Search Results (588)

During the last decade, artificial intelligence (AI) has enabled key technological innovations within the modern dementia and frailty healthcare and prevention landscape. This has boosted the impact of technology in the clinical setting, enabling earlier diagnosis with improved specificity and sensitivity, leading to accurate and time-efficient support that has driven the development of preventative interventions minimizing the risk and rate of progression. Background/Objectives: The rapid ageing of the European population places a substantial strain on the current healthcare system and imposes several challenges. COMFORTage is the joint effort of medical experts (i.e., neurologists, psychiatrists, neuropsychologists, nurses, and memory clinics), social scientists and humanists, technical experts (i.e., data scientists, AI experts, and robotic experts), digital innovation hubs (DIHs), and living labs (LLs) to establish a pan-European framework for community-based, integrated, and people-centric prevention, monitoring, and progression-managing solutions for dementia and frailty. Its main goal is to introduce an integrated and digitally enabled framework that will facilitate the provision of personalized and integrated care prevention and intervention strategies on dementia and frailty, by piloting novel technologies and producing quantified evidence on the impact to individuals’ wellbeing and quality of life. Methods: A robust and comprehensive design approach adopted through this framework provides the guidelines, tools, and methodologies necessary to empower stakeholders by enhancing their health and digital literacy. The integration of the initial information from 13 pilots across 8 European countries demonstrates the scalability and adaptability of this approach across diverse healthcare systems. Through a systematic analysis, it aims to streamline healthcare processes, reduce health inequalities in modern communities, and foster healthy and active ageing by leveraging evidence-based insights and real-world implementations across multiple regions. Results: Emerging technologies are integrated with societal and clinical innovations, as well as with advanced and evidence-based care models, toward the introduction of a comprehensive global coordination framework that: (a) improves individuals’ adherence to risk mitigation and prevention strategies; (b) delivers targeted and personalized recommendations; (c) supports societal, lifestyle, and behavioral changes; (d) empowers individuals toward their health and digital literacy; and (e) fosters inclusiveness and promotes equality of access to health and care services. Conclusions: The proposed framework is designed to enable earlier diagnosis and improved prognosis coupled with personalized prevention interventions. It capitalizes on the integration of technical, clinical, and social innovations and is deployed in 13 real-world pilots to empirically assess its potential impact, ensuring robust validation across diverse healthcare settings. Full article

Postpartum lactating people are particularly vulnerable to inequities in social determinants of health (SDH), yet no validated tool currently exists to assess these factors comprehensively. This study aimed to co-develop and establish the content validity of an instrument to integratively evaluate SDH in this population. Guided by the Mixed Methods Appraisal Tool, an interdisciplinary e-Delphi panel assessed item sufficiency, clarity, coherence, and relevance. Statistical analyses included the item-level (I-CVI) and scale-level (S-CVI/Ave) content validity indices, average agreement between experts (AABE), Fleiss’ kappa (κ), and Aiken’s V coefficient (V) (p < 0.05). Cognitive interviews were conducted with postpartum lactating participants representing diverse characteristics to assess interpretability. The initial version of the instrument included 135 items across nine sections addressing general demographics, education, employment, home environment, lifestyle, social support, healthcare access, stress, intimate partner violence, insomnia, and nutrition. Based on expert input, it was refined to 131 items through structural and lexical revisions. Content validity indices indicated strong agreement: I-CVI ranged from 0.66–1.00, S-CVI/Ave > 0.95, AABE > 14.26, and κ and V > 0.90. Final adjustments following cognitive interviews led to a 128-item version optimized for clarity and relevance. This instrument offers strong content validity for SDH assessment in postpartum lactating people and supports sustainable use in health research. Full article

