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This article investigates the covariation of belief and science credibility in Kazakhstan in the context of COVID-19 and vaccination. The research methodology is based on a multi-country analysis of COVID-19 indicators from a global database of COVID-19 vaccinations, and the covariance of belief and science credibility was estimated in the case of Kazakhstan. According to the survey, 33.5% of respondents changed their opinions in favor of vaccination and 29.6% of those surveyed affirmed their commitment to vaccination. Furthermore, 58.8% of respondents believe that this is the only and an effective way to protect themselves from COVID-19. Some of the main reasons for refusing to get a vaccine include contraindications (14.1%), fear of possible severe consequences (4.5%), and lack of confidence in vaccines and medicine in general (4.5%). Less than 1% of all respondents cited religious beliefs as the main reason for unwillingness to get vaccinated. [ABSTRACT FROM AUTHOR]

The issue of access to the American health care system seems destined to reappear in the 2024 presidential election. The political and economic debates regarding single-payer systems providing (near) universal health care are well documented. Supporters of the status quo, knowingly or unknowingly, rest their argument on the basic assumptions of utilitarianism. In response patrons investigating inequalities in access to the American health care system can turn to biblical, philosophical, and theological reflections on justice. [ABSTRACT FROM AUTHOR]

Introduction: Lip and oral cavity cancer is the second most frequent cancer in India, accounting for more than 10% of the total cancer incidence in the country. Oral malignancies are frequently found and diagnosed at advanced stages, resulting in dismal survival rates. The influence of healthcare-related factors in the diagnostic interval of oral cancer remains poorly understood. Methods and material: This study followed the principles of the Aarhus statement for early cancer diagnosis research. Researchers non-selectively recruited 261 patients with histopathologically proven Squamous Cell Carcinoma of the oral cavity at the comprehensive Cancer Care Centre in Northern Kerala, India. They acquired information in direct patient interviews using validated instruments. They triangulated self-reported data with case notes, referral letters and biopsy results. Results: The median (Interquartile range) diagnostic interval reported by the study participants (n = 261) was 36.00 (14.00-76.50) days. The proportion of participants having diagnostic intervals of more than 30 days was 57.9% (n = 151). The predictors of diagnostic interval include 'Type of advice provided by the health care provider', Number of healthcare providers consulted in the diagnostic journey, 'Age of the participant', 'Monthly income' and 'Caste'. Conclusion: Nearly three-fifths of the study participants had diagnostic intervals that exceeded the acceptable limit, highlighting the need to streamline the facilities and processes required for early diagnosis of oral cancer. Strengthening the health system at the primary level by incorporating referral guidelines and in-service training of primary care practitioners will reduce diagnostic intervals for oral cancer. [ABSTRACT FROM AUTHOR]

Abstract This study determined the prevalence and the associated factors with meeting the recommended amount of physical activity among type 2 diabetes mellitus (T2DM) patients receiving care in resource-limited settings of the West Bank of Palestine. Physical activity was assessed using the World Health Organization’s Global Physical Activity Questionnaire. Associations were examined using multivariate logistic regression. Of the 302 patients included, 117 (38.7%) met the recommended amount of physical activity. Being younger than 58 years [aOR = 2.1 (95% CI 1.0–4.3], were employed [aOR = 2.3 (95% CI 1.1–4.9)], had high income [aOR = 3.9 (95% CI 1.3–11.9)], had thought that physical activity was crucial for T2DM patients [aOR = 32.7 (95% CI 3.9–275.5)], did not have comorbidities [aOR = 2.2 (95% CI 1.1–4.4)], had normal weight [aOR = 2.8 (95% CI 1.3–6.0)], and those who were overweight [aOR = 2.6 (95% CI 1.1–6.0)] were more likely to meet the recommended amount of physical activity compared to the patients who were 58 years or older, had low income, did not think that physical activity was crucial for T2DM patients, had comorbidities, and were obese, respectively. There is a need to increase physical activity among T2DM patients in resource limited settings.

Background The ongoing conflict in Syria has significantly affected the health care system, particularly in the realm of rheumatology. The purpose of this study is to assess the current state of rheumatic diseases in the northwestern region of Syria, where the health care infrastructure has been severely impacted.

The object of this study is a new design of an overhead microstrip antenna, including Epsilon Negative (ENG) metamaterials and L-shaped parasitic overlays aimed at achieving dual-band operation and improving the performance of modern wireless communication systems. The research is aimed at solving the problem of limited bandwidth and dual-band functionality in conventional antenna designs. This study solves the problem of limited bandwidth and dual-band functionality in conventional microstrip patch antenna designs, which are crucial for modern wireless communication systems. The inclusion of L-shaped parasitic overlays effectively expands the bandwidth in each frequency range. The results indicate significant improvements: at the upper resonant frequency, a 10 dB return loss bandwidth of 27.84 % (2.88–3.81 GHz) and a 3 dB axial ratio bandwidth of 5.05 % (2.90–3.05 GHz) are achieved, while at the lower resonant frequency, a return loss bandwidth is 10 dB, which is 6.11 % (2.22–2.36 GHz). These improvements indicate a significant increase in antenna performance compared to conventional designs, which is confirmed by comparing the simulation results with the measurement results. Distinctive features contributing to these results include the use of ENG metamaterials, which improve electromagnetic properties and signal propagation; vertical transitions, which provide efficient dual-band operation; and L-shaped parasitic overlays, which significantly expand bandwidth. These characteristics combine to eliminate the limitations of traditional designs, which makes the proposed antenna suitable for use in a wide frequency range in modern wireless communication systems. [ABSTRACT FROM AUTHOR]

Understanding physicians' labour supply changes during the COVID-19 pandemic informs health workforce planning. Using representative Canadian data, we observed a reduction in work hours during the first wave. However, hours did not differ from pre-pandemic norms throughout subsequent phases. Reductions were concentrated among community-based family practitioners and specialists, whereas hospital-based physicians, on average, maintained their pre-pandemic hours. Notably, men and women exhibited statistically indistinguishable declines, with a slightly larger reduction observed among men. Except for single parents with children, whose hours did not decline, observed reductions were very similar across marital status and for women and men with and without children, even young children. There were no differences in hour declines by immigration status. Physicians aged older than 60 years experienced larger reductions in hours than younger ones. With some variations, similar trends were observed for absences. No evidence supported the notion that physicians were more likely to exit practice during the pandemic. [ABSTRACT FROM AUTHOR]

