搜索结果：Scandinavian journal of primary health care

Demand for health care is constantly increasing due to the ongoing demographic change, while at the same time health service providers face difficulties in finding skilled personnel. This creates pressure on health care systems around the world, such that the efficient, nationwide provision of primary health care has become one of society's greatest challenges. Due to the complexity of health care systems, unforeseen future events, and a frequent lack of data, analyzing and optimizing the performance of health care systems means tackling a wicked problem. To support this task for primary care, this paper introduces the hybrid agent-based simulation model SiM-Care. SiM-Care models the interactions of patients and primary care physicians on an individual level. By tracking agent interactions, it enables modelers to assess multiple key indicators such as patient waiting times and physician utilization. Based on these indicators, primary care systems can be assessed and compared. Moreover, changes in the infrastructure, patient behavior, and service design can be directly evaluated. To showcase the opportunities offered by SiM-Care and aid model validation, we present a case study for

The health needs of those living in resource-limited settings are a vastly overlooked and understudied area in the intersection of machine learning (ML) and health care. While the use of ML in health care is more recently popularized over the last few years from the advancement of deep learning, low-and-middle income countries (LMICs) have already been undergoing a digital transformation of their own in health care over the last decade, leapfrogging milestones due to the adoption of mobile health (mHealth). With the introduction of new technologies, it is common to start afresh with a top-down approach, and implement these technologies in isolation, leading to lack of use and a waste of resources. In this paper, we outline the necessary considerations both from the perspective of current gaps in research, as well as from the lived experiences of health care professionals in resource-limited settings. We also outline briefly several key components of successful implementation and deployment of technologies within health systems in LMICs, including technical and cultural considerations in the development process relevant to the building of machine learning solutions. We then draw on

This review underscores the vital role of interoperability in digital health, advocating for a standardized framework. It focuses on implementing a Fast Healthcare Interoperability Resources (FHIR) server, addressing technical, semantic, and process challenges. FHIR's adaptability ensures uniformity within Primary Care Health Information Systems, fostering interoperability. Patient data management complexities highlight the pivotal role of semantic interoperability in seamless patient care. FHIR standards enhance these efforts, offering multiple pathways for data search. The ADR-guided FHIR server implementation systematically addresses challenges related to patient identity, biometrics, and data security. The detailed development phases emphasize architecture, API integration, and security. The concluding stages incorporate forward-looking approaches, including HHIMS Synthetic Dataset testing. Envisioning FHIR integration as transformative, it anticipates a responsive healthcare environment aligned with the evolving digital health landscape, ensuring comprehensive, dynamic, and interconnected systems for efficient data exchange and access.

Adopting a good health information system (HIS) is essential for providing high-quality healthcare. With rapid advances in technology in the healthcare industry in recent years, healthcare providers seek effective options to deal with numerous diseases and a growing number of patients, adopting advanced HIS such as for clinical decision support. While the clinical decision support systems (CDSS) can help medical personnel make better decisions, they may bring negative results due to a lack of understanding of the elements that influence GP's adoption of CDSS. This paper focuses on discovering obstacles that may contribute to the problems surrounding CDSS adoption. Thirty general practitioners were interviewed from different primary health centers in Saudi Arabia in order to determine the challenges and obstacles in the sector. While the outcome confirms that there are obstacles that affect the aspects, such as time risk, quality of the system used, slow Internet speed, user interface, lack of training, high costs, patient satisfaction, multiple systems used, technical support, computer skills, lack of flexibility, system update, professional skills and knowledge, computer efficienc

This study is mainly aimed at evaluating the effectiveness of current health care systems of several representative countries and improving that of the US. To achieve these goals, a people-oriented non-linear evaluation model is designed. It comprises one major evaluation metric and four minor metrics. The major metric is constituted by combining possible factors that most significantly determine or affect the life expectancy of people in this country. The four minor metrics evaluate less important aspects of health care systems and are subordinate to the major one. The authors rank some of the health care systems in the world according to the major metric and detect problems in them with the help of minor ones. It is concluded that the health care system of Sweden scores higher than the US and Chinese system scores lower than that of the US. Especially, the health care system of US lags behind a little bit compared with its economic power. At last, it is reasonable for the American government to optimize the arrangement of funding base on the result of goal programming model.

