Search Results (1,297)

The proliferation of Edge-AI in personalized healthcare has driven significant demand for energy-efficient Systems-on-Chip (SoCs) capable of executing high-accuracy, real-time disease detection. Conventional accelerator architectures struggle to simultaneously accommodate disparate AI models. Specifically, memory-intensive Convolutional Neural Networks (CNNs) for high-fidelity feature extraction and event-driven Spiking Neural Networks (SNNs) for ultra-low-power, brain-inspired computation. To address this bottleneck, this paper presents a comprehensive survey of Reconfigurable Hybrid Neural Networks (RHNNs), an emerging paradigm that dynamically merges the strengths of CNNs and SNNs to meet the stringent resource constraints of biomedical edge devices. We establish a comprehensive taxonomy of existing RHNN architectures, categorizing them by hardware interconnection topologies, dataflow orchestration strategies, and internal structural adaptation mechanisms. Furthermore, we examine the integration of these hybrid accelerators within the open-source RISC-V processor ecosystem, evaluating how custom instruction set extensions optimize control efficiency and minimize energy overhead. The survey also analyzes commonly used datasets based on three major biomedical signal modalities, including electroencephalography (EEG), electrocardiography (ECG), and electromyography (EMG), in the context of processing systems for hardware accelerators. Finally, we highlight the open research challenges and outline future research directions to guide the development of next-generation biomedical intelligent systems. Full article

Background/Objectives: Cardiac arrest and fluid, electrolyte, and acid–base disorders frequently coexist in critically ill patients and are associated with poor clinical outcomes. However, long-term population-level trends in mortality involving both conditions remain poorly characterized. This study evaluated temporal trends and demographic disparities in mortality involving cardiac arrest and fluid, electrolyte, and acid–base disorders among U.S. adults from 2004 to 2024. Methods: We conducted a retrospective population-based study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death database. Adults aged ≥25 years with cardiac arrest (ICD-10: I46) and fluid, electrolyte, and acid–base disorders (ICD-10: E87) listed anywhere on the same death certificate between 2004 and 2024 were included. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC), with analyses stratified by demographic and geographic characteristics. Results: A total of 152,937 deaths involved both cardiac arrest and fluid, electrolyte, and acid–base disorders during the study period. The AAMR nearly doubled, increasing from 2.06 (95% CI, 2.00–2.13) in 2004 to 4.08 (95% CI, 4.00–4.16) in 2024, corresponding to an overall AAPC of 3.42% (95% CI, 2.58–4.26; p < 0.001). Mortality remained consistently higher among males, adults aged ≥65 years, and non-Hispanic Black individuals, with significant increases observed across all demographic groups. The West demonstrated the highest regional mortality burden (AAPC, 3.75%; p < 0.001). Urbanization analyses (2004–2020) showed higher mortality in non-metropolitan than metropolitan areas (AAPCs, 5.36% vs. 4.13%; both p < 0.001). Mortality increased through 2021 before declining modestly during 2021–2024. Conclusions: Mortality involving both cardiac arrest and fluid, electrolyte, and acid–base disorders increased substantially in the United States over the past two decades, with persistent disparities in age, sex, race/ethnicity, and geography. These findings identify populations at increased risk and support targeted public health strategies, equitable healthcare access, and improved recognition and management of metabolic disturbances in patients at risk for cardiac arrest. Full article

