The public health systems in Latin America are being transformed and restructured with the help of digital technologies and the use of Data analytics. This transformation is occurring in countries where there is a significant imbalance between the amount and quality of health care services provided, as well as between the institutions that provide these services, particularly in Peru. The increased use of digital health technologies, predictive analytics, and interoperable information systems in Peru provides an opportunity for the improvement of the overall performance of Peru's Public Health System through the use of digital health technologies and predictive analytics and therefore also the ability to allocate resources in a more equitable manner and provide improved epidemiological surveillance. In this review, the author examines the role of data analytics in strengthening Peru's public health systems, as well as the main structural, regulatory, and technology barriers inhibiting data analytics' implementation in Peru's public healthcare systems. A literature review was conducted using readily accessible peer-reviewed articles contained within institutional and governmental publications as well as international health governance documents found in Scopus, PubMed, SciELO, Web of Science, and Google Scholar from 2014 through 2026 for the subject areas of digital health, predictive analytics, interoperability, the use of artificial intelligence, and the ways in which these technologies affect the future of public health governance in Peru and throughout Latin America. The research highlights that analytics are improving how chronic diseases are monitored, how quickly diseases are detected, as well as improving the decision-making abilities of health systems and governments across multiple countries within Latin America. Additional barriers still exist in Peru; these include limited interoperability between healthcare organizations, unevenly distributed technology infrastructure, fragmented governance structures, an inadequate amount of technical resources, and continuing differences in the level of provision of technological resources in urban vs. rural areas. In addition, it was identified through the review that the mere adoption of technology alone will not result in a change; rather, it is essential that there be good institutional coordination for implementing and overseeing regulatory practices, ethical governance of the use of this technology, and development of a strategy for ensuring inclusiveness of implementation. Through its proposed integrated analytical framework, this study expands the public health literature by demonstrating how interoperability (including the impact of governance), predictive analytics and equity dimensions of healthcare systems are related to public health systems in Peru. Also, based on findings from this research, public health systems will need to invest for the long term in improving their infrastructure, creating modern regulatory schemes for digital health, training their workforce in using these tools, and developing policies designed to provide digital inclusion to all members of the community if they want to achieve a sustainable digital transformation.
Recent crises involving zoonotic diseases (Ebola, COVID-19, and Mpox) have highlighted the limitations of fragmented public health systems for the prevention and response to health emergencies at the international and continental level, and particularly in Africa, more specifically in the Democratic Republic of the Congo (DRC). In this context, the One Health (OH) approach and its extension, One Digital Health (ODH), articulated with the findable, accessible, interoperable, reusable (FAIR) principles, offer a framework for rethinking the digital transition in health in the DRC. This study analyzes the reality of this transition in Kinshasa, DRC, and questions the feasibility of ODH in this context. This study aimed to (1) explore how stakeholders across human, animal, and environmental health sectors perceive and experience digital tool integration and data interoperability in Kinshasa; (2) identify structural, institutional, and technical constraints affecting cross-sectoral data sharing; and (3) analyze the sociotechnical conditions required for the operationalization of ODH in a fragmented digital health (DH) context. A qualitative study was conducted in Kinshasa, DRC, between November 10, 2025, and November 25, 2025, combining semistructured interviews with key actors (health professionals, administrative officials, digital experts, and engaged citizens) and a document review of strategic and regulatory texts related to DH in the DRC. The data were analyzed using a thematic approach to identify the representations, uses, and constraints related to DH and the operationalization of ODH. Overall, 22 stakeholders participated (n=9, 40.9% human health; n=8, 36.4% animal health; n=4, 18.2% environmental health; n=1, 4.50% digital sector), predominantly male (n=15, 68.2%) and mainly in operational roles (n=12, 54.5%). Three interrelated topics emerged. First, a dual-track digital ecosystem characterized by the coexistence of formal platforms (eg, District Health Information Software 2 and electronic records) and informal tools (eg, WhatsApp [Meta]), with persistent paper-digital double-entry generating inefficiencies. Second, structural and governance bottlenecks, including electricity instability, limited connectivity, software incompatibility, external data-hosting concerns that affect sovereignty, and institutional silos that privilege human health over animal and environmental sectors. Third, prerequisites for operationalizing ODH emphasize foundational infrastructure (energy and internet), sustainable capacity building beyond one-off training, interoperable "bridges" between fragmented systems, and high-level political leadership. These elements were synthesized into an ODH-FAIR DRC conceptual model structured around three enabling pillars linking sectors for integrated zoonotic surveillance. Operationalizing ODH in DRC requires addressing foundational enablers beyond tools: synchronized energy-digital policies, decompartmentalized governance, and context-adapted capacity building. These insights inform low- and middle-income countries' DH strategies, urging donors and ministries to prioritize interoperability over isolated pilots to achieve sustainable zoonotic surveillance.
Understanding how Ukrainian refugee children accessed the health care system after fleeing the war is essential to inform future preparedness and resource allocation in host countries. To use latent class analysis of registry data to identify distinct health care utilization profiles among young Ukrainian refugee children who accessed the health care system in southern Poland in 2022. This registry-based retrospective cohort study used electronic health record data from 2022 and included Ukrainian refugee children, aged 0 to 5 years, who received health care services in facilities in Małopolska Voivodeship, Poland. Participants were followed up from February 24 through December 31, 2022. The data were analyzed from April to October 2025. Healthcare utilization indicators among postwar displaced Ukrainian refugee children used as inputs to the latent profile analysis. Latent profile membership of health care utilization based on health care visit types, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coded diagnoses, and intensity of health care use, with temporal patterns of system entry and service trajectories examined after profile identification. The analytic sample included 9845 Ukrainian refugee children aged 0 to 5 years (4849 [49.3%] female) who received 35 199 health care services in Małopolska Voivodeship in 2022. Age at first health care contact was evenly distributed across categories (mean [SD] of 2.7 [1.6] years), 3802 children (38.6%) had a single recorded service, 1845 (18.7%) had more than 5 services, and nearly half (4505 [45.8%]) received care in the regional capital (Krakow). Based on latent class analysis, 5 pediatric patient profiles were identified: mostly primary care (5216 [53.0%]), hospitalized with infectious diseases (1539 [15.6%]), highest health care use (1329 [13.5%]), emergency care for injuries (900 [9.1%]), and dental and preventive care (861 [8.7%]), differing in visit type, diagnostic patterns, and health care utilization intensity. Temporal patterns varied across profiles with earlier system entry among children requiring hospitalization for infectious diseases or emergency care for injuries, and later entry among those using primary care or dental and preventive care. In this cohort study of pediatric Ukrainian refugees in southern Poland, distinct health care utilization patterns were observed with early reliance on hospital and emergency care followed by greater use of primary services. These findings underscore the need for refugee-hosting countries to rapidly adapt health care resources, prioritizing inpatient and emergency care in the initial months following a crisis.