Innovation in healthcare payment and service delivery utilizes high cost, high risk pilots paired with traditional program evaluations. Decision-makers are unable to reliably forecast the impacts of pilot interventions in this complex system, complicating the feasibility assessment of proposed healthcare models. We developed and validated a Discrete Event Simulation (DES) model of primary care for patients with Diabetes to allow rapid prototyping and assessment of models before pilot implementation. We replicated four outcomes from the Centers for Medicare and Medicaid Services Federally Qualified Health Center Advanced Primary Care Practice pilot. The DES model simulates a synthetic population's healthcare experience, including symptom onset, appointment scheduling, screening, and treatment, as well as the impact of physician training. A network of detailed event modules was developed from peer-reviewed literature. Synthetic patients' attributes modify the probability distributions for event outputs and direct them through an episode of care; attributes are in turn modified by patients' experiences. Our model replicates the direction of the effect of physician training on the sele

Past research has shown the benefits of food journaling in promoting mindful eating and healthier food choices. However, the links between journaling and healthy eating have not been thoroughly examined. Beyond caloric restriction, do journalers consistently and sufficiently consume healthful diets? How different are their eating habits compared to those of average consumers who tend to be less conscious about health? In this study, we analyze the healthy eating behaviors of active food journalers using data from MyFitnessPal. Surprisingly, our findings show that food journalers do not eat as healthily as they should despite their proclivity to health eating and their food choices resemble those of the general populace. Furthermore, we find that the journaling duration is only a marginal determinant of healthy eating outcomes and sociodemographic factors, such as gender and regions of residence, are much more predictive of healthy food choices.

Citation network analysis has become one of methods to study how scientific knowledge flows from one domain to another. Health informatics is a multidisciplinary field that includes social science, software engineering, behavioral science, medical science and others. In this study, we perform an analysis of citation statistics from health informatics journals using data set extracted from CrossRef. For each health informatics journal, we extract the number of citations from/to studies related to computer science, medicine/clinical medicine and other fields, including the number of self-citations from the health informatics journal. With a similar number of articles used in our analysis, we show that the Journal of the American Medical Informatics Association (JAMIA) has more in-citations than the Journal of Medical Internet Research (JMIR); while JMIR has a higher number of out-citations and self-citations. We also show that JMIR cites more articles from health informatics journals and medicine related journals. In addition, the Journal of Medical Systems (JMS) cites more articles from computer science journals compared with other health informatics journals included in our analysi

Objectives: To assess the use of artificial intelligence-based software in ruling out chest X-ray cases, with no significant findings in a primary health care setting. Methods: In this retrospective study, a commercially available artificial intelligence (AI) software was used to analyse 10 000 chest X-rays of Finnish primary health care patients. In studies with a mismatch between an AI normal report and the original radiologist report, a consensus read by two board-certified radiologists was conducted to make the final diagnosis. Results: After the exclusion of cases not meeting the study criteria, 9579 cases were analysed by AI. Of these cases, 4451 were considered normal in the original radiologist report and 4644 after the consensus reading. The number of cases correctly found nonsignificant by AI was 1692 (17.7% of all studies and 36.4% of studies with no significant findings). After the consensus read, there were nine confirmed false-negative studies. These studies included four cases of slightly enlarged heart size, four cases of slightly increased pulmonary opacification and one case with a small unilateral pleural effusion. This gives the AI a sensitivity of 99.8% (95% CI