Background: Child hospitalisation can have emotional, practical, financial, and social sequalae for the family. By understanding the impact and challenges involved, this research can inform clinical practice and interventions to help mitigate the impacts of hospitalisation. Exploring the experiences and realities of child hospitalisation for main caregivers, extended caregivers, and child siblings is the focus of this research. Method: Semi-structured interviews were designed and conducted. Eight families participated in the research. Three interviews were conducted per family, with a total of twenty-three interviews conducted overall. Interviews were recorded using Microsoft Teams application. Analysis: The interviews underwent analysis employing the Framework Method, uncovering patterns and insights relevant to the impact of child hospitalisation from varying familial perspectives. Results: Overarching themes of emotional impact, relational impact, practicalities, adjustment, communication, and “take-home messages from families” were identified and discussed. Conclusions: By identifying gaps in support, communication barriers, access inequalities, and other implications, targeted clinical interventions and preventions can be developed to empower families and healthcare professionals. This study promotes a greater understanding of the challenges associated with child hospitalisation and signifies the importance of restructuring support systems worldwide. Full article

Background: In Italy, voluntary termination of pregnancy (VTP) is a legally protected healthcare service. However, in Apulia, a southern region, access remains uneven due to ongoing healthcare rationalization, which has reduced service availability, particularly in decentralized areas. Conscientious objection among providers may also contribute, although the number of VTPs per provider has decreased over time. This study examines whether women access VTP services outside their healthcare catchment area (CA) and how socioeconomic deprivation and individual factors may influence mobility. Methods: We applied a ranking method, based on spatial and temporal distance between hospitals and municipalities to define the catchment area (CA) around hospitals of the Apulia region that offers VTP service. A Poisson multivariable clustered model was applied to evaluate the association among demographic and socioeconomic factors and the choice of the VTP service. Results: The analysis revealed that 54.7% of VTPs were performed outside the women’s catchment area. This mobility was significantly more frequent among women from medium and low socioeconomically deprived areas compared to very low deprived areas (RR = 1.20; 95%CI: [1.02–1.42]) and (RR = 1.28; 95%CI: [1.03–1.57]). Higher education level (RR = 1.09; 95% CI: [1.04–1.14]) and employment (RR = 1.09; 95%CI: [1.03–1.14]) were also associated with higher rates of undergoing a VTP outside of CA, with variations observed across local health authorities. Conclusions: These findings have shown the influence of socioeconomic conditions and educational level on women’s access to VTP services, suggesting that structural inequalities continue to shape healthcare choices and mobility. Full article

Background: Pain detection and management in older people with impaired cognition is an unmet need, leading to healthcare inequalities. This study aimed to enhance pain detection by translating and culturally adapting the PAIC-15 questionnaire into Brazilian Portuguese, establishing its content validity and comparing findings with a similar Dutch study. Methods: Following the same international standards used in the English-to-Dutch validation, we translated and culturally adapted PAIC-15 for Brazil. Content validity was assessed using two questions: (A) whether the item indicated pain and (B) whether it was specific to pain. An online form was distributed to ‘target users’ (nurses and geriatricians in LTCFs or other settings) and other healthcare professionals (HCPs) experienced in pain assessment in people with cognitive decline. Results were compared with the English-to-Dutch validation. Results: A total of 103 HCPs responded (mean age 45.2 ± 11.4 years)—76 (74%) were female and 54 (52%) had previously used pain assessment tools. Among the 63 target users, 13 items (87%) were validated as indicative and/or specific to pain. Comparing Brazilian and Dutch users, 10 items (67%) showed agreement on pain specificity. Conclusions: The Brazilian Portuguese PAIC-15 is now available, showing acceptable content validity. Linguistic challenges highlight the need for training and further validation in larger samples. Full article