This study determined the prevalence and the associated factors with meeting the recommended amount of physical activity among type 2 diabetes mellitus (T2DM) patients receiving care in resource-limited settings of the West Bank of Palestine. Physical activity was assessed using the World Health Organization's Global Physical Activity Questionnaire. Associations were examined using multivariate logistic regression. Of the 302 patients included, 117 (38.7%) met the recommended amount of physical activity. Being younger than 58 years [aOR = 2.1 (95% CI 1.0–4.3], were employed [aOR = 2.3 (95% CI 1.1–4.9)], had high income [aOR = 3.9 (95% CI 1.3–11.9)], had thought that physical activity was crucial for T2DM patients [aOR = 32.7 (95% CI 3.9–275.5)], did not have comorbidities [aOR = 2.2 (95% CI 1.1–4.4)], had normal weight [aOR = 2.8 (95% CI 1.3–6.0)], and those who were overweight [aOR = 2.6 (95% CI 1.1–6.0)] were more likely to meet the recommended amount of physical activity compared to the patients who were 58 years or older, had low income, did not think that physical activity was crucial for T2DM patients, had comorbidities, and were obese, respectively. There is a need to increase physical activity among T2DM patients in resource limited settings. [ABSTRACT FROM AUTHOR]

The term "systemwell-being" canmove forward a new vision, meaning the result coming from the addition of the well-being of persons belonging to different institutions and organizations, which are all parts of the "health care system." Beginning with this "new definition," with the aim of analyzing the multifaceted issues related to nurses' well-being, we could use the "classical nursing metaparadigm" composed of 4 concepts: "health,""nursing," "environment," and "person."We briefly describe this conceptualmap and provide some focused suggestions for further reflection on topics such as physical and psychological well-being, economic gain and career opportunities, work climate, burnout, low job satisfaction, moral distress, compassion fatigue, and a joyful work environment. This view may help organizations to focus on interventions to prevent or eliminate stress, whichmay be more proactive and effective than interventions to manage stress. Moreover, it offers a multidimensional map to analyze the different aspects influencing the well-being issue, keeping in mind that a concrete solution can be obtained only if all the components of health care systems and society do their part. Some solutions proposed by authors and organizations to increase nurses' well-being are mindfulness based, such asmeditation, yoga, acupuncture, gratitude, journaling, choirs, coaching, workload reduction, job crafting, and peer networks. Other reflections on work organization, expected professional behaviors, nurses' retention, and education should be added to the discussion on this multidimensional issue. [ABSTRACT FROM AUTHOR]

Background: There is an increasing demand for comprehensive geriatric care. Nurse practitioners (NPs), who undergo specialized training, are situated to provide such care. In Israel, the role of a geriatric nurse practitioner was introduced in the health care system 10 years ago. However, little is known about the rate of professional satisfaction and realization of full potential among these nurses. Purpose: The aims of this study are (1) to describe the geriatric NP workforce in Israel, (2) to measure the current geriatric scope of practice, and (3) to measure the geriatric NP satisfaction from their working environment. Methodology: For this cross-sectional study, a survey, comprising three sections relating to demographics, professional qualifications and scope of practice, and career satisfaction, was sent to 53 geriatric nurse practitioners in Israel who currently work as geriatric nurse practitioners. Results: Forty-seven nurses participated in the survey. Almost 64% reported that they are satisfied with their position, and 72% reported that they are able to fulfill their full scope of practice. The mean score for scope of practice was 68.31 out of a possible score of 100. Conclusions: A number of qualifications were correlated with satisfaction at work, indicating that nurses tend to be more satisfied at work when they are able to fulfill their potential. Implications: Ensuring nurse practitioners' ability to realize their full potential should be a goal of the health care system. Interventions should be in place to encourage nurses to perform tasks related to their work, for which they are trained. [ABSTRACT FROM AUTHOR]

The purpose of the article is to study the state and results of state management of financial support in the field of health care in Ukraine. The methodological basis of the article is dialectical methods of scientific knowledge: analysis and synthesis, critical analysis, logical abstraction, comparison, abstract-logical and statistical analysis. It pointed out the need to expand the state management of the financial support industry beyond the function of allocation of budgetary resources. It noted that the insufficiency of the budget requires the consolidation of available resources and opportunities for the proper provision of the medical industry, unification efforts of subjects of all forms of ownership, and all sources of funding. It indicated that the problems of health care budgeting in Ukraine lead to an increase in the risks of deterioration of the population's health and give grounds to predict an increase in the share of own funds in the volume of financing of the industry, which will lead to an increase in the volume of illegal payments for medical services and a deterioration in the solvency of the population. This will form the preconditions for the growth of social tension. Directions for improving the efficiency of state management of financial support are proposed. The low level of salary incentives for medical workers, in particular doctors, creates the problem of providing quality medical services. It is proposed to introduce regional structures, which should become a mechanism for regional diversification of budget funds aimed at health care, coordination of financial resources of communities and private funds, etc. The expansion of public-private partnerships is proposed, in particular, the use of comprehensive state management measures to stimulate the development of private medical institutions as a reserve for the provision of medical services in crisis conditions. Specific measures to improve the efficiency of state financial support to the industry are proposed. [ABSTRACT FROM AUTHOR]