To reduce perinatal deaths, identification of their causes is paramount. 'The WHO application of ICD-10 to deaths during the perinatal period' (ICD-PM) was developed to improve the quality of perinatal death data. To determine stillbirth and very early neonatal death rates across 16 hospitals in Benin, Malawi, Tanzania, and Uganda, examine causes of death and associated maternal conditions applying the ICD-PM, and assess how a clinical perinatal e-registry performed when applying the ICD-PM. We used cross-sectional data collected between 1st July 2021 and 29th February 2024 of babies weighing ≥1000 g or ≥28 weeks of gestational age, born to women aged 13-50 years in the participating hospitals. After analyzing 143,105 births, the stillbirth rate was 36.9 per 1,000 births and very early neonatal death rate was 7.7 per 1,000 live births. Nine in ten antepartum stillbirths could not be assigned a cause of death. Among intrapartum stillbirths, the most common cause of death was 'disorders of fetal growth' and for very early neonatal death it was 'complications of intrapartum events'. The e-registry provided information to report on 17 out of the 24 ICD-PM categories. Collecting high-quality clinical data through an e-registry allowed the identification of a cause of death for most intrapartum stillbirths and very early neonatal deaths. A specifically designed clinical questionnaire and simple diagnostic procedures could enable the application of the ICD-PM in settings with limited diagnostic resources and high mortality rates. Main findings: After applying the International Classification of Diseases to Perinatal Mortality classification system to a clinical dataset, a cause of death or an associated maternal condition was established for the majority of perinatal deaths, while most intrapartum stillbirths were a consequence of disorders of fetal growth, complications of intrapartum events were the main cause of very early neonatal deaths.Added knowledge: This study reveals that collecting basic clinical information through a structured questionnaire in high-burden and resource-limited settings can support the application of the International Classification of Diseases to Perinatal Mortality.Global health impact for policy and action: This study highlights that despite revisions and updates are needed, the International Classification of Diseases to Perinatal Mortality is still a valuable instrument that could help better understand the pathways to perinatal death, thus contributing to the development of targeted prevention strategies.
Globally, the growth of ageing populations is significant, with more people requiring supported living environments, including residential aged care (RAC). Given the influence of the environment on health outcomes, it is important to consider approaches to evaluate aged care design, including both the built environment and products and technology. With the overarching aim to identify the scope of RAC-built environment and assistive technology design interventions and the way this data is captured methodologically, this review (i) identified methods and measures used to evaluate RAC-built environment and assistive technology design, and examined populations these methods and measures were used with, and (ii) mapped identified approaches to the International Classification of Functioning, Disability and Health (ICF). An a priori review protocol was developed, and a scoping review was then conducted. Eight databases were searched for publications between January 2000 and February 2023, resulting in 81 included studies, which were then mapped to ICF activity, participation and environment domains. Twenty methods and 16 methodologies were identified. Sixty-one articles collected data directly from resident populations, primarily including older adults (n = 52). Forty-nine publications reported on the evaluation of built design, 23 reported on products and technology, and nine reported on both, but with limited inclusion of valued participation as a goal or outcome. While some participatory methods were identified, 25% of the studies did not include consumer perspectives. Analyzing aged care design can identify ways to facilitate, or remove barriers to, healthier spaces and lives in RAC. Use of internationally recognized terminology and an integrative lens on the relationship between technology and environmental design is recommended.
Worldwide, around 1.9 million babies are stillborn, and 2.5 million newborns die soon after birth annually, the overwhelming majority occur in low- and middle-income countries (LMICs). Perinatal death has devastating impacts for families and communities, but not all parents receive adequate respectful bereavement support. Healthcare workers in LMICs often report that bereavement support is challenging, but few studies have explored factors that impact their confidence to deliver optimal care. To explore healthcare worker's views and experiences of factors impacting their confidence to provide bereavement support to parents after stillbirth or neonatal death in Malawi and Zimbabwe. Using qualitative approaches, a purposive sample of healthcare workers in four maternity facilities in Malawi and Zimbabwe was recruited. Guided by the principles of information power, six dual-moderated focus groups supplemented with eight individual in-depth interviews were conducted. The focus group discussions and interviews were audio-recorded and transcribed verbatim. Data were analyzed using the framework method. Sixty-six healthcare workers, including midwives, nurses, service managers, nurse educators, and doctors, participated. Two main themes were identified: (1) 'at least we tried our best' reflecting individual factors including feelings of inadequacy and insufficient education, and (2) 'as a facility we are not quite there yet' characterized by a lack of organizational support, feeling unsupported and a lack of continuing professional development. Findings highlight the need to address the individual and environmental barriers to providing support to bereaved women and families. Improving access to pre- and in-service education and training, mentorship and management support are potential solutions. Main Findings: Healthcare workers in LMICs lack confidence to provide support to women and families following stillbirths or neonatal deaths.Added knowledge: Sub-optimal working environments with lack of explicit clinical guidance, unavailability of education and lack of management priority and support are an important influence on lack of confidence.Global health impact for policy and action: Interventions targeting the enhancement of healthcare worker education and skills through context-specific guidelines and training provide a basis for increasing healthcare worker confidence.