Growth of the older adult population has led to an increasing interest in technology-supported aged care. However, the area has some challenges such as a lack of caregivers and limitations in understanding the emotional, social, physical, and mental well-being needs of seniors. Furthermore, there is a gap in the understanding between developers and ageing people of their requirements. Digital health can be important in supporting older adults wellbeing, emotional requirements, and social needs. Requirements Engineering (RE) is a major software engineering field, which can help to identify, elicit and prioritize the requirements of stakeholders and ensure that the systems meet standards for performance, reliability, and usability. We carried out a systematic review of the literature on RE for older adult digital health software. This was necessary to show the representatives of the current stage of understanding the needs of older adults in aged care digital health. Using established guidelines outlined by the Kitchenham method, the PRISMA and the PICO guideline, we developed a protocol, followed by the systematic exploration of eight databases. This resulted in 69 primary studies o

Abundant evidence has tracked the labour market and health assimilation of immigrants, including static analyses of differences in how foreign-born and native-born residents consume health care services. However, we know much less about how migrants' patterns of health care usage evolve with time of residence, especially in countries providing universal or quasi-universal coverage. We investigate this process in Spain by combining all the available waves of the local health survey, which allows us to separately identify period, cohort, and assimilation effects. We find that the evidence of health assimilation is limited and solely applies to migrant females' visits to general practitioners. Nevertheless, the differential effects of ageing on health care use between foreign-born and native-born populations contributes to the convergence of utilisation patterns in most health services after 20 years in Spain. Substantial heterogeneity over time and by region of origin both suggest that studies modelling future welfare state finances would benefit from a more thorough assessment of migration.

Missing data, inaccuracies in medication lists, and recording delays in electronic health records (EHR) are major limitations for target trial emulation (TTE), the process by which EHR data are used to retrospectively emulate a randomized control trial. EHR TTE relies on recorded data that proxy true drug exposures and outcomes. We investigate the under-utilized criterion that a patient has indications of primary care provider (PCP) encounters within the EHR. Such patients tend to have more records overall and a greater proportion of the types of encounters that materialize comprehensive and up-to-date records. We examine the impact of including a PCP feature in the TTE model or as an eligibility criterion for cohort selection, contrasted with ignoring it altogether. To that end, we compare the estimated effects of two first line antidiabetic drug classes on the onset of Alzheimer's Disease and Related Dementias (ADRD). We find that the estimated treatment effect is sensitive to the consideration of a PCP feature, particularly when used as an eligibility criterion. Our work suggests that this PCP feature should be further researched.

Hospitals and health care organizations collect large amounts of detailed health care data that is in high demand by researchers. Thus, the possessors of such data are in need of methods that allow for this data to be released without compromising the confidentiality of the individuals to whom it pertains. As the geographic aspect of this data is becoming increasingly relevant for research being conducted, it is important for an \emph{anonymization} process to pay due attention to the geographic attributes of such data. In this paper, a novel system for health care data anonymization is presented. At the core of the system is the aggregation of an initial regionalization guided by the use of a Voronoi diagram. We conduct a comparison with another geographic-based system of anonymization, GeoLeader. We show that our system is capable of producing results of a comparable quality with a much faster running time.

Artificial intelligence (AI)-enabled digital interventions, including Generative AI (GenAI) and Human-Centered AI (HCAI), are increasingly used to expand access to digital psychiatry and mental health care. This PRISMA-ScR scoping review maps the landscape of AI-driven mental health (mHealth) technologies across five critical phases: pre-treatment (screening/triage), treatment (therapeutic support), post-treatment (remote patient monitoring), clinical education, and population-level prevention. We synthesized 36 empirical studies implemented through early 2024, focusing on Large Language Models (LLMs), machine learning (ML) models, and autonomous conversational agents. Key use cases involve referral triage, empathic communication enhancement, and AI-assisted psychotherapy delivered via chatbots and voice agents. While benefits include reduced wait times and increased patient engagement, we address recurring challenges like algorithmic bias, data privacy, and human-AI collaboration barriers. By introducing a novel four-pillar framework, this review provides a comprehensive roadmap for AI-augmented mental health care, offering actionable insights for researchers, clinicians, and poli

I study households' primary health care usage in India, which presents a paradox. I examine why most households use fee-charging private health care services even though (1) most providers have no formal medical qualifications and (2) in markets where qualified doctors offer free care through public hospitals. I present evidence that this puzzling practice has deep historical routes. I examine India's coercive forced sterilization policy implemented between 1976 and 1977. Utilizing the unexpected timing of the policy, multiple measures of forced sterilization, including at a granular level, and an instrumental variable approach, I document that places heavily affected by the policy have lower public health care usage today. I also show that the instrument I use is unrelated to a battery of demographic, economic, or political aspects before the forced sterilization period. Finally, I explore the mechanism and document that supply-side factors do not explain these differences. Instead, I demonstrate that places with greater exposure to forced sterilization have higher confidence in private hospitals and doctors to provide good treatment.