In the current academic literature, the right to health is considered in the context of a wide range of disciplines, including medical law, international law and social sciences. An important step in the formation of the legal framework for the right to health was the adoption of the WHO Constitution in 1946, which proclaimed that «the enjoyment of the highest attainable standard of health is a fundamental right of every human being». This declaration became the basis for the further development of international health standards, including the 1966 International Covenant on Economic, Social and Cultural Rights, which in Article 12 recognises the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Research and scholarship on the right to health covers various aspects of this issue, including analyses of national health systems, examination of international standards and their impact on national legislation, and development of recommendations to ensure equal access to health services. Despite the significant achievements in the development of international norms and standards, there are challenges related to their implementation at the national level, including the need to adapt national legislative and institutional frameworks to international obligations. Ukraine, like many other countries, is striving to meet international standards in the field of the right to health, while facing a number of challenges that require a comprehensive approach to reforming the national healthcare system. Scientific research plays an important role in this process, helping to identify gaps in legislation and practice, as well as to develop sound recommendations for their elimination. Given these aspects, this article aims not only to analyse the theoretical foundations of the right to healthcare, but also to highlight the practical steps and challenges that Ukraine faces on the way to its full implementation. [ABSTRACT FROM AUTHOR]

Osteoporosis is a widespread disease and affects over 500,000 people in Austria. Fragility fractures are associated with it and represent not only an individual problem for the patients, but also an enormous burden for the healthcare system. While trauma surgery care is well provided in Vienna, there is an enormous treatment gap in secondary prevention after osteoporotic fracture. Systematic approaches such as the Fracture Liaison Service (FLS) aim to identify patients with osteoporosis after fracture, to clarify diagnostically, to initiate specific therapy, and to check therapy adherence. The aim of this article is to describe the practical implementation and operational flow of an already established FLS in Vienna. This includes the identification of potential FLS inpatients, the diagnostic workup, and recommendations for an IT solution for baseline assessment and follow-up of FLS patients. We summarize the concept, benefits, and limitations of FLS and provide prospective as well as clinical and economic considerations for a city-wide FLS, managed from a central location. Future concepts of FLS should include artificial intelligence for vertebral fracture detection and simple IT tools for the implementation of FLS in the outpatient sector. [ABSTRACT FROM AUTHOR]

Systems thinking has a lot to offer to the field of strategizing. Calls for a greater use of the Systems Approaches to management are increasingly being advanced in the world of organizations, public and private. Yet, practical implementation of such postulates is lagging. This article aims to demonstrate the potential of systems thinking in shaping strategy in management and organization. It builds on a framework known as Integrative Systems Methodology, a circular set of established components of strategic processes: all elements of the methodology are covered, from finding purpose and goals, modeling, and diagnosing to the design of strategies and change. Along this path, complementary methodologies are combined to cope with high environmental complexity. In the present case, these are the systems methodologies of Organizational Cybernetics (namely Viable System Model) and System Dynamics. The layout of the treatise is conceptual in nature. Nevertheless, long-term empirical evidence from a set of real-world organizations-one center and several peripheral healthcare entities-is presented to make the methodology tangible: theoretically grounded and experientially corroborated. The case study we are introducing is from health care, concretely: an oncological care system. Structural patterns are elicited, which are isomorphic, applicable to any health care system. From a conceptual-theoretical stance, crucial factors conducive to continuous organizational learning are elaborated. Professionals can benefit from acquiring new ways of coping with the ever-increasing complexity. [ABSTRACT FROM AUTHOR]

In the last few years, following the relative stability of the political, economic, and security environments, Iraq has embarked on a transformation towards an ambitious program of automation across various sectors. However, this automation program faces numerous challenges, including significant investments in technology and training, addressing social impacts, and combating widespread illiteracy

Abstract Background The possibility of adverse effects of medical treatment (AEMT) is increasing worldwide, but little is known about AEMT in China. This study analyzed the health burden of AEMT in China in recent years through the Global Burden of Disease Study (GBD) 2019 and compared it with the worldwide average level and those in different sociodemographic index (SDI) regions. Methods We calculated the age-standardized rate (ASR) of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), incidence and prevalence attributed to AEMT in China, worldwide and countries with different sociodemographic indices during 1990–2019 using the latest data and methods from the GBD 2019. Results From 1990 to 2019, the global age-standardized death rate (ASDR), DALYs, and YLLs for AEMT showed a significant downward trend and were negatively associated with the SDI. By 2040, the ASDR is expected to reach approximately 1.58 (95% UI: 1.33–1.80). From 1990 to 2019, there was no significant change in the global incidence of AEMT. The occurrence of AEMT was related to sex, and the incidence of AEMT was greater among females. In addition, the incidence of AEMT-related injuries and burdens, such as ASR of DALYs, ASR of YLLs and ASR of YLDs, was greater among women than among men. Very old and very young people were more likely to be exposed to AEMT. Conclusions From 1990 to 2019, progress was made worldwide in reducing the harm caused by AEMT. However, the incidence and prevalence of AEMT did not change significantly overall during this period. Therefore, the health sector should pay more attention to AEMT and take effective measures to reduce AEMT.

Abstract Background In the summer of 2021, heavy precipitation led to extreme flooding across Western Europe. In Germany, North Rhine-Westphalia and Rhineland-Palatinate were particularly affected. More than 180 people lost their lives, and over 700 were left injured and traumatized. In the North Rhine district alone, more than 120 practices were only able to operate to a limited extent or had to close their practices completely. The aim of this study was to assess the impact of the 2021 flood on the outpatient care in the North Rhine region. Methods The cross-sectional study was conducted in January 2022 in practices affected by the flood in the North Rhine region. For this purpose, 210 affected practices were identified using a list of the Association of Statutory Health Insurance Physicians for North Rhine (KVNO) and via telephone and/or e-mail. These practices were forwarded a questionnaire that addressed, among other things, the local accessibility of the practices before and after the flood, possibilities of patient care in different premises and received support. Results A total of 103 practices (49.1%) returned the completed questionnaire, of which 1/4 were general practitioners. 97% of the practices reported power failure, more than 50% water supply damage and nearly 40% the loss of patient records. 76% of the participating practices stated that they needed to close their practice at least temporarily. 30 doctors took up patient care in alternative premises. The average number of patients seen by doctors per week before the flood was 206.5. In the first week working in alternative premises, doctors saw an average of 66.2 patients (-50.3%). Especially elderly/geriatric patients and patients with disabilities were identified as particularly vulnerable in terms of access to health care after the flood. Conclusions The flood had a significant negative impact on outpatient care. We determined not only a high number of closed practices and a large decrease in patient numbers but also differences in patient care assessment depending on the type of alternative premises. To address outpatient care disruptions after extreme weather events more effectively, appropriate measures should be implemented pre-emptively.