Many frameworks and tools are available to evaluate the quality of mobile health apps (MHAs), which are increasingly used by health care professionals (HCPs) for accessing medical information, clinical decision support, and communication. However, existing tools are not well equipped to assess the quality of apps designed for HCPs from their perspectives. We aimed to develop a new tool based on the Mobile App Rating Scale (MARS) to capture the unique perspectives of HCPs on MHAs. We then conducted a psychometric analysis of this new questionnaire to determine its effectiveness in assessing the quality of MHAs designed specifically for HCPs from their perspectives. This study was conducted in 2 phases. In phase 1, the original MARS tool was adapted for HCPs through expert panel review and subsequent qualitative interviews, resulting in the development of the pMARS (MARS for health care professionals) tool. This phase focused on establishing face and content validity. Qualitative interviews were conducted with HCPs from a tertiary hospital in Singapore to gather their perspectives on the tool's structure, clarity, applicability, and usability. In phase 2, we invited HCP participants to complete pMARS based on their experience with the LabMed app, an mHealth tool designed to provide medical laboratory-related information to HCPs. We established the construct validity of pMARS through multiple psychometric techniques. Internal consistency reliability was measured using the Cronbach α, while structural equation modeling was used to examine the interrelationships among latent constructs. Additionally, we used item response theory (IRT) to evaluate each item's impact on latent constructs of interest, that is, discriminative performance of individual items within each domain. Based on the results from phase 1, the pMARS comprised 26 items across 5 domains: engagement, functionality, aesthetics, information, and subjective quality, refined through interviews with 10 HCPs. In phase 2 (n=218), pMARS demonstrated good internal consistency reliability across all domains (Cronbach α=0.855-0.931). Structural equation modeling demonstrated that functionality had the strongest influence on end-user willingness to use, recommend, and purchase the MHA (P<.001). IRT identified that customization and interactivity of the engagement domain had a weak impact on latent constructs, whereas entertainment had a higher impact. Ease of use and gestural design had a weak impact on the functionality domain, whereas arrangement and size of content and quantity and quality had a strong impact on the aesthetics and information domains, respectively. This study reports the development and psychometric analysis of pMARS. Our findings demonstrate strong internal consistency reliability and construct validity, supporting its potential use in health care. Further research should validate pMARS across diverse MHAs and contexts and apply IRT to further refine its precision and efficiency.
In super-aged societies such as Japan, achieving "healthy longevity with well-being" requires not only medical and long-term care services but also a seamless continuum that integrates health promotion, frailty prevention, and community-based support, along with age-friendly physical and social environments that support functional ability, social participation, and independent living. Within this framework, oral frailty (OF)-defined as the accumulation of slight declines in oral function, including tooth loss, chewing and swallowing difficulties, oral dryness, and low articulatory oral motor skills-has emerged as a key indicator linking oral health to systemic frailty, disability, and mortality. Originating in Japan, the concept of OF emphasizes early detection and reversibility through multidisciplinary collaboration. The 2024 Consensus Statement issued by three academic societies (the Japan Geriatrics Society, the Japanese Society of Gerodontology, and the Japanese Association on Sarcopenia and Frailty) proposed a definition, conceptual model, and assessment using the Oral Frailty 5-item Checklist (OF-5). This review summarizes the development of OF initiatives within Japan's Community-Based Integrated Care System and discusses recent international trends, including the WHO Global Oral Health Action Plan (2023-2030), the FDI policy statement "Oral Health for Healthy Ageing," and emerging global research evidence. Practical examples, such as a community-wide campaign in Hiratsuka City, illustrate multisectoral collaboration to prevent and raise awareness of OF. Finally, we highlight future directions, including integration of oral health into community development, strengthening interprofessional collaboration, and leveraging digital technologies for monitoring and education. By integrating clinical, community, and policy perspectives, the Japanese concept of OF offers a promising, implementable model for global healthy aging.
Since the launch of the Lancang-Mekong Cooperation in 2015, a core platform for regional health governance has been established. This paper systematically deconstructs 28 multilateral official documents issued between 2015 and 2024 by using policy text analysis to trace the logical trajectory of Lancang-Mekong health cooperation's development from project-driven initiatives to institutionalized governance. The study concludes that major public health emergencies within the region is the key factor to improve the institutional development and resource allocation of the system. This has expanded the cooperative agenda from initial joint prevention and control of infectious diseases to a comprehensive governance framework encompassing health service delivery, human resources, information systems, pharmaceutical products, health financing, and leadership and governance. By systematically analyzing achievements in building the six cornerstones of the health system, this paper reveals the platform's systemic integration advantages and collaborative governance effectiveness in addressing complex challenges. Based on the strategic requirement for quality enhancement and upgrading under "Lancang-Mekong Cooperation 2.0", this paper suggests continuing the efforts to improve the linkage between "water and health", fully implement the "One Health" approach, and accelerate digital health transformation to build a more resilient regional health community. 澜沧江-湄公河（澜湄）合作自2015年启动以来，已逐步演进为区域卫生治理的核心平台。本文采用政策文本分析法，对2015-2024年发布的28份多边官方文件进行系统分析，从而梳理澜湄卫生合作从项目驱动向制度化治理演进的逻辑路径。研究认为，区域内重大公共卫生事件是推动该机制深化制度建设与资源投入的关键驱动因素，促使合作议程由初期的传染病联防联控，全面拓展至涵盖卫生服务提供、人力资源、信息系统、医药产品、卫生筹资及领导力与治理在内的综合治理格局。文章通过对卫生体系六大基石建设成就的系统梳理，揭示了该平台在应对复杂挑战中的系统集成优势与协同治理效能。针对“澜湄2.0”提质升级的战略需求，本文提出应在深化“水与健康”联动、全面落实“同一健康”方针及加速数字健康转型等方面持续发力，以构建更具韧性的区域卫生健康共同体。.
To estimate the longitudinal interrelationship between health, personal, and environmental predictors of Quality of life (QOL) and their impact on QOL among older adults with heart or pulmonary diseases. This longitudinal study analyzed data from the International Mobility in Aging Study. Structural equation modeling, guided by Wilson and Cleary model, was used to estimate the relationships among baseline factors (depression, clinical and demographic variables), intermediate outcomes at two-year follow-up (self-efficacy, physical function, and health perception), and QOL at four-year follow-up. Multi-group analysis was conducted to assess differences in health predictors between lung and heart diseases. A total of 479 people were included, with 144 and 335 people reported having pulmonary and heart diseases, respectively. Among people with lung diseases, lower depression, multi-morbidity, and high self-efficacy, health perception, and physical function positively influenced QOL. Among people with heart diseases, lower depression, multi-morbidity, high level of hemoglobin, male gender, non-smoking, high self-efficacy, health perception, and physical function were positively associated with QOL. Heart and pulmonary conditions showed some variations in the strength and significance of these associations; however, multi-group analysis revealed no statistically significant differences between groups. QOL in older adults with heart or lung conditions is associated with a number of interrelated factors, including physical function, psychological factors, and health perception. The results highlight the importance of comprehensive assessment using patient-reported outcome measures and support multidisciplinary rehabilitation and self-management approaches that address physical and psychological burden.
