搜索结果：International journal for equity in health

There are concerns about the fairness of clinical prediction models. 'Fair' models are defined as those for which their performance or predictions are not inappropriately influenced by protected attributes such as ethnicity, gender, or socio-economic status. Researchers have raised concerns that current algorithmic fairness paradigms enforce strict egalitarianism in healthcare, levelling down the performance of models in higher-performing subgroups instead of improving it in lower-performing ones. We propose assessing the fairness of a prediction model by expanding the concept of net benefit, using it to quantify and compare the clinical impact of a model in different subgroups. We use this to explore how a model distributes benefit across a population, its impact on health inequalities, and its role in the achievement of health equity. We show how resource constraints might introduce necessary trade-offs between health equity and other objectives of healthcare systems. We showcase our proposed approach with the development of two clinical prediction models: 1) a prognostic type 2 diabetes model used by clinicians to enrol patients into a preventive care lifestyle intervention prog

Large language models (LLMs), such as ChatGPT and Claude, have emerged as essential tools for information retrieval, often serving as alternatives to traditional search engines. However, ensuring that these models provide accurate and equitable information tailored to diverse demographic groups remains an important challenge. This study investigates the capability of LLMs to retrieve disaggregated health-related information for sub-ethnic groups within the Asian American population, such as Korean and Chinese communities. Data disaggregation has been a critical practice in health research to address inequities, making it an ideal domain for evaluating representation equity in LLM outputs. We apply a suite of statistical and machine learning tools to assess whether LLMs deliver appropriately disaggregated and equitable information. By focusing on Asian American sub-ethnic groups, a highly diverse population often aggregated in traditional analyses; we highlight how LLMs handle complex disparities in health data. Our findings contribute to ongoing discussions about responsible AI, particularly in ensuring data equity in the outputs of LLM-based systems.

Prognostics is concerned with predicting the future health of the equipment and any potential failures. With the advances in the Internet of Things (IoT), data-driven approaches for prognostics that leverage the power of machine learning models are gaining popularity. One of the most important categories of data-driven approaches relies on a predefined or learned health indicator to characterize the equipment condition up to the present time and make inference on how it is likely to evolve in the future. In these approaches, health indicator forecasting that constructs the health indicator curve over the lifespan using partially observed measurements (i.e., health indicator values within an initial period) plays a key role. Existing health indicator forecasting algorithms, such as the functional Empirical Bayesian approach, the regression-based formulation, a naive scenario matching based on the nearest neighbor, have certain limitations. In this paper, we propose a new `generative + scenario matching' algorithm for health indicator forecasting. The key idea behind the proposed approach is to first non-parametrically fit the underlying health indicator curve with a continuous Gauss

Selecting the right monitoring level in Remote Patient Monitoring (RPM) systems for e-healthcare is crucial for balancing patient outcomes, various resources, and patient's quality of life. A prior work has used one-dimensional health representations, but patient health is inherently multidimensional and typically consists of many measurable physiological factors. In this paper, we introduce a multidimensional health state model within the RPM framework and use dynamic programming to study optimal monitoring strategies. Our analysis reveals that the optimal control is characterized by switching curves (for two-dimensional health states) or switching hyper-surfaces (in general): patients switch to intensive monitoring when health measurements cross a specific multidimensional surface. We further study how the optimal switching curve varies for different medical conditions and model parameters. This finding of the optimal control structure provides actionable insights for clinicians and aids in resource planning. The tunable modeling framework enhances the applicability and effectiveness of RPM services across various medical conditions.

An exploratory, descriptive analysis is presented of the national orientation of scientific, scholarly journals as reflected in the affiliations of publishing or citing authors. It calculates for journals covered in Scopus an Index of National Orientation (INO), and analyses the distribution of INO values across disciplines and countries, and the correlation between INO values and journal impact factors. The study did not find solid evidence that journal impact factors are good measures of journal internationality in terms of the geographical distribution of publishing or citing authors, as the relationship between a journal's national orientation and its citation impact is found to be inverse U-shaped. In addition, journals publishing in English are not necessarily internationally oriented in terms of the affiliations of publishing or citing authors; in social sciences and humanities also USA has their nationally oriented literatures. The paper examines the extent to which nationally oriented journals entering Scopus in earlier years, have become in recent years more international. It is found that in the study set about 40 per cent of such journals does reveal traces of internati

Large language models (LLMs) hold promise to serve complex health information needs but also have the potential to introduce harm and exacerbate health disparities. Reliably evaluating equity-related model failures is a critical step toward developing systems that promote health equity. We present resources and methodologies for surfacing biases with potential to precipitate equity-related harms in long-form, LLM-generated answers to medical questions and conduct a large-scale empirical case study with the Med-PaLM 2 LLM. Our contributions include a multifactorial framework for human assessment of LLM-generated answers for biases, and EquityMedQA, a collection of seven datasets enriched for adversarial queries. Both our human assessment framework and dataset design process are grounded in an iterative participatory approach and review of Med-PaLM 2 answers. Through our empirical study, we find that our approach surfaces biases that may be missed via narrower evaluation approaches. Our experience underscores the importance of using diverse assessment methodologies and involving raters of varying backgrounds and expertise. While our approach is not sufficient to holistically assess w