Refugees and asylum seekers in Germany face significant barriers to accessing routine dental care, leading to untreated conditions that escalate into costly emergency hospital admissions and increased public healthcare expenditures. This study evaluates the economic impact of an NGO-led dental care facility designed to address this critical gap in care for uninsured populations. Using a retrospective cost-effectiveness analysis, we compare three scenarios: (1) the NGO intervention, (2) the “status quo” reliance on emergency care, and (3) a dental clinic arm-based model. We test the hypothesis that NGO-led interventions reduce public healthcare costs by curbing preventable emergency admissions, thereby addressing systemic policy and market failures. Results demonstrate that the NGO facility is a cost-effective solution, generating a return of €0.60 for every euro invested, while the alternative scenarios yielded no financial returns. By providing equitable, preventive dental care, the NGO model reduced emergency admissions by addressing delayed treatment-seeking behaviors and structural access barriers. These findings confirm that NGO-led interventions can mitigate market failures by serving as a Pareto-improving solution, optimizing resource allocation and reducing long-term fiscal burdens. The study underscores the potential of NGOs to complement public health systems in achieving equitable and sustainable healthcare delivery. Policymakers should consider scaling such models to alleviate disparities in underserved populations while curbing avoidable costs linked to emergency care. This research contributes critical evidence for integrating NGO-led initiatives into healthcare strategies, particularly in contexts marked by fragmented access and systemic inefficiencies. Full article

Background/Objectives: Childhood-onset systemic lupus erythematosus (cSLE) is a chronic, multisystem autoimmune disease that is associated with more severe organ involvement, more intensive drug therapy, and increased long-term organ damage compared with adult-onset disease. The objectives of this study were to evaluate the performance of widely used small area-level multidimensional indicators of neighborhood disadvantage in a mixed urban–rural cSLE cohort against disease outcomes. Methods: This retrospective cohort study utilized electronic health records to identify and evaluate pediatric patients with cSLE across a single center in South Carolina between 1 January 2020 and 31 December 2024. Primary outcomes included disease activity at diagnosis, measured by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K); the achievement of a low lupus disease activity state (LLDAS) by the last visit; the development of major organ involvement; and the rates of unplanned hospitalizations and emergency department visits. The associations of the census tract-level Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Childhood Opportunity Index (COI) with clinical presentation and outcomes were estimated using generalized linear models and logistic regression. Results: A total of 85 patients with cSLE were included, of which 76% reported being of Black race, and 28% lived in rural areas. Lupus disease severity was inconsistent across the metrics of area-level social vulnerability, neighborhood deprivation, child opportunity, and rurality. Patients who lived in more socially vulnerable communities were more likely to attain LLDAS during follow-up, while those who lived in lower-opportunity areas were more likely to develop CNS lupus. Baseline disease activity, renal involvement, and healthcare use were not significantly associated with area-level social disadvantages or rurality. Conclusions: In this single-center, mixed urban–rural cohort of children with cSLE, indicators of neighborhood-level disadvantage and rurality alone explained little variation in disease severity and disease control overall. The utility of available small area-level metrics is likely context-dependent and influenced by regional features, population characteristics, and the outcomes being studied. Future work should integrate individual- and area-level factors across diverse settings to better understand the drivers of health disparities. Full article

Background: Timely hepatitis B vaccine birth-dose (HepBV-BD) vaccination is a cornerstone strategy for preventing mother-to-child transmission of hepatitis B virus (HBV). Although hepatitis B vaccination coverage in China has improved substantially, evidence regarding long-term district-level spatiotemporal inequalities in timely birth-dose vaccination remains limited, particularly in western China. This study assessed spatiotemporal disparities in hepatitis B vaccination coverage across Chongqing, China, from 2016 to 2025. Methods: This ecological descriptive study used district- and county-level vaccination surveillance data from the Chongqing Immunization Information Management System. Temporal trends in HepBV-BD, timely birth-dose (TBD), HepBV2, and HepBV3 coverage were analyzed. Regional disparities, interregional inequalities, and spatial clustering were assessed using Global Moran’s I and Local Indicators of Spatial Association (LISA). Results: All vaccination indicators improved substantially during the study period. TBD coverage increased from 81.9% to 95.4%, whereas HepBV3 coverage increased from 83.7% to 98.7%. TBD coverage was strongly positively associated with HepBV3 coverage(r = 0.95, p < 0.001). Mountainous ethnic minority regions consistently exhibited the lowest TBD coverage despite marked improvement over time. Absolute interregional inequality decreased from 30.8 to 8.4 percentage points. Although Global Moran’s I was not statistically significant, LISA analysis identified persistent localized low-coverage clusters in southeastern mountainous regions and emerging high–high clusters in northern Chongqing. Conclusions: Hepatitis B vaccination coverage in Chongqing improved markedly between 2016 and 2025, accompanied by declining geographic inequality. Nevertheless, persistent spatial inequities in timely birth-dose vaccination remained in mountainous ethnic minority areas. Continued monitoring of spatial inequalities, together with strengthened primary healthcare capacity, culturally tailored health education, and equitable resource allocation, may help support geographically targeted immunization strategies and accelerate progress toward the WHO goal of eliminating viral hepatitis as a public health threat by 2030. Full article