To close gaps in implementing care of people with hepatitis B virus (HBV) infection in resource-limited settings, we evaluated the accuracy of a novel liver point-of-care ultrasound (POCUS) protocol for hepatitis (PUSH) among front-line non-radiology healthcare workers in Zambia. At University Teaching Hospital in Lusaka, Zambia, from March to June 2024, we trained four nurses and six physicians with experience in HBV management, but not in ultrasound (US), in the PUSH protocol, which includes visualizing the liver in three windows (epigastric, subcostal and right transcostal) to identify cirrhosis-suggestive features and liver lesions suspicious for hepatocellular carcinoma (HCC). Then, consecutive adult participants with chronic hepatitis B (PWHB) alone or HBV/HIV coinfection underwent PUSH with operators blinded to clinical data. We evaluated the accuracy of PUSH for significant fibrosis and cirrhosis using transient elastography (TE) as the reference standard test (RST) and for liver lesions that were possible HCC using a comprehensive abdominal ultrasound by an experienced radiographer as the RST. Nonparametric analysis of the receiver operating curve (ROC) for PUSH was adjusted for operator type (doctor vs. nurse), sex and HIV status. Among 197 PWHBs analysed, 69.5% were taking HBV antivirals and 27.9% had HBV/HIV. According to RSTs, 17.7% of PWHBs had significant fibrosis, 11.6% had cirrhosis and 3.5% had liver lesions. PUSH had low accuracy for significant fibrosis, with sensitivity of 8.3% (17.5-41.4), specificity of 100.0% (96.1-100) and an area under the curve (AUROC) of 0.54 (0.43-0.65), moderate accuracy for cirrhosis, with sensitivity of 60.9% (38.5-80.3), specificity of 97.7% (94.2-99.4) and AUROC of 0.79 (0.69-0.89), and higher accuracy for liver lesions, with 85.7% (42.1-99.6) sensitivity, 98.4% (95.5-99.7) specificity, AUROC of 0.92 (0.78-1.00). After an expedited training, front-line nurses and physicians treating HBV in Zambia were able to use PUSH to diagnose cirrhosis with moderate accuracy and liver lesions with high accuracy, although confidence intervals around performance estimates were wide. Liver POCUS including PUSH may be useful in HBV management when laboratory systems and TE are lacking.
Traditional epidemiological surveillance methods are often limited by delays in reporting and fragmented data systems. Saudi Arabia faces additional public health challenges from mass gatherings during Hajj and Umrah, an increasing burden of noncommunicable diseases and rapid urbanization, highlighting the need for investing in digital epidemiology. Saudi Arabia has accelerated digital transformation in health care through Vision 2030 initiatives. The strategies include health information exchange platforms, analytics driven by artificial intelligence, telemedicine services and digital monitoring systems used during Hajj. We review current initiatives to invest in digital epidemiology in Saudi Arabia, implementation challenges and policy priorities. Saudi Arabia's health system operates under a predominantly public model. The health ministry is the main provider, regulator and finance provider of most health-care services. Health-care coverage is nearly universal, with citizens receiving services free of charge through the public system. Ongoing reforms aim to gradually decentralize certain functions. The initiatives under Vision 2030 have supported disease surveillance, data integration and public health response capacities. Existing digital health reforms have created a foundation for integrating digital epidemiology into routine public health practice. However, challenges remain, including fragmented interoperability between institutions, workforce shortages, unequal digital access, and concerns about data governance, privacy and algorithmic bias. Saudi Arabia's experience suggests that digital epidemiology is more effective when integrated within broader digital health reforms. Successful implementation requires not only digital infrastructure, but also workforce development, ethical governance, transparency and mechanisms for integrating digital data into public health decision-making. Les méthodes traditionnelles de surveillance épidémiologique sont souvent limitées par des retards dans la transmission des données et par la fragmentation des systèmes de données. L’Arabie saoudite est confrontée à des défis supplémentaires en matière de santé publique liés aux rassemblements de masse lors du Hajj et de la Omra, au fardeau croissant des maladies non transmissibles et à l’urbanisation rapide, ce qui souligne la nécessité d’investir dans l’épidémiologie numérique. L’Arabie saoudite a accéléré la transformation numérique dans le domaine des soins de santé grâce aux initiatives de la Vision 2030. Ces stratégies comprennent des plateformes d’échange d’informations de santé, des analyses alimentées par l’intelligence artificielle, des services de télémédecine et des systèmes de surveillance numérique employés pendant le Hajj. La présente étude passe en revue les initiatives actuelles visant à investir dans l’épidémiologie numérique en Arabie saoudite, les défis liés à leur mise en œuvre et les priorités politiques. Le système de santé saoudien fonctionne selon un modèle majoritairement public. Le ministère de la Santé est le principal prestataire, régulateur et bailleur de fonds de la plupart des services de santé. La couverture des soins de santé est pratiquement universelle, les citoyens bénéficiant de services gratuits au travers du système public. Les réformes en cours visent à décentraliser progressivement certaines fonctions. Les initiatives menées dans le cadre de la Vision 2030 ont favorisé la surveillance des maladies, l’intégration des données et le renforcement des capacités d’intervention de santé publique. Les réformes existantes en matière de santé numérique ont jeté les bases nécessaires à l’intégration de l’épidémiologie numérique dans les pratiques courantes de santé publique. Toutefois, des défis subsistent, notamment le manque d’interopérabilité entre les établissements, la pénurie de main-d’œuvre, les inégalités d’accès au numérique, ainsi que des préoccupations en matière de gouvernance des données, de confidentialité et de biais dû aux algorithmes. L’expérience de l’Arabie saoudite suggère une plus grande efficacité de l’épidémiologie numérique lorsque celle-ci s’inscrit dans le cadre de réformes plus larges en matière de santé numérique. La réussite de la mise en œuvre nécessite non seulement une infrastructure numérique, mais aussi le développement des ressources humaines, une gouvernance éthique, la transparence ainsi que des mécanismes d’intégration des données numériques dans la prise de décision en matière de santé publique. Los métodos tradicionales de vigilancia epidemiológica suelen verse limitados por retrasos en la notificación y por sistemas de datos fragmentados. Arabia Saudí se