Data-driven decisions shape public health policies and practice, yet persistent disparities in data representation skew insights and undermine interventions. To address this, we advance a structured roadmap that integrates public health data science with computer science and is grounded in reflexivity. We adopt data equity as a guiding concept: ensuring the fair and inclusive representation, collection, and use of data to prevent the introduction or exacerbation of systemic biases that could lead to invalid downstream inference and decisions. To underscore urgency, we present three public health cases where non-representative datasets and skewed knowledge impede decisions across diverse subgroups. These challenges echo themes in two literatures: public health highlights gaps in high-quality data for specific populations, while computer science and statistics contribute criteria and metrics for diagnosing bias in data and models. Building on these foundations, we propose a working definition of public health data equity and a structured self-audit framework. Our framework integrates core computational principles (fairness, accountability, transparency, ethics, privacy, confidentiali

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.

Linking clinical narratives to standardized vocabularies and coding systems is a key component of unlocking the information in medical text for analysis. However, many domains of medical concepts lack well-developed terminologies that can support effective coding of medical text. We present a framework for developing natural language processing (NLP) technologies for automated coding of under-studied types of medical information, and demonstrate its applicability via a case study on physical mobility function. Mobility is a component of many health measures, from post-acute care and surgical outcomes to chronic frailty and disability, and is coded in the International Classification of Functioning, Disability, and Health (ICF). However, mobility and other types of functional activity remain under-studied in medical informatics, and neither the ICF nor commonly-used medical terminologies capture functional status terminology in practice. We investigated two data-driven paradigms, classification and candidate selection, to link narrative observations of mobility to standardized ICF codes, using a dataset of clinical narratives from physical therapy encounters. Recent advances in lang

Mobile health has the potential to revolutionize health care delivery and patient engagement. In this work, we discuss how integrating Artificial Intelligence into digital health applications-focused on supply chain, patient management, and capacity building, among other use cases-can improve the health system and public health performance. We present an Artificial Intelligence and Reinforcement Learning platform that allows the delivery of adaptive interventions whose impact can be optimized through experimentation and real-time monitoring. The system can integrate multiple data sources and digital health applications. The flexibility of this platform to connect to various mobile health applications and digital devices and send personalized recommendations based on past data and predictions can significantly improve the impact of digital tools on health system outcomes. The potential for resource-poor settings, where the impact of this approach on health outcomes could be more decisive, is discussed specifically. This framework is, however, similarly applicable to improving efficiency in health systems where scarcity is not an issue.

This research paper presents a meta-analysis of the multifaceted role of technology in mental health. The pervasive influence of technology on daily lives necessitates a deep understanding of its impact on mental health services. This study synthesizes literature covering Behavioral Intervention Technologies (BITs), digital mental health interventions during COVID-19, young men's attitudes toward mental health technologies, technology-based interventions for university students, and the applicability of mobile health technologies for individuals with serious mental illnesses. BITs are recognized for their potential to provide evidence-based interventions for mental health conditions, especially anxiety disorders. The COVID-19 pandemic acted as a catalyst for the adoption of digital mental health services, underscoring their crucial role in providing accessible and quality care; however, their efficacy needs to be reinforced by workforce training, high-quality evidence, and digital equity. A nuanced understanding of young men's attitudes toward mental health is imperative for devising effective online services. Technology-based interventions for university students are promising, al

In this paper, we present novel research methods for collecting and analyzing personal financial data alongside mental health factors, illustrated through a N=1 case study using data from one individual with bipolar disorder. While we have not found statistically significant trends nor our findings are generalizable beyond this case, our approach provides an insight into the challenges of accessing objective financial data. We outline what data is currently available, what can be done with it, and what factors to consider when working with financial data. More specifically, using these methods researchers might be able to identify symptomatic traces of mental ill health in personal financial data such as identifying early warning signs and thereby enable preemptive care for individuals with serious mental illnesses. Based on this work, we have also explored future directions for developing interventions to support financial wellbeing. Furthermore, we have described the technical, ethical, and equity challenges for financial data-driven assessments and intervention methods, as well as provided a broad research agenda to address these challenges. By leveraging objective, personalized

The Oregon Health Insurance Experiment (OHIE) offers a unique opportunity to examine the causal relationship between Medicaid coverage and happiness among low-income adults, using an experimental design. This study leverages data from comprehensive surveys conducted at 0 and 12 months post-treatment. Previous studies based on OHIE have shown that individuals receiving Medicaid exhibited a significant improvement in mental health compared to those who did not receive coverage. The primary objective is to explore how Medicaid coverage impacts happiness, specifically analyzing in which direction variations in healthcare spending significantly improve mental health: higher spending or lower spending after Medicaid. Utilizing instrumental variable (IV) regression, I conducted six separate regressions across subgroups categorized by expenditure levels and happiness ratings, and the results reveal distinct patterns. Enrolling in OHP has significantly decreased the probability of experiencing unhappiness, regardless of whether individuals had high or low medical spending. Additionally, it decreased the probability of being pretty happy and having high medical expenses, while increasing the