Relevance: Obstructive sleep apnea (OSA) is a major public health problem with significant social and economic consequences. With increasing prevalence associated with urbanization and aging, untreated OSA is a considerable burden to the healthcare system, work productivity, and accident costs. Objectives: To analyze the global socioeconomic burden of OSA and evaluate epidemiological, economic, and healthcare policy perspectives across different regions and income levels. Materials and Methods: We conducted a narrative comprehensive review of published studies and WHO reports, covering direct medical costs, indirect social costs, and the cost-effectiveness of both existing and emerging diagnostic and therapeutic techniques. Results: OSA is estimated to afflict some 936 million adults around the world, and if it remains untreated, OSA results in 2.5 times higher healthcare costs compared to non-OSA individuals. The annual societal cost of untreated OSA in the U.S. now exceeds USD 150 billion, when considering direct medical expenses, productivity losses, and accident-related costs. Recent studies also highlight significant global costs, with annual per-patient estimates up to EUR 28,000 in the U.S. and EUR 1700–5000 in Europe. The inequality of treatment access continues between the affluent and the poor regions. Novel approaches as AI diagnostics and telemedicine, hold promise for reducing costs and improving treatment adherence among underserved populations with limited access to conventional care. Discussion: This review underscores the importance of uniform care throughout the world, timely diagnosis initiatives using portable technology, and scalable technological solutions to help reduce the social toll of OSA. Policymaker support, public education campaigns, and insurance changes are necessary to optimize both the cost and effectiveness of OSA management worldwide. Full article

(1) Background: Data literacy is becoming increasingly important for healthcare professionals in both outpatient care and research. Since healthcare data and the possibilities for its use and misuse are increasing in these areas, healthcare professionals need diverse knowledge regarding the collection, use and evaluation of data. A core component of this is an understanding of the ethical, legal, and social implications (ELSI) of working with health data. (2) Methods: Within the DIM.RUHR project (Data Competence Center for Interprofessional use of Health Data in the Ruhr Metropolis), the challenge of training in data literacy for different healthcare professionals is addressed. Based on a learning objectives matrix for interprofessional data literacy education, an ELSI concept was developed through collaboration with interprofessional project partners. The study was conducted between December 2024 and April 2025. (3) Results: The foundational structure of the ELSI concept was based on the learning objectives matrix and an unstructured literacy search for ELSI concepts in similar contexts. Using an iterative design-based research approach, a group of experts from different fields (didactics, applied ethics, health sciences, law, sociology, informatics, and psychology) developed an ELSI concept for healthcare professionals. The following categories were identified as crucial: 1. philosophy of science: a basic understanding of science and the hurdles and opportunities; 2. ethics: an overview of the biomedical principles and a technological assessment; 3. law: an overview of the reservation of permission and self-determination; 4. social aspects: an overview of health inequalities and different forms of power relations and imbalances. (4) Conclusions: The ELSI concept can be used in the orientation of healthcare professionals in outpatient care and research—regardless of their profession—to develop data competencies, with the aim of providing a holistic view of the challenges and potential in the collection, use, and evaluation of healthcare data. The DIM.RUHR project’s approach is to develop open educational resources that build on the ELSI concept to teach specific skills at different competence levels. Full article

Background: Children with disabilities face complex, systemic health access barriers rooted in societal, institutional, and structural inequities, requiring urgent global policy attention. Publications on access to health services for this population category have been found to have a significant growth in both quantity and content. The article aims to examine the structure and evolution of scientific literature in analyzing the healthcare system through the lens of inclusive services. Methods: We present the bibliometric profile of the global literature on access to health services for children with disabilities, the publication trends, the structure of research in this field concerning geographical distribution, methodological approaches, and interdisciplinary collaborations, and the core research topics, conceptual clusters, and future research directions in the field. The publications were screened from Web of Science databases, using PRISMA methodology. Finally, 1100 academic publications published between 1984 and 2025, obtained from a total of 432 different sources, the majority of which were peer-reviewed journals, were screened. Results: The calculated annual publication growth rate of 8.37% and the distinct upward trend observed, especially after 2015. The highest level was reached in 2023, with over 90 publications showing that the topic has become a focus of international academic interest. The USA (33.5%), the United Kingdom (15.7%), Australia (9.5%), and Canada (9.5%) stood out in publications, and there were strong collaborative networks among European nations (8.2%). Conclusions: Although high-income countries still appear to play a dominant role in research production, expanding international collaborations and distributing resources more equitably will contribute to the development of more inclusive solutions on a global scale. Temporal trends show an evolution toward diagnostic processes, family-centered approaches, and psychosocial dimensions. The results draw a clear picture of the current research landscape regarding access to health services for pediatric disability populations and identify potential directions for future research. Full article