enfrenta además a desafíos de salud pública derivados de las concentraciones masivas de personas durante el Hach y la Umrah, del aumento de la carga de las enfermedades no transmisibles y de la rápida urbanización, lo que destaca la necesidad de invertir en epidemiología digital. Arabia Saudí ha acelerado la transformación digital de la atención sanitaria mediante las iniciativas de la Visión 2030. Las estrategias incluyen plataformas de intercambio de información sanitaria, análisis basados en inteligencia artificial, servicios de telemedicina y sistemas digitales de vigilancia utilizados durante el Hach. Se examinan las iniciativas actuales de inversión en epidemiología digital en Arabia Saudí, los desafíos para su implementación y las prioridades en materia de políticas. El sistema sanitario de Arabia Saudí funciona bajo un modelo predominantemente público. El ministerio de salud es el principal proveedor, regulador y financiador de la mayoría de los servicios sanitarios. La cobertura sanitaria es prácticamente universal y la ciudadanía recibe servicios gratuitos a través del sistema público. Las reformas en curso tienen por objeto descentralizar gradualmente determinadas funciones. Las iniciativas de la Visión 2030 han fortalecido la vigilancia de enfermedades, la integración de datos y la capacidad de respuesta en salud pública. Las reformas existentes en materia de salud digital han creado una base para integrar la epidemiología digital en la práctica habitual de la salud pública. No obstante, persisten desafíos, entre ellos la interoperabilidad fragmentada entre instituciones, la escasez de personal, las desigualdades en el acceso digital y las preocupaciones relacionadas con la gobernanza de los datos, la privacidad y los sesgos algorítmicos. La experiencia de Arabia Saudí sugiere que la epidemiología digital es más eficaz cuando se integra en reformas más amplias de salud digital. Su implementación satisfactoria requiere no solo infraestructura digital, sino también desarrollo de capacidades del personal, gobernanza ética, transparencia y mecanismos para incorporar los datos digitales a la toma de decisiones en salud pública. غالبًا ما تكون طرق الرصد الوبائي التقليدية محدودة بسبب التأخيرات في الإبلاغ وأنظمة البيانات المشتتة. وتواجه المملكة العربية السعودية تحديات إضافية في مجال الصحة العامة نتيجة للتجمعات الكبيرة خلال موسمي الحج والعمرة، وتزايد عبء الأمراض غير المعدية، والتوسع الحضري السريع، مما يُبرز الحاجة إلى الاستثمار في علم الأوبئة الرقمي. سارعت المملكة العربية السعودية في التحول الرقمي في مجال الرعاية الصحية من خلال مبادرات رؤية 2030. وتشمل هذه الاستراتيجيات منصات تبادل المعلومات الصحية، والتحليلات المدعومة بالذكاء الاصطناعي، وخدمات العلاج الطبي عن بُعد، وأنظمة المراقبة الرقمية المستخدمة خلال موسم الحج. نستعرض في هذا البحث المبادرات الحالية للاستثمار في علم الأوبئة الرقمي في المملكة العربية السعودية، وتحديات التنفيذ، وأولويات السياسة الحكومية. يعمل النظام الصحي في المملكة العربية السعودية بموجب نموذج حكومي بشكل رئيسي. وتُعد وزارة الصحة هي المزود الرئيسي، والجهة المنظمة، والممول لمعظم خدمات الرعاية الصحية. وتعد تغطية الرعاية الصحية شاملة تقريبًا، حيث يحصل المواطنون على الخدمات مجانًا من خلال النظام الحكومي. وتهدف الإصلاحات الجارية إلى تطبيق اللامركزية تدريجيًا على وظائف محددة. إن المبادرات بموجب رؤية 2030 تدعم رصد الأمراض، وتكامل البيانات، وقدرات الاستجابة في مجال الصحة العامة. لقد أدت إصلاحات الصحة الرقمية إلى إنشاء أساس لدمج علم الأوبئة الرقمي في ممارسات الصحة العامة الروتينية. ومع ذلك، لا تزال هناك تحديات، تشمل التشغيل المشترك المشتت بين المؤسسات، ونقص الكوادر، والوصول غير العادل إلى البيانات الرقمية، والمخاوف المتعلقة بحوكمة البيانات، والخصوصية، والتحيز الخوارزمي. تشير تجربة المملكة العربية السعودية إلى أن علم الأوبئة الرقمي يكون أكثر فعالية عند دمجه ضمن إصلاحات أوسع نطاقًا في مجال الصحة الرقمية. ويتطلب التنفيذ الناجح ليس فقط بنية تحتية رقمية، بل أيضًا تطوير القوى العاملة، والحوكمة الأخلاقية، والشفافية، وآليات دمج البيانات الرقمية في عملية صنع القرار في مجال الصحة العامة. 传统流行病学监测手段常受制于报告滞后与数据系统碎片化的问题。沙特阿拉伯还面临朝觐与副朝期间大型聚众活动、非传染性疾病负担攀升以及快速城市化带来的额外公共卫生难题，凸显出投资发展数字流行病学的必要性。. 沙特阿拉伯依托《2030 愿景》(Vision 2030) 相关举措，加快推进医疗健康领域数字化转型。相关举措包括医疗信息交互平台、人工智能驱动的数据分析、远程医疗服务以及朝觐期间启用的数字化监测系统。本文梳理了沙特阿拉伯的当前数字流行病学投资项目、项目实施方面的挑战及政策优先发展方向。. 沙特阿拉伯的医疗卫生体系以公立运营模式为主。卫生部是大多数医疗护理服务的主要提供方、监管机构和出资主体。医疗卫生保障基本实现全民覆盖，本国公民可通过公立医疗体系免费就医。现行改革旨在逐步下放部分职能。. 《2030 愿景》框架下的各项举措，助力完善疾病监测、数据整合与公共卫生应急处置能力建设。现有的数字医疗改革为将数字流行病学融入常规公共卫生工作奠定了基础。然而，仍存在一些挑战：医疗机构间数据互通割裂、人才短缺、数字资源获取不均衡，以及数据治理、隐私安全与算法偏见等隐患问题。. 沙特阿拉伯的实践经验表明，将数字流行病学融入大范围数字医疗改革体系中，其实施成效更佳。实施成功不仅需要数字化基础设施，还需人才队伍建设、合规伦理治理、信息公开制度，以及把数字化数据纳入公共卫生决策的配套机制。. Традиционные методы эпидемиологического надзора часто ограничены задержками в предоставлении отчетности и фрагментированностью систем данных. Саудовская Аравия сталкивается с дополнительными проблемами общественного здравоохранения, связанными с массовыми скоплениями людей во время хаджа и умры, растущим бременем неинфекционных заболеваний и стремительной урбанизацией. Все это подчеркивает необходимость инвестиций в цифровую эпидемиологию. Саудовская Аравия ускорила цифровую трансформацию здравоохранения в рамках инициатив программы Vision 2030. Среди ключевых направлений – платформы для обмена медицинской информацией, аналитические системы на основе искусственного интеллекта, телемедицинские сервисы и цифровые системы мониторинга, используемые во время хаджа. Авторы рассматривают текущие инвестиционные инициативы в области цифровой эпидемиологии в Саудовской Аравии, проблемы внедрения и приоритетные направления политики. Система здравоохранения Саудовской Аравии опирается преимущественно на государственную модель. Министерство здравоохранения является основным поставщиком медицинских услуг, регулятором и главным источником финансирования большинства медико-санитарных услуг. Охват медицинской помощью практически всеобщий: граждане получают услуги бесплатно через государственную систему. Текущие реформы направлены на постепенную децентрализацию отдельных функций. Инициативы в рамках программы Vision 2030 способствовали развитию эпидемиологического надзора, интеграции данных и укреплению потенциала реагирования системы общественного здравоохранения. Проводимые реформы в области цифрового здравоохранения заложили фундамент для внедрения цифровой эпидемиологии в повседневную практику общественного здравоохранения. Однако сохраняются проблемы, включая недостаточную совместимость информационных систем разных учреждений, нехватку кадров, неравномерный доступ к цифровым технологиям, а также вопросы управления данными, конфиденциальности и алгоритмической предвзятости. Опыт Саудовской Аравии показывает, что цифровая эпидемиология наиболее эффективна, когда интегрирована в более широкие реформы цифрового здравоохранения. Для успешного внедрения необходима не только цифровая инфраструктура, но и развитие кадрового потенциала, этическое регулирование, прозрачность и механизмы интеграции цифровых данных в процессы принятия решений в сфере общественного здравоохранения.