Objective: Women in recovery from opioid use disorder (OUD) experience sexual and reproductive health disparities which worsen health outcomes and may negatively impact recovery. While in recovery programs, women engage with different healthcare professionals, but how these professionals provide sexual and reproductive healthcare (SRH) is not well known. The purpose of this study is to identify perceived barriers and strategies to overcome barriers to providing SRH to women in recovery from OUD from the perspective of OUD recovery healthcare professionals. Methods: Guided by the social ecological framework, we used a qualitative descriptive study design to conduct individual semi-structured interviews with healthcare professionals (nurses, doctors, leaders/managers, peer support specialists, therapists, and case managers). Data was analyzed using thematic analysis. Results: Among individual interviews with N = 34 healthcare professionals, we identified two overarching themes: Barriers and Facilitators. Barriers included unmet provider training needs, navigating patient stigma and shame surrounding SRH, and fragmented healthcare systems. Facilitators included leveraging communities of shared experiences and developing ideal models of SRH programming. This included co-location of SRH and recovery spaces and the importance of peer support specialists in women’s recovery journeys. Conclusions: Multi-level challenges to address SRH in recovery require discipline specific training of healthcare professionals, empowering peer professionals, and policy and advocacy to address systemic issues. Full article

Background/Objectives: Telehealth (TH) and Telemedicine (TM) can significantly benefit individuals who live far from healthcare institutions and those with limited financial resources by improving access to essential health services. This review explores the attitudes and determinants affecting the use of TH and TM, focusing on the MENA region with insights from the global context. Methods: A narrative review was created using a compilation of scientific articles published between 2020 and 2025 from PubMed and Scopus. Studies were screened to be relevant with the determinants, attitudes or use of TH and TM. Forty one sources met the eligibility criteria and covered evidence from the MENA region with supporting background from global developments. Results: In the MENA region, although high perceived effectiveness is recorded, the use of TH and TM remains below optimal levels. The majority of the studies reviewed suggested that participants have positive attitudes towards TH and TM. Nevertheless, some studies suggest low awareness and limited utilization of available TH and TM services. Determinants affecting TH and TM included pandemic-based, socioeconomic, cultural, financial, health literacy, and infrastructure-based factors, and those relating to physician implementation. Disparities in utilization of these services were evident among individuals with low digital literacy, older individuals and low-income workers. Conclusions: TH and TM are observed to increase the availability and accessibility of preventative and treatment-based health services, especially in regions facing geographic limitations. The findings exhibit the disparities in institution and uptake of these services due to socioeconomic, geographic and cultural aspects. Interventions at the system level, supported by evidence such as multilingual digital platforms, investments in digital infrastructure and coverage in insurance, need to be implemented to ensure equitable utilization of these services in the MENA region. Full article