This study explored the subjective well-being of hospital volunteers during the COVID-19 pandemic from a mental health perspective using a health care system sustainability perspective, and adopted the purposive sampling method to conduct a questionnaire survey. A total of 520 questionnaires were distributed, and 500 questionnaires were recovered, with a recovery rate of 96.1%. Of the recovered questionnaires, 43 invalid questionnaires were eliminated, and 457 valid questionnaires were collected, for a valid recovery rate of 91.4%. The data analysis method explored the variable path analysis through descriptive analysis and structural equation modeling. In addition, new data analysis methods have been added to explore the variable path analysis, such as descriptive analysis, discriminant validity, mediation effects, and structural equation modeling. The results show that: (1) the work resources of the hospital volunteers exerted a significant impact on their subjective well-being; (2) the work resources of the hospital volunteers exerted no significant impact on their flow experience; (3) the work resources of the hospital volunteers exerted a significant impact on their leisure involvement; (4) the leisure involvement of the hospital volunteers exerted no significant impact on their subjective well-being; (5) the leisure involvement of the hospital volunteers exerted a significant impact on their flow experience; (6) the flow experience of the hospital volunteers exerted no significant impact on their subjective well-being; and (7) the leisure involvement of the hospital volunteers exerted a mediating effect between work resources and flow experience. [ABSTRACT FROM AUTHOR]

The relevance of this article is due to the fact that international standards in the field of health care and medical services are central to the field of world principles of functioning and development of medical law. The aim of the article is to conduct research on the peculiarities of international standards in the field of health care and medical services, as well as to study the prospects of their implementation in Ukraine. Leading research methods are general and special research methods, including methods of logic, analysis, comparison. The results of this study are to outline recommendations for the use of international standards in the field of health care and medical services in Ukraine and to summarize the legal framework on this issue. The significance of the results is reflected in the fact that this study can serve as a basis for outlining future changes in current legislation of Ukraine on the functioning of the health care system and implementation of world practices in health care. Within the framework of this study, systematized the main international and European documents that reflect the main international standards in the field of health care and medical services and ratified in Ukraine and have a direct impact on the legal framework for this area. [ABSTRACT FROM AUTHOR]

The article examines the essence of administrative and legal regulation in the field of health care through the prism of the systematization of administrative legislation in the specified field. The legal regulation of public administration is defined as a purposeful activity of state authorities regulated by laws and other normative acts, which is aimed at consolidating, organizing and protecting social relations in the specified sphere, which is carried out with the aim of preserving and strengthening health, protecting the rights of patients and medical employees. Attention is focused on determining the role and importance of such types of systematization as incorporation, consolidation, codification, adaptation and their application in the field of health care It was determined that the codification of administrative legislation in the field of health care is the most advanced form of systematization, which is directly related to the change in the form and content of the current legislation by its revision, elimination of conflicts, gaps, obsolescence and multiplicity of legal norms. Special attention is paid to adaptation, as a fundamental component of the European integration course of Ukraine, which consists in the phased adoption and implementation of laws and subordinate normative legal acts of Ukraine, developed considering the European Union legislation, as well as in making appropriate changes to the current legal acts of Ukraine. Analysis was conducted and the reasons that complicate the classification of legislation in the field of health care were determined, with the complexity of legal regulation being the main one. The classification of health care legislation according to the principle of hierarchy, subject and scope of legal regulation, as well as by the number of persons is proposed. The necessity of supplementing the current Code of Administrative Offences with the section “Offences in the Sphere of Health Care” is substantiated, which will establish responsibility for administrative offences in the sphere of health care, as well as strengthen administrative responsibility for their commission. The specified changes will ensure regulation of relations in the field of medical services, protection of the rights of doctors and patients, and as a result will improve the quality of medical assistance to the population. [ABSTRACT FROM AUTHOR]

Study Design. This was a retrospective study. Objective. To assess the impact of surgical costs on patient-reported outcomes in adult spinal deformity (ASD). Summary of Background Data. With increased focus on delivering cost-effective health care, interventions with highresource utilization, such as ASD surgery, have received greater scrutiny. Materials and Methods. ASD patients aged 18 years and older with BL and 2-year data were included. Surgical costs were calculated using the 2021 average Medicare reimbursement by Current Procedural Terminology code. Costs of complications and reoperations were intentionally excluded. Patients were ranked into tertiles by surgical cost: highest surgical costs (HC) and lowest surgical costs (LC). They were propensity score matched to account for differences in baseline age and deformity. Bivariate logistic regressions assessed odds of achieving outcomes. Results. Four hundred twenty-one patients met inclusion (60.7 yr, 81.8% female, Charlson Comorbidity Index: 1.6, 27.1 kg/m²), 139 LC and 127 HC patients. After propensity score matching, 102 patients remained in each cost group with an average reimbursement of LC: $12,494 versus HC: $29,248. Matched cohorts had similar demographics and baseline health-related quality of life. Matched groups had similar baseline sagittal vertical axis (HC: 59.0 vs. LC: 56.7 mm), pelvic incidence and lumbar lordosis (HC: 13.1 vs. LC: 13.4°), and pelvic tilt (HC: 25.3 vs. LC: 22.4°). Rates of complications were not significantly different between the cost groups. Compared with the LC group, by 2 years, HC patients had higher odds of reaching substantial clinical benefit in Oswestry Disability Index [odds ratio (OR): 2.356 (1.220, 4.551), P= 0.011], in Scoliosis Research Society-Total [OR: 2.988 (1.515, 5.895), P=0.002], and in Numerical Rating Scale Back [OR: 2.739 (1.105, 6.788), P=0.030]. Similar findings were appreciated for HC patients in the setting of Schwab deformity outcome criteria. Conclusions. Although added cost did not guarantee an ideal outcome, HC patients experienced superior patient-reported outcomes compared with LC patients. Although cost efficiency remains an important priority for health policy, isolating cost reduction may compromise outcomes and add to future costs of reintervention, particularly with more severe baseline deformity. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the dementia care system in a local area and aimed to include all specialised services designed to provide health and social services to people with dementia or age-related cognitive impairment, as well as general services with a high or very high proportion of clients with dementia. Methods: The study used an internationally standardised service classification instrument called Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) to identify and describe all services providing care to people with dementia in the Australian Capital Territory (ACT). Results: A total of 47 service providers were eligible for inclusion. Basic information about the services was collected from their websites, and further information was obtained through interviews with the service providers. Of the 107 services offered by the 47 eligible providers, 27% (n = 29) were specialised services and 73% (n = 78) were general services. Most of the services were residential or outpatient, with a target population mostly of people aged 65 or older, and 50 years or older in the case of Aboriginal and Torres Strait Islander Australians. There were government supports available for most types of care through various programmes. Conclusions: Dementia care in the ACT relies heavily on general services. More widespread use of standardised methods of service classification in dementia will facilitate comparison with other local areas, allow for monitoring of changes over time, permit comparison with services provided for other health conditions and support evidence-informed local planning. [ABSTRACT FROM AUTHOR]