Anemia among children under five remains a major public health problem in the Democratic Republic of Congo (DRC), affecting growth, cognitive development, and overall child health. We estimated the prevalence, spatial distribution, and determinants of anemia and identified high-risk geographic areas using multilevel and spatial analyses. We analyzed data from 11,393 children aged 6-59 months from the 2023-24 Democratic Republic of Congo Demographic and Health Survey (DHS). Weighted prevalence estimates were calculated, and multilevel mixed-effects logistic regression was used to assess individual- and community-level determinants of anemia. We applied Moran's I, hotspot detection, Kriging interpolation, and SaTScan analyses to identify high-risk areas. Model performance was evaluated using AIC, BIC, and log-likelihood ratio tests to ensure the results were reliable. Overall, 51.7% of children (95% CI: 49.5%-53.9%) were anemic, most cases were mild (25.6%) or moderate (25.0%), while severe anemia was rare (1.1%). Prevalence was highest among infants 0-5 months (56.2%) and boys (52.5%) than girls (50.8%). Key risk factors for anemia included wasting (AOR = 1.29), malaria infection (AOR = 1.21), high community malaria risk (AOR = 1.42), and low altitude (AOR = 1.39). Children were less likely to be anemic if their mothers were overweight (AOR = 0.66), if they came from wealthier households (AOR = 0.77), or if they lived in moderately sized families (AOR = 0.84). Spatial analysis revealed high-prevalence areas in Haut-Lomami, Maniema, and Tshuapa, whereas lower prevalence was seen in Haut-Uele and Nord Ubangi. Anemia among under-five children in the DRC is geographically clustered and influenced by both individual- and community-level factors. Targeted and integrated interventions focusing on malaria prevention, nutrition, and maternal health are needed in high-burden areas.
Fragmentation of health information systems remains a major barrier to effective health system performance across Europe, particularly in decentralized settings. Federated data infrastructures have been proposed as a scalable solution, but evidence on their implementation at population level remains limited. We aimed to describe the implementation of a federated information infrastructure at regional level and assess the completeness and variability of linked data across participating centers, discussing implications of scaling up the approach within the European Health Data Space. We carried out a population-based cohort study linking administrative, clinical, and patient-reported data across three healthcare organizations in Emilia-Romagna, Italy, covering over 2.1 million residents. Data were analyzed using a federated architecture without sharing individual-level information. Baseline characteristics were assessed at 1 January 2019, with longitudinal follow-up over 6 years. We identified 116,552 individuals with diabetes (prevalence 5.6%). Among individuals with available classification, 90.8% had type 2 diabetes. Clinical data were available for 43.5% of patients in charge of diabetes clinics, with substantial heterogeneity across centers (12.8-80.6%). Among those with clinical data, 27.5% had baseline HbA1c levels below 48 mmol/mol, while 69% had elevated systolic pressure (≥130 mmHg) and 56.6% had high diastolic pressure (≥80 mmHg). Sociodemographic variables were largely missing. Patient-reported outcomes were collected in 521 individuals, demonstrating feasibility but limited scalability. Federated linkage of administrative, clinical, and patient-reported data is feasible at regional scale and enables population-level monitoring of diabetes care. However, variability in data completeness was primarily driven by organizational and governance factors rather than technical capacity. These findings provide empirical evidence that strengthening health data systems requires alignment of healthcare organization and service delivery models, beyond technical solutions alone. The REWINDER project built a collaborative information infrastructure using federated linkage of different data sources and person-reported outcomes, independently managed by local healthcare organizations. The project has made available a large database to inform policy and planning of diabetes care across the region. The system may be used as a model that can be conveniently scaled up to other geographical areas and chronic diseases.
Ultra-processed foods (UPFs) are increasingly prevalent in global diets and have been consistently associated with adverse health outcomes. Their consumption during sensitive life stages, such as pregnancy and early childhood, raises significant public health concerns due to potential intergenerational effects. This narrative review critically examines the impact of UPF consumption during pregnancy and early life, with a focus on maternal and child health outcomes, including alterations in gut microbiota composition. Accumulating evidence indicates that UPF consumption is linked to increased risks of obesity, type 2 diabetes, cardiovascular disease, and all-cause mortality. During pregnancy, high UPF intake is associated with poorer diet quality, excessive gestational weight gain, increased inflammation, and unfavorable neonatal outcomes, including altered microbiota transmission and impaired neurodevelopment. In early childhood, UPFs were linked to microbiota dysbiosis, obesity, micronutrient deficiencies, and allergic conditions. Notably, maternal dietary pattern strongly influences the early and sustained incorporation of UPFs into children's diets. Overall, UPF consumption during pregnancy and early childhood represents a modifiable risk factor with far-reaching health implications. A deeper understanding of the dietary-microbiome-health axis is essential for developing effective nutritional strategies to optimize maternal and child health outcomes and reduce long-term disease risks.