Biologic therapies have significantly improved outcomes for patients with moderate-to-severe atopic dermatitis (AD), yet access to these treatments remains uneven and frequently limited. This systematic review synthesizes evidence on insurance-related, financial, administrative, prescriber-level, and structural barriers that limit equitable access to biologic therapies for AD. In contrast to prior reviews that primarily focus on biologic efficacy, safety, or general disease management, this review evaluates access itself as the primary outcome. Across diverse study designs and populations, findings consistently demonstrate that high out-of-pocket costs, restrictive insurance policies, and administrative burdens disproportionately impact low-income, minority, and Medicaid-insured patients. However, racial and ethnic disparities should be interpreted cautiously, as factors like insurance type, Medicaid enrollment, socioeconomic status, geographic access, and other structural determinants may influence these associations. Pediatric patients and caregivers also face challenges such as insurance delays, financial burden, and long-term effects of poor disease control. These barriers contribute to delays in treatment initiation, reduced adherence, and poorer clinical outcomes. Persistent racial, socioeconomic, and geographic disparities further exacerbate inequities in care delivery. Variability in prescribing patterns and provider familiarity with biologics also influence treatment access. Collectively, these findings underscore the need for comprehensive policy reform, streamlined authorization processes, and targeted interventions to improve equitable access to biologic therapies in AD. Full article

(1) Background: Ambulatory services are the main interface between populations and health systems, yet their benefits are unevenly distributed due to structural inequalities—systemic differences rooted in the social, economic, and political organisation of society. Inequities in access and quality are well documented, but patient safety remains the least examined. (2) Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, PubMed/MEDLINE and Scopus were searched for studies published from 2010 to 2026. In total, 44 studies were included, predominantly from the USA (n = 31), and synthesised narratively. (3) Results: Inequalities operated through geographic maldistribution, financial barriers, exclusionary institutional cultures, and market-driven practices. Access and quality were each addressed by 17 studies, whereas only four examined patient safety directly; the limited safety evidence indicated disproportionate diagnostic errors, medication-safety failures, and care-coordination breakdowns among vulnerable groups. Evidence was concentrated in the USA. (4) Conclusions: Structural inequalities are well documented for access and quality but are markedly under-studied for patient safety—the principal evidence gap identified. Patient safety warrants treatment as an equity outcome, measured with stratification by structural disadvantage and addressed through system-level interventions. Full article

Introduction: Multimorbidity, defined as the coexistence of two or more chronic conditions in the same person, represents a major challenge for modern health systems due to its association with adverse health outcomes, increased mortality, and high healthcare utilization. We aimed to assess the prevalence of multimorbidity in the adult population of Serbia and examine its association with demographic and socioeconomic factors and healthcare utilization. Methodology: Data were drawn from the 2019 Serbian National Health Survey. Descriptive statistics, chi-square and independent-samples t-tests, as well as univariate and multivariate logistic regression analyses, were performed to examine the associations. Results: The study included 12,439 adults—48.5% men and 51.5% women (mean age: 52.83 ± 17.69). Multimorbidity was present in 35.2% of participants. It was significantly more frequent among women than men (39.65% vs. 30.53%, p < 0.001) and increased markedly with age, reaching 68.63% among individuals aged ≥80 years. Participants with multimorbidity were significantly older than those without it (p < 0.001). Higher prevalence was observed among widowed individuals, participants with lower education, economically inactive persons, those with poorer material status, and residents of Southern and Eastern Serbia (all p < 0.001). Multivariable regression analysis confirmed independent associations between multimorbidity and female sex, older age, lower education, poorer socioeconomic status, and regional disparities. Multimorbidity was a strong predictor of healthcare utilization. Individuals with multimorbidity were significantly more likely to use inpatient and day hospital services, visit specialist physicians, use prescribed medications, and receive home care (all p < 0.05). Conclusion: Multimorbidity affects more than one-third of adults in Serbia and is strongly associated with demographic and socioeconomic disadvantage. It substantially increases healthcare utilization, underscoring the need for integrated, patient-centered care and targeted public health interventions. Full article