Korean Americans in the United States are more likely than other Asian ethnic groups to lack health insurance despite their high education and economic prosperity. According to the model of health service selection, immigrants' perceptions of the health care system and health care behaviors in their host country are affected by sociocultural referents including premigration health care experience in the country of origin. This study explored Korean immigrants' perceptions of health insurance and their intentions to purchase and maintain health insurance in the United States. We conducted in-depth interviews with 24 self-employed Korean immigrants who migrated from South Korea and were living in the Greater Los Angeles area in 2015. Participants generally had negative perceptions of U.S. health insurance in terms of cost, benefits, simplicity, and accessibility. Coupled with their positive experiences with the single-payer, universal health insurance in South Korea, respondents evaluated U.S. health insurance as not worth purchasing, and indicated they would not maintain health insurance once the individual mandate of the Affordable Care Act was abolished. On the contrary, respondents who immigrated prior to the establishment of the Korean universal health insurance in South Korea were relatively satisfied with U.S. health insurance and had maintained health insurance for substantial periods of time. Korean immigrants' premigration health care experiences appeared to influence their decisions to purchase health insurance in the United States and their intention to maintain health insurance. The study findings highlight the necessity of tailored health education that takes into account sociocultural determinants of health coverage among immigrants. [ABSTRACT FROM AUTHOR]

Background: The possibility of adverse effects of medical treatment (AEMT) is increasing worldwide, but little is known about AEMT in China. This study analyzed the health burden of AEMT in China in recent years through the Global Burden of Disease Study (GBD) 2019 and compared it with the worldwide average level and those in different sociodemographic index (SDI) regions. Methods: We calculated the age-standardized rate (ASR) of deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), incidence and prevalence attributed to AEMT in China, worldwide and countries with different sociodemographic indices during 1990–2019 using the latest data and methods from the GBD 2019. Results: From 1990 to 2019, the global age-standardized death rate (ASDR), DALYs, and YLLs for AEMT showed a significant downward trend and were negatively associated with the SDI. By 2040, the ASDR is expected to reach approximately 1.58 (95% UI: 1.33–1.80). From 1990 to 2019, there was no significant change in the global incidence of AEMT. The occurrence of AEMT was related to sex, and the incidence of AEMT was greater among females. In addition, the incidence of AEMT-related injuries and burdens, such as ASR of DALYs, ASR of YLLs and ASR of YLDs, was greater among women than among men. Very old and very young people were more likely to be exposed to AEMT. Conclusions: From 1990 to 2019, progress was made worldwide in reducing the harm caused by AEMT. However, the incidence and prevalence of AEMT did not change significantly overall during this period. Therefore, the health sector should pay more attention to AEMT and take effective measures to reduce AEMT. [ABSTRACT FROM AUTHOR]

Background: In the summer of 2021, heavy precipitation led to extreme flooding across Western Europe. In Germany, North Rhine-Westphalia and Rhineland-Palatinate were particularly affected. More than 180 people lost their lives, and over 700 were left injured and traumatized. In the North Rhine district alone, more than 120 practices were only able to operate to a limited extent or had to close their practices completely. The aim of this study was to assess the impact of the 2021 flood on the outpatient care in the North Rhine region. Methods: The cross-sectional study was conducted in January 2022 in practices affected by the flood in the North Rhine region. For this purpose, 210 affected practices were identified using a list of the Association of Statutory Health Insurance Physicians for North Rhine (KVNO) and via telephone and/or e-mail. These practices were forwarded a questionnaire that addressed, among other things, the local accessibility of the practices before and after the flood, possibilities of patient care in different premises and received support. Results: A total of 103 practices (49.1%) returned the completed questionnaire, of which 1/4 were general practitioners. 97% of the practices reported power failure, more than 50% water supply damage and nearly 40% the loss of patient records. 76% of the participating practices stated that they needed to close their practice at least temporarily. 30 doctors took up patient care in alternative premises. The average number of patients seen by doctors per week before the flood was 206.5. In the first week working in alternative premises, doctors saw an average of 66.2 patients (-50.3%). Especially elderly/geriatric patients and patients with disabilities were identified as particularly vulnerable in terms of access to health care after the flood. Conclusions: The flood had a significant negative impact on outpatient care. We determined not only a high number of closed practices and a large decrease in patient numbers but also differences in patient care assessment depending on the type of alternative premises. To address outpatient care disruptions after extreme weather events more effectively, appropriate measures should be implemented pre-emptively. [ABSTRACT FROM AUTHOR]