Continuity of care is essential in psychiatric services due to the chronic, relapsing nature of mental health conditions, yet care pathways remain heavily fragmented at critical transition points. Although advancements in AI and machine learning (ML) offer powerful capabilities to track longitudinal data and automate clinical decision-making, a structured appraisal of their efficacy in supporting continuity of psychiatric care is lacking. This protocol outlines a mixed methods systematic review to evaluate how AI-driven workflows can proactively enhance monitoring, optimize triage and care resource allocation, and address systemic coordination gaps. The primary objective of this systematic review is to evaluate the effectiveness of AI and ML interventions in psychiatric care settings in improving the continuity of patient care. Secondary objectives include stratifying the types of AI architectures used and identifying implementation barriers and facilitators. A systematic literature search of MEDLINE, Embase, CENTRAL, CINAHL, and APA PsycInfo will be conducted to identify peer-reviewed randomized controlled trials, nonrandomized interventional studies, and qualitative or mixed methods evaluations published between January 1, 2016, and December 31, 2025. Two independent reviewers will perform study screening, data extraction, and quality assessment. A mixed methods convergent synthesis using the Joanna Briggs Institute (JBI) convergent segregated approach will be carried out to synthesize quantitative evidence on effectiveness and qualitative data on implementation. This review is self-funded and was officially registered with PROSPERO on January 24, 2026 (CRD420251245352). Comprehensive database searches have commenced, with full-text screening and transcript reviews projected to conclude by late August 2026, followed by data analysis and submission of the systematic review manuscript targeted for early spring 2027. By systematically mapping interventions across patient, institutional, and health system levels, this review will clarify the clinical effectiveness, ethical boundaries, and logistical implementation factors of psychiatric AI tools. Ultimately, these consolidated insights will provide an evidence-based foundation to inform clinical guidelines; governance frameworks; and the design of proactive, learning mental health systems. PROSPERO CRD420251245352; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251245352. PRR1-10.2196/95931.
Pakistan is confronting the climate crisis as an immediate and systemic threat to national health security rather than an environmental concern. Recurrent floods between 2022 and 2025 affected more than 26 million people, damaged health infrastructure, disrupted essential services, and placed the country at the top of the Germanwatch Climate Risk Index. These shocks have intensified pre-existing health system fragilities by driving surges in malaria, waterborne infections, malnutrition, antimicrobial resistance, and forced displacement, while constraining routine service delivery. Climate-related migration to peri-urban informal settlements has created new epidemiological vulnerabilities characterized by overcrowding, poor sanitation, and outbreaks such as extensively drug-resistant typhoid. Simultaneously, crop losses and food system disruption have worsened child undernutrition in districts already exceeding emergency thresholds, with women and children disproportionately affected because of structural barriers to maternal, neonatal, and immunization services. Climate variability is also increasing the risk of zoonotic spillover and undermining progress toward Universal Health Coverage. We argue that climate change functions as a threat multiplier for Pakistan's health security and must be systematically integrated into health policy and planning. Key priorities include climate-resilient health infrastructure, strengthened integrated surveillance using digital and geospatial tools, prevention-oriented primary care, and operationalization of a One Health framework. Effective intersectoral governance, provincial implementation, and sustained collaboration with international partners, including the World Health Organization, are essential for building a resilient health system capable of maintaining continuity of care during increasingly frequent climate shocks.
Rare diseases affect a small percentage of the population but collectively impact millions worldwide. In the Middle East, the challenges are intensified by regional factors such as high rates of consanguinity, sociocultural stigma, limited diagnostic capacity, and inadequate healthcare infrastructure. These challenges often lead to delayed diagnoses, restricted access to treatment, and poor quality of life for affected individuals and their families. The Rare Advocacy Council conducted two 1.5-hour virtual expert panels involving 14 regional and international stakeholders (5 clinicians, 4 patient advocates, and 5 international academic experts) to identify and prioritize the challenges of managing rare diseases in the Middle East region. Discussions were organized across four domains: disease recognition and diagnosis, the patient journey and continuum of care, access to timely diagnostics, and access to adequate treatment, followed by structured online voting (involving only clinicians and patient advocates; n = 9), discussions focused on prioritization, and a descriptive follow-up survey to identify the most critical barriers and propose actionable solutions. Key challenges identified included the lack of national disease registries, limited public awareness, underrepresentation of patient voices in decision-making, fragmented multidisciplinary care, and restricted access to diagnostics and advanced therapies. Top priorities included developing national registries, enhancing media-driven education, strengthening collaboration among care providers, and improving treatment accessibility through policy reforms. Effective management of rare diseases in the Middle East requires a coordinated, patient-centered approach. Strengthening health system infrastructure, investing in education, and aligning policy with patient needs are essential for sustainable improvement. Collaborative action among policymakers, healthcare providers, and advocacy groups can significantly advance care delivery and improve outcomes for individuals living with rare diseases.
