Invasive candidiasis (IC) in Latin America is undergoing a significant epidemiological shift, increasingly driven by non-albicans strains such as Candida tropicalis, Candida parapsilosis, and Candidozyma auris. These pathogens often exhibit multidrug resistance, which complicates treatment and increases mortality. Diagnostic limitations, particularly in rural and public hospitals, delay detection and hinder the provision of rapid care. Environmental pressures, such as climate change and the widespread use of azoles in agriculture, appear to favor the selection of resistant and thermotolerant strains. Migratory birds may also play a role in the environmental transmission of pathogenic fungi. These factors are amplified by socioeconomic inequalities that restrict access to diagnostics and first-line antifungals. To help mitigate this emerging challenge, a One Health-oriented framework combining integrated environmental surveillance, robust antifungal-stewardship programmers, broader diagnostic access, and coordinated cross-sector public health actions should be developed. Reinforcing these pillars could lessen the regional burden of IC and slow the advance of antifungal resistance. Full article

Research on commuting patterns has mainly focused on urban and metropolitan areas, and such studies are not typically applied to rural and small-town regions, where workers often face longer commutes due to limited job opportunities and inadequate public transportation. By using the Census Transportation Planning Package (CTPP) data, this research fills that gap by analyzing commuting behavior by ethnic group and industry in south-central Minnesota, which is a predominantly rural area of 13 counties in the United States. The results show that both white and minority groups in District 7 experienced an increase in excess commuting from 2006 to 2016, with the minority group in Nobles County showing a significantly higher rise. Analysis by industry reveals that excess commuting in the leisure and hospitality sector (including arts, entertainment, and food services) in Nobles County increased five-fold during this time, indicating a severe spatial mismatch between jobs and affordable housing. In contrast, manufacturing experienced a decline of 50%, possibly indicating better commuting efficiency or a loss of manufacturing jobs. These findings can help city and transportation planners conduct an in-depth analysis of rural-to-urban commuting patterns and develop potential solutions to improve rural transportation infrastructure and accessibility, such as promoting telecommuting and hybrid work options, expanding shuttle routes, and adding more on-demand transit services in rural areas. Full article