One crucial step to improving maternal health outcomes in any region is understanding the social determinants of maternal health, which vary significantly across the world's geographical areas and within individual countries. The variability in these determinants is manifested in the Middle East and North Africa (MENA) region. Using a scoping review process, we identified articles analyzing social factors influencing maternal health outcomes in the MENA region. A total of 50 articles were included in this review. Several social factors impact independently or in association with maternal health outcomes or utilization of maternal health in the MENA region. These factors include: residing in an area of conflict, residing in a rural region, low accessibility and quality of health care, low level of education, antagonistic relationship with spouse and family-in-law, cultural practices such as female genital mutilation and early marriage, traditional practices, and beliefs, low household wealth, women's financial security, women's bad childbirth history, and interpersonal violence. Multi-sector collaboration across governmental ministries, nongovernmental organizations, local authorities, healthcare delivery programs, and community members is critical to creating long-term solutions in maternal health for MENA nations. Together they must address traditional practices harmful to women, poor accessibility, availability, and affordability of health services. To benefit women, a long-term commitment of organizations at local, national, and international levels to social investments in women's education, financial status, and cultural norms is recommended for MENA nations. [ABSTRACT FROM AUTHOR]

In today's conditions, the implementation of telemedicine is a key direction of the health care system of the world. After all, modern telemedicine solutions make it possible to provide a full range of medical services at a distance, namely consultations, diagnostics and treatment with further monitoring of dynamics, reducing time consumption and increasing work efficiency. That is why the use of telemedicine technologies plays an important role and improves the quality of receiving qualified medical care, especially in cases of diagnosing wounds, injuries and illnesses of military personnel. [ABSTRACT FROM AUTHOR]

The purpose of the article is to study the state and results of state management of financial support in the field of health care in Ukraine. The methodological basis of the article is dialectical methods of scientific knowledge: analysis and synthesis, critical analysis, logical abstraction, comparison, abstract-logical and statistical analysis. It pointed out the need to expand the state management of the financial support industry beyond the function of allocation of budgetary resources. It noted that the insufficiency of the budget requires the consolidation of available resources and opportunities for the proper provision of the medical industry, unification efforts of subjects of all forms of ownership, and all sources of funding. It indicated that the problems of health care budgeting in Ukraine lead to an increase in the risks of deterioration of the population's health and give grounds to predict an increase in the share of own funds in the volume of financing of the industry, which will lead to an increase in the volume of illegal payments for medical services and a deterioration in the solvency of the population. This will form the preconditions for the growth of social tension. Directions for improving the efficiency of state management of financial support are proposed. The low level of salary incentives for medical workers, in particular doctors, creates the problem of providing quality medical services. It is proposed to introduce regional structures, which should become a mechanism for regional diversification of budget funds aimed at health care, coordination of financial resources of communities and private funds, etc. The expansion of public-private partnerships is proposed, in particular, the use of comprehensive state management measures to stimulate the development of private medical institutions as a reserve for the provision of medical services in crisis conditions. Specific measures to improve the efficiency of state financial support to the industry are proposed.

Background: To evaluate the decision-making proficiency among medical residents at Tehran University of Medical Sciences in the year 2022-2023. Methods: A structured online web-survey via national approved services Author’s designed questionnaire was used to collect the relative data based on variables of the study and was developed by the authors of the study by reviewing the previously conducted studies. The forms were sent to the medical residents at Tehran University of Medical Sciences as a link via electronic mail and social media; assistance was offered via direct or indirect contact upon request. Results: In this study, 88 medical residents of Tehran University of Medical Sciences were evaluated. Out of 88 participants, the frequency of females was 52(59.09%) and frequency of males was found out to be 36(40.91%). The frequency of the first- year residents was 28(37.50), second year residents was 33(21.59), third year residents was 19(9.09) and the fourth- year residents was found out to be 8(31.82). The frequency of different specialties were: Pathology 1(1.14%), Infectious diseases 1(1.14%), Cardio vascular diseases 1(1.14%), Emergency medicine 1(1.14%), Orthopedics2(2.27%), Psychiatry 3(3.41%), ENT 12(13.64%), Internal Medicine 13(14.77%), Pediatrics13(14.77%), OB&GYN 19(21.59%), Anesthesiology19(21.59%), Dermatology 2(2.27%), General Surgery 1(1.14%). Conclusion: There is a significant relationship based on linear regression between not having self - reported availability bias and surgical residency specialties. The surgical specialty is less prone to the availability bias. A difference of communication exists between the surgical and nonsurgical speciality and the nonsurgical specialties need to confirm their decision using other methods to prevent the patient harm.

Osteoporosis is a widespread disease and affects over 500,000 people in Austria. Fragility fractures are associated with it and represent not only an individual problem for the patients, but also an enormous burden for the healthcare system. While trauma surgery care is well provided in Vienna, there is an enormous treatment gap in secondary prevention after osteoporotic fracture. Systematic approaches such as the Fracture Liaison Service (FLS) aim to identify patients with osteoporosis after fracture, to clarify diagnostically, to initiate specific therapy, and to check therapy adherence. The aim of this article is to describe the practical implementation and operational flow of an already established FLS in Vienna. This includes the identification of potential FLS inpatients, the diagnostic workup, and recommendations for an IT solution for baseline assessment and follow-up of FLS patients. We summarize the concept, benefits, and limitations of FLS and provide prospective as well as clinical and economic considerations for a city-wide FLS, managed from a central location. Future concepts of FLS should include artificial intelligence for vertebral fracture detection and simple IT tools for the implementation of FLS in the outpatient sector.

Background: Primary healthcare is a cornerstone of the healthcare system, playing a vital role in addressing individual healthcare needs, and organizing and strengthening the national healthcare system. Owing to the rapid growth in healthcare demand and the treatment-focused approach, primary healthcare may face challenges in providing preventive healthcare. Current Concepts: Disease prevention measures in primary healthcare including health education, nutrition counseling, and immunization have demonstrated clinical benefits such as increased life expectancy. Therefore, it is imperative to revise the insurance system and educate individuals on disease prevention practices to reduce disease incidence and control soaring medical expenses. Furthermore, it has been observed that underestimated fees for medical consultation and the absence of compensation for disease prevention measures in primary healthcare may have inadvertently led to excessive prescriptions, while counseling and education are insufficient. Unlike the fee-for-service system in South Korea, the United States has implemented the Affordable Care Act, which offers reimbursement for evidence-based preventive care activities, thus encouraging disease prevention measures. Discussion and Conclusion: South Korea's healthcare system has undergone a shift towards treatment-focused care due to a rapid increase in medical demand. However, it may be necessary to revise the insurance system and educate individuals on disease prevention practices to reduce disease incidence and medical expenses. [ABSTRACT FROM AUTHOR]