Global rates of mental health concerns are rising, and there is increasing realization that existing models of mental health care will not adequately expand to meet the demand. With the emergence of large language models (LLMs) has come great optimism regarding their promise to create novel, large-scale solutions to support mental health. Despite their nascence, LLMs have already been applied to mental health related tasks. In this paper, we summarize the extant literature on efforts to use LLMs to provide mental health education, assessment, and intervention and highlight key opportunities for positive impact in each area. We then highlight risks associated with LLMs' application to mental health and encourage the adoption of strategies to mitigate these risks. The urgent need for mental health support must be balanced with responsible development, testing, and deployment of mental health LLMs. It is especially critical to ensure that mental health LLMs are fine-tuned for mental health, enhance mental health equity, and adhere to ethical standards and that people, including those with lived experience with mental health concerns, are involved in all stages from development through

Rankings of scholarly journals based on citation data are often met with skepticism by the scientific community. Part of the skepticism is due to disparity between the common perception of journals' prestige and their ranking based on citation counts. A more serious concern is the inappropriate use of journal rankings to evaluate the scientific influence of authors. This paper focuses on analysis of the table of cross-citations among a selection of Statistics journals. Data are collected from the Web of Science database published by Thomson Reuters. Our results suggest that modelling the exchange of citations between journals is useful to highlight the most prestigious journals, but also that journal citation data are characterized by considerable heterogeneity, which needs to be properly summarized. Inferential conclusions require care in order to avoid potential over-interpretation of insignificant differences between journal ratings. Comparison with published ratings of institutions from the UK's Research Assessment Exercise shows strong correlation at aggregate level between assessed research quality and journal citation `export scores' within the discipline of Statistics.

A sound performance of health care organizations depends on vigorous financing system, skilled and well paying personnel, trustworthy information, well sustained health services and reliable technologies they used. The management and organization of health care systems and other health care settings can deeply have an effect on health result, excellence of care, and patient pleasure. Environmental assessment of an organization must considered political, technical and environmental aspects. This research is paying attention on dangerous and unresolved issues resulting from waste. The insufficient managing of hospital waste be capable of creating a danger to people, in the spreading of infectious diseases, and also for the environment. Issues are classified in different groups like dangerous chemical waste, cytotoxic with carcinogenic, mutagenic and teratogenic risk and radioactive. This study focuses on the analysis of above mentioned risks and decision will be made through Multi-Criteria Decision Analysis (MCDA). MCDA techniques give considerable enhancement in decision making. Survey is used for collecting information and results are evaluated by applying some statistical tool.

Telehealth is a valuable tool for primary health care (PHC), where depression is a common condition. PHC is the first point of contact for most people with depression, but about 25% of diagnoses made by PHC physicians are inaccurate. Many other barriers also hinder depression detection and treatment in PHC. Artificial intelligence (AI) may help reduce depression misdiagnosis in PHC and improve overall diagnosis and treatment outcomes. Telehealth consultations often have video issues, such as poor connectivity or dropped calls. Audio-only telehealth is often more practical for lower-income patients who may lack stable internet connections. Thus, our study focused on using audio data to predict depression risk. The objectives were to: 1) Collect audio data from 24 people (12 with depression and 12 without mental health or major health condition diagnoses); 2) Build a machine learning model to predict depression risk. TPOT, an autoML tool, was used to select the best machine learning algorithm, which was the K-nearest neighbors classifier. The selected model had high performance in classifying depression risk (Precision: 0.98, Recall: 0.93, F1-Score: 0.96). These findings may lead to