Despite global commitments to universal health coverage, persons with disabilities (PwD) continue to face significant barriers in accessing appropriate healthcare, including diagnostics, treatments and preventive healthcare, with lower participation in cancer screening and vaccination programs. These disparities are driven by diverse, intersecting obstacles (structural, financial, communicative, and social) that vary by disability type and context. Inclusive approaches, co-designed with PwD and supported by standardized assessment tools, are urgently needed to address persistent inequities in healthcare access and outcomes. Full article

Artificial Intelligence (AI) is reshaping global healthcare systems by offering innovative solutions to improve diagnostic accuracy, optimize treatment planning, and enhance public health management. This article provides a structured perspective on the role of international partnerships in accelerating the adoption of AI-driven healthcare, with a focus on advancing the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). Drawing on representative global initiatives, the paper explores best practices in technology transfer, ethical data sharing, and capacity building—key enablers for inclusive and equitable AI healthcare adoption. It further analyzes common challenges such as digital infrastructure gaps, regulatory fragmentation, and global inequities in data and talent. Through a synthesis of recent collaborations and policy frameworks, this article offers actionable insights for fostering global alliances that bridge innovation with healthcare accessibility. Full article

Over the past two decades, pregnancy and birth trends have undergone significant shifts across Australia, the United States of America (USA), and the United Kingdom (UK), reflecting changes in societal norms, healthcare advancements, and demographic patterns. Variations in maternal age, birth interventions, and fertility rates highlight the evolving nature of reproductive behaviors and healthcare systems in these nations. The analysis reveals consistent increases in maternal age and gestational diabetes, alongside rising caesarean section rates—particularly in private healthcare settings. While perinatal mortality has declined overall, maternal mortality has increased in the USA and remains disproportionately high among Indigenous women and those in ethnic minorities in all three countries. These findings highlight the influence of structural inequities, healthcare access, and policy differences in maternal health. The review underscores the urgent need for equity-focused, culturally safe, and system-level interventions, as well as improved data collection and international collaboration to reduce preventable maternal and neonatal harms. By comparing these three regions, this review aims to provide insights into the shared challenges and unique approaches shaping childbirth practices in high-income countries in the 21st century. Full article

This paper investigates how Sustainable Development Goals SDG 3 (Health and Well-being) and SDG 10 (Reducing Inequality) interacted during the period 2009–2021 within the context of income disparities in the European Union and Ukraine. The central assumption is that lowering income inequality improves overall population health. The research proposes a conceptual model with four main elements: classifying countries according to their Gini index along with their performance on SDG 3 and SDG 10; analyzing how income inequality and progress on SDG 10 influence health outcomes (SDG 3); categorizing countries based on the strength of links between inequality measures and well-being indicators; and interpreting these results in the context of Ukraine’s European integration aspirations. Methodologically, cluster analysis, correlation and regression models, and semantic differentiation are applied. The findings show that a reduction in income inequality positively affects health and well-being. Nonetheless, Ukraine continues to face considerable structural and institutional hurdles. From a governance standpoint, the study highlights the need for cohesive policies that integrate economic, health, and social dimensions. Effective public management should coordinate national reforms to match EU healthcare and social policy standards. Strengthening institutions, ensuring fair access to healthcare services, and adopting inclusive policy instruments remain crucial to advancing both SDG 3 and SDG 10 targets, as well as supporting Ukraine’s broader integration with the European Union. Full article