Respiratory syncytial virus (RSV) remains a leading cause of severe lower respiratory tract infection in early infancy, with the highest burden concentrated in the first months of life. Two immunoprophylactic strategies—maternal RSVpreF vaccination and long-acting monoclonal antibodies—now offer effective early life protection, yet differ in biological mechanisms, operational requirements, and programmatic implications. Maternal vaccination induces high-quality neutralizing antibodies that are transferred transplacentally, providing immediate protection from birth and integrating efficiently into antenatal care platforms. However, its effectiveness is constrained by gestational timing, physiological antibody waning, and reduced protection when vaccination occurs shortly before delivery. Long-acting monoclonal antibodies, including nirsevimab and clesrovimab, bypass maternal immune variability and provide standardized, season-long protection across gestational ages, including preterm infants. Economic evaluations demonstrate that both strategies can be cost-effective, though their relative value depends on local epidemiology, pricing, and coverage patterns. Economic outcomes for monoclonal antibodies and maternal vaccination are highly context-dependent and influenced by regional RSV epidemiology, healthcare utilization, product pricing, and implementation capacity, rather than universally favoring one strategy over the other. Global equity considerations remain critical: disparities in antenatal care access, supply chain fragility, and pricing differentials may widen gaps between high- and low-income countries. Remaining evidence gaps—including long-term safety monitoring, durability of protection, viral evolution, and implementation challenges—underscore the need for continued research and careful integration of these tools into national immunization programs. Full article

Urban–rural public facility disparity is a systemic challenge that reflects dysfunctional feedback loops within and across social and technical subsystems. Traditional administrative-unit-based analyses cannot capture such systemic alignments. This study applies the marker-controlled watershed segmentation (MWS) algorithm, the Two-Step Floating Catchment Area (2SFCA) method, and spatial clustering methods sequentially to dynamically separate urban from rural areas and assess the urban–rural disparity in public facility provisions within the Chengdu–Chongqing economic circle (CCEC). The results indicate: (1) The distribution of public facilities in the CCEC is characterized by significant spatial inequity, predominantly manifested as a substantial disparity between urban and rural areas. (2) A significant misalignment exists between the supply of public facilities and the demands of vulnerable groups. Rural residents, low-income groups, and elderly people are at a disadvantage in accessing public facilities. (3) Rural residents are concentrated in low-income areas and have the most limited ability to obtain public facility services and resources, especially in terms of healthcare facilities. By replacing predefined administrative boundaries with image-derived functional urban–rural patches, the proposed framework enables a more spatially realistic assessment of urban–rural public facility disparities. This approach provides a transferable tool for system-level decision-making in regional planning, particularly for targeting resource allocation in underserved areas. Full article

Background/Objectives: Many Medicare beneficiaries often face substantial financial strain due to healthcare costs. This study examined out-of-pocket expenditures for healthcare services by demographics among Medicare beneficiaries in 2019 and 2021. Methods: A repeated cross-sectional study analyzed the 2019 and 2021 Medicare Current Beneficiary Survey Cost Files of beneficiaries aged ≥65 years (2019, n = 6895; 2021, n = 6094). Survey-weighted generalized linear models with a log link and gamma distribution with a three-way interaction of sex (male, female), age (65–74, ≥75), and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and Other), adjusted for covariates, and to 2021 USD, were conducted to estimate per capita annual out-of-pocket expenditures for healthcare services, excluding premiums. Results: Estimated average per capita annual out-of-pocket expenditures for healthcare services were $2511 in 2019 and $2641 in 2021. Differences in out-of-pocket expenditures were observed among various demographic groups in 2019 and 2021. Non-Hispanic Blacks had lower out-of-pocket expenditures than non-Hispanic Whites in both years (in 2021, $2139 [1761–2517] vs. $2730 [2580–2879]). Beneficiaries aged 65–74 years who were non-Hispanic Black had lower out-of-pocket expenditures than non-Hispanic Whites in the same age group for both years. A significant proportion of non-Hispanic Blacks had lower incomes (in 2021, income < $25,000, 46.1% vs. 17.0%) and more comorbidities (in 2021, comorbidities ≥ 4, 55.6% vs. 44.7%), compared to non-Hispanic Whites in both years. Similar differences in incomes and comorbidities were observed among those aged 65–74 years of both groups. Conclusions: Medicare beneficiaries face substantial out-of-pocket burdens for healthcare services, with persistent demographic disparities. Understanding contributing factors and implementing effective policies/practices are essential to reduce/mitigate high out-of-pocket expenditures for beneficiaries. Full article