YouTube has rapidly emerged as a predominant platform for content consumption, effectively displacing conventional media such as television and news outlets. A part of the enormous video stream uploaded to this platform includes health-related content, both from official public health organizations, and from any individual or group that can make an account. The quality of information available on YouTube is a critical point of public health safety, especially when concerning major interventions, such as vaccination. This study differentiates itself from previous efforts of auditing YouTube videos on this topic by conducting a systematic daily collection of posted videos mentioning vaccination for the duration of 3 months. We show that the competition for the public's attention is between public health messaging by institutions and individual educators on one side, and commentators on society and politics on the other, the latest contributing the most to the videos expressing stances against vaccination. Videos opposing vaccination are more likely to mention politicians and publication media such as podcasts, reports, and news analysis, on the other hand, videos in favor are more li

Large AI models, or foundation models, are models recently emerging with massive scales both parameter-wise and data-wise, the magnitudes of which can reach beyond billions. Once pretrained, large AI models demonstrate impressive performance in various downstream tasks. A prime example is ChatGPT, whose capability has compelled people's imagination about the far-reaching influence that large AI models can have and their potential to transform different domains of our lives. In health informatics, the advent of large AI models has brought new paradigms for the design of methodologies. The scale of multi-modal data in the biomedical and health domain has been ever-expanding especially since the community embraced the era of deep learning, which provides the ground to develop, validate, and advance large AI models for breakthroughs in health-related areas. This article presents a comprehensive review of large AI models, from background to their applications. We identify seven key sectors in which large AI models are applicable and might have substantial influence, including 1) bioinformatics; 2) medical diagnosis; 3) medical imaging; 4) medical informatics; 5) medical education; 6) pu

Sonification can provide valuable insights about data but most existing approaches are not designed to be controlled by the user in an interactive fashion. Interactions enable the designer of the sonification to more rapidly experiment with sound design and allow the sonification to be modified in real-time by interacting with various control parameters. In this paper, we describe two case studies of interactive sonification that utilize publicly available datasets that have been described recently in the International Conference on Auditory Display (ICAD). They are from the health and energy domains: electroencephalogram (EEG) alpha wave data and air pollutant data consisting of nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone. We show how these sonfications can be recreated to support interaction utilizing a general interactive sonification framework built using ChucK, Unity, and Chunity. In addition to supporting typical sonification methods that are common in existing sonification toolkits, our framework introduces novel methods such as supporting discrete events, interleaved playback of multiple data streams for comparison, and using frequency modulation (FM) synth

A number of journal classification systems have been developed in bibliometrics since the launch of the Citation Indices by the Institute of Scientific Information (ISI) in the 1960s. These systems are used to normalize citation counts with respect to field-specific citation patterns. The best known system is the so-called "Web-of-Science Subject Categories" (WCs). In other systems papers are classified by algorithmic solutions. Using the Journal Citation Reports 2014 of the Science Citation Index and the Social Science Citation Index (n of journals = 11,149), we examine options for developing a new system based on journal classifications into subject categories using aggregated journal-journal citation data. Combining routines in VOSviewer and Pajek, a tree-like classification is developed. At each level one can generate a map of science for all the journals subsumed under a category. Nine major fields are distinguished at the top level. Further decomposition of the social sciences is pursued for the sake of example with a focus on journals in information science (LIS) and science studies (STS). The new classification system improves on alternative options by avoiding the problem

We investigated the intersectional nature of race/racism and gender/sexism in broad scale inequities in physics student learning using a critical quantitative intersectionality. To provide transparency and create a nuanced picture of learning, we problematized the measurement of equity by using two competing operationalizations of equity: Equity of Individuality and Equality of Learning. These two models led to conflicting conclusions. The analyses used hierarchical linear models to examine student's conceptual learning as measured by gains in scores on research-based assessments administered as pretests and posttests. The data came from the Learning About STEM Student Outcomes' (LASSO) national database and included data from 13,857 students in 187 first-semester college physics courses. Findings showed differences in student gains across gender and race. Large gender differences existed for White and Hispanic students but not for Asian, Black, and Pacific Islander students. The models predicted larger gains for students in collaborative learning than in lecture-based courses. The Equity of Individuality operationalization indicated that collaborative instruction improved equity b

Electronic Health Record (EHR) has become an essential tool in the healthcare ecosystem, providing authorized clinicians with patients' health-related information for better treatment. While most developed countries are taking advantage of EHRs to improve their healthcare system, it remains challenging in developing countries to support clinical decision-making and public health using a computerized patient healthcare information system. This paper proposes a novel EHR architecture suitable for developing countries--an architecture that fosters inclusion and provides solutions tailored to all social classes and socioeconomic statuses. Our architecture foresees an internet-free (offline) solution to allow medical transactions between healthcare organizations, and the storage of EHRs in geographically underserved and rural areas. Moreover, we discuss how artificial intelligence can leverage anonymous health-related information to enable better public health policy and surveillance.