Abstract Background Firearm injury is a significant public health concern in the United States. Methods Data on fatal and nonfatal firearm injuries were obtained from a cohort of N = 7,473,650 members of Kaiser Permanente Southern California, a large integrated healthcare system between 2010 and 2020. Age-adjusted rates of combined fatal and nonfatal firearm injury per 100,000 members were calculated by year, with the 2010 US census as the reference population. Trends were evaluated using Poisson or negative binomial regression. Results There was an increasing trend in overall firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system (p

Abstract Background Health care systems in low and middle-income countries are decentralizing and devolving power to the periphery. Transferring power without systematic processes to develop and nurture leaders at the district compromises the effectiveness and sustainability of the decentralized health system. To address this problem, we developed an approach to leadership learning by observation and experience that improved the organization and performance of the health care system in a district in Ghana. Methodology Using two rounds of a longitudinal qualitative study, the study explores the determinants of implementing the Community-Based Health Planning and Services (CHPS) initiative in a district in Ghana. Insights were gained concerning the leadership regimes of two leaders who administered health services in a common geographic area at different points in time with remarkably contrasting outcomes. Insights of health workers who participated in both periods were elicited to clarify interview contexts. Ten focus group discussions (FGDs) and five expert interviews were conducted for each round of the study. The study was informed by a systems appraisal approach that utilized a thematic analytical framework. Results Providing district leaders with a practical observational experience had a significant influence on health care delivery in all aspects of health care provision at the district level. Exposing participants to models of best practices facilitated the replication of processes that improved the conduct of service delivery and CHPS implementation. Upon reflection, district leaders attributed performance constraints to their lack of understanding of practical ways of responding to complex district health system development needs. Observation from community members, volunteers, and health workers who witnessed the system development period corroborated narratives that leaders had expressed. Conclusion Effective leadership is optimally developed with participatory learning that provides leaders with direct access to fully functioning systems. Learning by observation can be structured and used to quicken the spread of managerial excellence.

Background Primary health care (PHC) is a fundamental aspect of healthcare systems globally, playing a crucial role in maintaining the health of the population. Despite its importance, there are still gaps in the delivery of PHC services. This study aims to analyze the healthcare system and the existing gaps to develop strategies for improving PHC services. Methods This study is a meta-analysis of the last ten years of written research on PHC services. The data sources include peer-reviewed articles and other relevant literature on PHC services. The study explores PHC services in different countries, assesses existing research, and creates and implements new strategies for improving medical services in practice Studies focused explicitly on primary health care systems, policies, or interventions were included in the study. Eligibiloty criteria included research conducted within the past ten years to present contemporary insights, studies available in peer-reviewed journals and reputable databases and literature examining the influence of PHC on population health outcomes. This meta-analysis incorporates 38 studies within the last decade. Results The study identifies gaps in PHC services, including issues with access to care, affordability, and quality of care. It provides insights into the challenges faced by PHC systems worldwide, highlighting the need for strategies to address these issues. Conclusions The study contributes to a better understanding of the challenges faced by PHC systems worldwide and provides insights for policymakers and healthcare providers to improve healthcare services. The study’s findings underscore the importance of addressing the gaps in PHC services to improve health outcomes and ensure the provision of equitable and accessible healthcare services.

The introduction of digital healthcare platforms has had a positive impact on the accessibility of the healthcare system among the population and increased the efficiency of state control over the healthcare of society. But like any evolution, this digital progress has a number of imperfections. In particular, digital methods for automated monitoring of the achievement of regional healthcare systems target indicators for the purpose of operational supervision and taking timely measures in the public health maintenance of certain territories are practically absent. The aim of the work is to develop a methodological toolkit for automated analysis of the achievement of regional health systems target indicators across state digital platforms. The proposed methodology is based on the author's system of indicators, the automated calculation of which will allow monitoring the effectiveness of health care systems in selected regions in real-time, as well as to take timely measures to maintain and protect public health, to form strategies in the development of regional health care systems. The object of the study is the regional health care system of the Russian Federation. The application of the proposed methodological tools makes it possible to rank the territories by the level of values of complex standardized indicators, taking into account financial conditions, resources, and markers for achieving target indicators. Automated monitoring of these indicators allows us to determine the types of strategies for the development of the healthcare system in selected regions. The proposed approach to monitoring the performance of regional healthcare systems will facilitate the development and enhancement of strategies for their progress, aiming to ensure high standards of quality of life among the population. [ABSTRACT FROM AUTHOR]

The pharmacist prescribing service was legally permitted in 2019 in Switzerland to face challenges in the health system; however, there has been a lack of implementation. The aims of this study were to identify implementation factors and to evaluate pharmacy association interventions that aim to support implementation. A qualitative study with two methods was carried out: (1) twelve semi-structured interviews with community pharmacists were recorded, transcribed, and a thematic analysis was carried out using the Consolidated Framework of Implementation Research (CFIR); (2) questionnaires were submitted to the six pharmacy associations of French-speaking Switzerland. The main barriers found were non-reimbursement by health insurance companies, medications' lack of clinical relevance, a negative perception of GPs, and a lack of time. The main facilitators were the availability of service information, pharmacies belonging to chains/groups, a reduction in the medical consultation burden, and the accessibility of pharmacies. Five associations answered, revealing different initiatives supporting implementation, but none of them had strategies at the political level nor communication strategies aimed at patients or GPs. Based on the CFIR, the most frequent implementation factors were highlighted, and this classification facilitates the transposition of the results to other contexts. The results will allow the development of targeted strategies and add the role of the pharmacy associations, which should be considered in future studies. [ABSTRACT FROM AUTHOR]