Background: Multimorbidity is a growing global health challenge in aging populations, yet its progression across physical, psychological, and cognitive domains and its contribution to health inequalities remain unclear. We compared longitudinal patterns of multimorbidity in China and the United States (US) and examined the socioeconomic and healthcare-related factors associated with these patterns and their functional consequences. Methods: This longitudinal cohort study included adults aged ≥45 years from China (2011–2020) and the US (2012–2020), matched 1:1 by baseline age and sex. Multimorbidity was classified into eight domains spanning physical, psychological, and cognitive conditions and their combinations. Longitudinal changes across five survey waves were assessed. Multinomial logistic mixed models examined socioeconomic and healthcare-related correlations, and Cox models estimated associations with subsequent limitations in activities of daily living (ADL) limitations and instrumental activities of daily living (IADL) limitations. Results: A total of 7064 participants from China (mean age 60.15 ± 7.93 years; 45.4% male) and 7064 matched participants from the US were included. Multimorbidity patterns were more complex in the US at baseline, but progression toward cross-domain multimorbidity occurred in both countries and was more pronounced in China. Psychological conditions occupied a central position in the development of more complex multimorbidity patterns. Higher educational and household wealth were consistently associated with lower odds of cognitive-related and cross-domain multimorbidity in both countries, whereas associations with healthcare-related factors varied across settings. Cross-domain multimorbidity was more strongly associated with functional limitations than within-domain multimorbidity. In particular, physical–psychological–cognitive multimorbidity was associated with substantially higher risks of ADL limitations (hazard ratio (HR)  =  5.70, 95% confidence interval (CI)  =  4.87–6.67 in China; HR  =  7.72, 95% CI  =  5.90–10.11 in the US) and IADL limitations (HR  =  4.14, 95% CI  =  3.64–4.71; HR  =  5.84, 95% CI  =  4.50–7.59, respectively). Conclusions: Multimorbidity increasingly spans physical, psychological, and cognitive domains in both China and the US. Psychological conditions appeared to bridge physical and cognitive conditions in more complex multimorbidity patterns. Integrated care models incorporating psychological health and strategies addressing socioeconomic inequalities may help reduce the burden of multimorbidity and related functional decline. Full article

Mild traumatic brain injury (mTBI) is a common cause for pediatric emergency department visits and can impose substantial burdens on families, including missed work and childcare needs. Socioeconomic context may influence both healthcare use and these downstream impacts. This study examined the association between Child Opportunity Index (COI), a neighborhood-level measure of socioeconomic status, and healthcare utilization and indirect costs following pediatric concussion. In a secondary analysis of a multisite randomized controlled trial of patients with acute (<72 h) concussion, participants were categorized into high, middle, and low COI groups. Outcomes included follow-up care, caregiver missed workdays, childcare needs, and indirect costs, analyzed using multivariable regression models. Participants from lower COI neighborhoods were more likely to present to the emergency department, with 93.02% compared to 71.43% in higher COI groups (p = 0.005); had higher symptom scores at 14 days, 28.69 versus 16.64 (p = 0.03); and were less likely to be seen by concussion specialists, 6.98% versus 28.57% (p = 0.005). They also had lower odds of attending follow-up within 14 days (OR = 0.36, p = 0.015) and higher caregiver burden, including more missed workdays and childcare needs. Although total indirect costs did not differ significantly for low COI groups after adjustment, middle COI participants had lower costs than high COI ones. Overall, disparities were observed in care patterns and caregiver burden despite similar recovery outcomes. These findings suggest that expanding access to affordable concussion follow-up through school-based programs, telehealth services, transportation assistance, and flexible scheduling may help reduce caregiver burden and improve continuity of care for children from lower COI neighborhoods following pediatric mTBI. Full article