In response to contemporary challenges such as the COVID-19 pandemic, climate change, armed conflicts, and economic instability, healthcare systems worldwide are increasingly confronted with multifaceted and overlapping crises—collectively referred to as polycrisis. These interconnected threats amplify one another, placing unprecedented strain on healthcare infrastructure, governance, and equity. The COVID-19 pandemic alone led to an estimated 16.3 million missed hospitalizations in 2020 and 14.7 million in 2021, revealing systemic vulnerabilities and deepening social inequalities. Armed conflicts, such as in Syria and Gaza, have devastated healthcare access. In Gaza, by mid-2024, 85% of the population had been forcibly displaced, with only 17 of 36 hospitals partially functioning and over 885 healthcare workers killed. Climate change further exacerbates health burdens, with over 86% of urban residents globally exposed to harmful air pollution, contributing to 1.8 million deaths annually. This study introduces a novel perspective by applying social epidemiology to the analysis of polycrisis. While the existing literature often emphasizes political or economic dimensions, our approach highlights how overlapping crises affect population health, social vulnerability, and systemic resilience. By integrating sociodemographic and environmental data, social epidemiology supports crisis-resilient care models, targeted interventions, and equitable health policies. We argue for a stronger mandate to invest in data infrastructure, enhance surveillance, and embed social determinants into health system responses. Full article

Background: The COVID-19 pandemic magnified long-standing health disparities in the United States, particularly among rural, disadvantaged populations. These communities experience greater barriers to healthcare access, a higher prevalence of chronic illness, and increased vaccine hesitancy factors that collectively contribute to poorer health outcomes. Methods: This narrative review examines rural–urban disparities in COVID-19 vaccine uptake and their impact on mortality, with a focus on cardiovascular disease (CVD) outcomes. We synthesized the peer-reviewed literature, CDC data, and U.S. Census reports to assess factors contributing to vaccine hesitancy, vaccination coverage, COVID-19-related mortality, and CVD mortality trends. Results: Rural residents were less likely to initiate COVID-19 vaccination, showed greater vaccine hesitancy, and experienced higher rates of both COVID-19 and CVD mortality. These disparities were further driven by safety concerns surrounding mRNA technology, misinformation, infrastructural barriers, and sociodemographic factors including political affiliation, education, poverty, and religion. Notably, pre-existing CVD increased vulnerability to severe COVID-19 outcomes in rural communities. Conclusions: Expanding vaccination efforts and improving healthcare infrastructure are essential for addressing these widening health inequities. Future public health strategies should prioritize culturally tailored interventions and rural-specific outreach to reduce vaccine hesitancy and improve mortality outcomes in underserved populations. Full article

Tuberculosis (TB) remains a critical public health issue in Johannesburg, South Africa, driven by a complex interplay of individual, social, and structural factors. This study assessed the syndemic relationship between these determinants to understand their collective impact on TB burden and treatment outcomes. A cross-sectional survey was conducted among TB patients attending selected clinics, examining behavioural risks (e.g., smoking, alcohol use, HIV co-infection), social conditions (poverty, overcrowding, stigma), and structural challenges (access to healthcare, migration status). The results revealed a significant co-occurrence of TB and HIV (56.1%), alongside high rates of smoking (33.1%) and alcohol use (45.2%). Unemployment (50.2%), inadequate housing, and limited healthcare access, particularly for undocumented migrants (26.2%), were also prominent. Factor analysis demonstrated a syndemic interaction between behavioural and social determinants, underscoring the compounded vulnerability of affected populations. The findings highlight the necessity of integrating medical interventions with social and structural reforms. Recommendations include TB-HIV co-management, substance abuse programmes, improved housing, and inclusive healthcare access. A multisectoral approach addressing both health and socioeconomic inequalities is critical for comprehensive TB control in urban South African contexts. Full article