We document community responses to the COVID-19 pandemic among Inuit living in the province of Manitoba, Canada. This study was conducted by the Manitoba Inuit Association and a Council of Inuit Elders, in partnership with researchers from the University of Manitoba. We present findings from 12 health services providers and decision-makers, collected in 2021.Although Public Health orders led to the closure of the Manitoba Inuit Association's doors to community events and drop-in activities, it also created opportunities for the creation of programming and events delivered virtually and through outreach. The pandemic exacerbated pre-existing health and social system's shortcomings (limited access to safe housing, food insecurity) and trauma-related tensions within the community. The Manitoba Inuit Association achieved unprecedented visibility with the provincial government, receiving bi-weekly reports of COVID-19 testing, results and vaccination rates for Inuit. We conclude that after over a decade of advocacy received with at best tepid enthusiasm by federal and provincial governments, the Manitoba Inuit Association was able effectively advocate for Inuit-centric programming, and respond to Inuit community's needs, bringing visibility to a community that had until then been largely invisible. Still, many programs have been fueled with COVID-19 funding, raising the issue of sustainability. [ABSTRACT FROM AUTHOR]

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Background: Firearm injury is a significant public health concern in the United States. Methods: Data on fatal and nonfatal firearm injuries were obtained from a cohort of N = 7,473,650 members of Kaiser Permanente Southern California, a large integrated healthcare system between 2010 and 2020. Age-adjusted rates of combined fatal and nonfatal firearm injury per 100,000 members were calculated by year, with the 2010 US census as the reference population. Trends were evaluated using Poisson or negative binomial regression. Results: There was an increasing trend in overall firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system (p <.0001), primarily driven by non-self-inflicted firearm injuries (p <.0001). Self-inflicted injuries decreased during this time (p =.01). Injuries among youth showed no significant change. Conclusion: There was an increasing trend in firearm injuries between 2010 and 2020 among adults in this large integrated healthcare system, primarily driven by non-self-inflicted firearm injuries; however, self-inflicted injuries decreased during this time. Injuries among youth showed no significant change. [ABSTRACT FROM AUTHOR]

Hospitals, as one of most important subsectors in human societies, are responsible for providing safe and effective medical services to clients. But sometimes these hospitals are the source of injury and death in patients by creating medical errors. In this systematic review study, the application of human factor analysis and classification system (HFACS) method in the classification of medical errors was investigated. Major electronic databases including Scopus, Web of Science, and MEDLINE were searched. All studies that investigated the application of HFACS method for coding, causation, and classification of medical errors and adverse events conducted from 2001 until February 2021 were included. A total of 108 articles were found. Due to duplication, 18 studies were removed from the review list. After reading the titles and abstracts, 50 of these publications were excluded because they had objectives different from this review. The remaining 40 publications were retrieved for further assessment. Of these, 28 publications were excluded because it did not meet the inclusion criteria. Finally, 12 articles remained for the final systematic review. We found that in 65% of the selected studies, preconditions for unsafe acts have been the major causal level of medical errors and adverse events. In the majority of the studies, communication and coordination, adverse mental states, physical environment, crew resource management, and technological environment have also been recognized as the most important causal categories in this study. As a result, to prevent medical errors and adverse events, the main focus should be on controlling the preconditions for unsafe acts including personnel factors, operator conditions, and environmental factors. [ABSTRACT FROM AUTHOR]

Background: Health care systems in low and middle-income countries are decentralizing and devolving power to the periphery. Transferring power without systematic processes to develop and nurture leaders at the district compromises the effectiveness and sustainability of the decentralized health system. To address this problem, we developed an approach to leadership learning by observation and experience that improved the organization and performance of the health care system in a district in Ghana. Methodology: Using two rounds of a longitudinal qualitative study, the study explores the determinants of implementing the Community-Based Health Planning and Services (CHPS) initiative in a district in Ghana. Insights were gained concerning the leadership regimes of two leaders who administered health services in a common geographic area at different points in time with remarkably contrasting outcomes. Insights of health workers who participated in both periods were elicited to clarify interview contexts. Ten focus group discussions (FGDs) and five expert interviews were conducted for each round of the study. The study was informed by a systems appraisal approach that utilized a thematic analytical framework. Results: Providing district leaders with a practical observational experience had a significant influence on health care delivery in all aspects of health care provision at the district level. Exposing participants to models of best practices facilitated the replication of processes that improved the conduct of service delivery and CHPS implementation. Upon reflection, district leaders attributed performance constraints to their lack of understanding of practical ways of responding to complex district health system development needs. Observation from community members, volunteers, and health workers who witnessed the system development period corroborated narratives that leaders had expressed. Conclusion: Effective leadership is optimally developed with participatory learning that provides leaders with direct access to fully functioning systems. Learning by observation can be structured and used to quicken the spread of managerial excellence. [ABSTRACT FROM AUTHOR]

Background: Increasing chronic diseases challenges the health systems of low- and middle-income countries, including Cameroon. Type 1 diabetes (T1D), among the most common chronic diseases in children, poses particular care delivery challenges. Aim: We examined social representations of patients’ roles and implementation of T1D care among political decision-makers, healthcare providers and patients within families. Setting: The study was conducted in Yaoundé, Cameroon. Methods: Eighty-two individuals were included in the study. The authors conducted semi-structured interviews with policy makers (n = 5), healthcare professionals (n = 7) and patients ’parents (n = 20). Questionnaires were administered to paediatric patients with T1D (n = 50). The authors also observed care delivery at a referral hospital and at a T1D-focused non-governmental organisation over 15 days. Data were analysed using thematic content analysis and descriptive statistics. Results: Cameroonian health policy portrays patients with T1D as passive recipients of care. While many practitioners recognised the complex social and economic determinants of adherence to T1D care, in practice interactions focused on specific biomedical issues and offered brief guidance. Cultural barriers and policy implementation challenges prevent patients and their families from being fully active participants in care. Parents and children prefer an ongoing relationship with a single clinician and interactions with other patients and families. Conclusion: Patients and families mobilise experience and lay knowledge to complement biomedical knowledge, but top-down policy and clinical practice limit their active engagement in T1D care. Contribution: Children with T1D and their families, policy makers, healthcare professionals, and civil society have new opportunities to contribute to person-centred care, as advocated by the Sustainable Development Goals.