Fragmented primary health care in China fails to tackle the growing burden of noncommunicable diseases. Despite substantial investment, fewer than half of patients with diabetes achieve glycaemic control. Tianjin's 2020-2023 reform established a public-private partnership model where WeDoctor managed community health centres under a capitation scheme. This strategy integrated: (i) monthly prepaid capitation covering all diabetes-related outpatient services; (ii) claims auditing and clinical decision support using artificial intelligence (AI); (iii) dedicated health managers for care coordination; and (iv) redesigned services incorporating complication screening and digital medication management. A pilot study including 494 945 patients with diabetes compared three care models from 2022 to 2023: WeDoctor-community health centre care, hospital care and usual care. Tianjin city serves 15 million residents through 177 hospitals and 266 community health centres. Chronic disease management is fragmented: the Health Commission regulates care standards, while the Insurance Bureau controls funding. Visits for diabetes at WeDoctor health centres increased 2.6% (0.7/26.6) but declined 10.6% (-3.8/35.7) for hospital-based care and 2.3% (-0.8/34.1) for usual care. All groups reduced outpatient expenditure. The WeDoctor model generated a 37.62 million United States dollars (US$) surplus, boosted health centre diabetes revenue by 65% (US$ 154 577/237 805) and raised physician annual salaries by 30% (US$ 5172/17 241). More than three quarters of patients expressed satisfaction with and trust in the WeDoctor model. Integrating capitation financing with third-party governance and AI support can strengthen primary health care, contain costs and enhance patient-centred care. La fragmentation des soins de santé primaires en Chine ne permet pas de faire face au fardeau croissant des maladies non transmissibles. Malgré des investissements considérables, moins de la moitié des patients diabétiques parviennent à contrôler leur glycémie. La réforme de Tianjin pour la période 2020–2023 a mis en place un modèle de partenariat public-privé dans le cadre duquel WeDoctor gérait les centres de santé communautaires selon un système de forfait par habitant. Cette stratégie intégrait: (i) un forfait mensuel prépayé couvrant tous les services de consultation externe liés au diabète; (ii) un audit des demandes de remboursement et un soutien aux décisions cliniques à l’aide de l’intelligence artificielle (IA); (iii) des cadres de santé dédiés à la coordination des soins; et (iv) des services repensés pour intégrer le dépistage des complications et la gestion numérique des médicaments. Une étude pilote portant sur 494 945 patients diabétiques a comparé trois modèles de soins entre 2022 et 2023: les soins dispensés par WeDoctor et les centres de santé communautaires, les soins hospitaliers et les soins habituels. La ville de Tianjin dessert 15 millions d’habitants grâce à 177 hôpitaux et 266 centres de santé communautaires. La prise en charge des maladies chroniques est fragmentée: la Commission de la santé réglemente les normes de soins, tandis que le Bureau des assurances oriente le financement. Les consultations pour le diabète dans les centres de santé WeDoctor ont augmenté de 2,6% (0,7/26,6), mais ont diminué de 10,6% (−3,8/35,7) pour les soins hospitaliers et de 2,3% (−0,8/34,1) pour les soins habituels. Tous les groupes ont réduit leurs dépenses pour des soins ambulatoires. Le modèle WeDoctor a généré un excédent de 37,62 millions de dollars américains (USD), augmenté les recettes des centres de santé liées au diabète de 65% (154 577 / 237 805 USD) et accru de 30% les salaires annuels des médecins (5 172 / 17 241 USD). Plus des trois quarts des patients ont exprimé leur satisfaction et leur confiance dans le modèle WeDoctor. L’intégration du financement par forfait à une gouvernance par des tiers et à un soutien par l’IA permet de renforcer les soins de santé primaires, de maîtriser les coûts et d’améliorer les soins axés sur le patient. La fragmentación de la atención primaria de salud en China no logra hacer frente a la creciente carga de las enfermedades no transmisibles. A pesar de las importantes inversiones realizadas, menos de la mitad de los pacientes con diabetes logran un control glucémico adecuado. La reforma aplicada en Tianjin entre 2020 y 2023 estableció un modelo de asociación público-privada en el que WeDoctor gestionaba centros comunitarios de salud mediante un sistema de capitación. Esta estrategia integró: (i) una capitación mensual prepagada que cubría todos los servicios ambulatorios relacionados con la diabetes; (ii) la auditoría de reclamaciones y el apoyo a la toma de decisiones clínicas mediante inteligencia artificial (IA); (iii) gestores sanitarios dedicados a la coordinación asistencial; y (iv) servicios rediseñados que incorporaban el cribado de complicaciones y la gestión digital de la medicación. Un estudio piloto que incluyó a 494 945 pacientes con diabetes comparó tres modelos asistenciales entre 2022 y 2023: la atención prestada por WeDoctor en centros comunitarios de salud, la atención hospitalaria y la atención habitual. La ciudad de Tianjin presta servicios a 15 millones de habitantes a través de 177 hospitales y 266 centros comunitarios de salud. La gestión de las enfermedades crónicas está fragmentada: la Comisión de Salud regula los estándares asistenciales, mientras que la Oficina de Seguros controla la financiación. Las consultas por diabetes en los centros de salud de WeDoctor aumentaron un 2,6% (0,7/26,6), mientras que disminuyeron un 10,6% (-3,8/35,7) en la atención hospitalaria y un 2,3% (-0,8/34,1) en la atención habitual. Todos los grupos redujeron el gasto ambulatorio. El modelo WeDoctor generó un superávit de US$ 37,62 millones, aumentó en un 65% los ingresos por atención de la diabetes en los centros de salud (US$ 154 577/237 805) e incrementó en un 30% los salarios anuales de los médicos (US$ 5172/17 241). Más de tres cuartas partes de los pacientes expresaron satisfacción y confianza en el modelo WeDoctor. La integración de la financiación mediante capitación con la gobernanza por terceros y el apoyo de la IA puede fortalecer la atención primaria de salud, contener los costes y mejorar la atención centrada en el paciente. تعجز الرعاية الصحية الأولية المجزأة في الصين عن مواجهة العبء المتزايد الناتج عن الأمراض غير المعدية. والرغم من الاستثمارات الضخمة، فإن أقل من نصف مرضى السكري يحققون السيطرة على مستوى السكر في الدم. أدت الإصلاحات في مدينة تيانجين خلال الفترة من 2020 إلى 2023 لتأسيس نموذج للشراكة بين القطاعين العام والخاص، حيث تولت شركة WeDoctor إدارة المراكز الصحية المجتمعية ضمن نظام الدفع الفردي. وقد اشتملت هذه الاستراتيجية على ما يلي: (1) دفع شهري مسبق يغطي جميع خدمات العيادات الخارجية المتعلقة بمرض السكري؛ و(2) تدقيق المطالبات ودعم القرارات الإكلينيكية باستخدام الذكاء الاصطناعي؛ و(3) مديرين للرعاية الصحية متخصصين لتنسيق الرعاية؛ و(4) خدمات أُعيد تنسيقها لتشمل فحص المضاعفات والإدارة الرقمية للأدوية. وقد قارنت دراسة تجريبية، شملت 494945 مريضًا بمرض السكري، بين ثلاثة نماذج للرعاية خلال الفترة من 2022 إلى 2023: الرعاية المقدمة في مراكز WeDoctor الصحية المجتمعية، والرعاية في المستشفيات، والرعاية المعتادة. تخدم مدينة تيانجين 15 مليون نسمة من خلال 177 مستشفى و266 مركزًا صحيًا مجتمعيًا. يتسم نظام إدارة الأمراض المزمنة بأنها مجزأة، حيث تتولى لجنة الصحة تنظيم معايير الرعاية، بينما يتحكم مكتب التأمين في التمويل. ارتفعت زيارات مرضى السكري إلى مراكز WeDoctor الصحية بنسبة %2.6 (0.7/26.6)، بينما انخفضت بنسبة %10.6 (3.8-/35.7) للرعاية المقدمة في المستشفيات، وبنسبة %2.3 (0.8-/34.1) للرعاية المعتادة. وقد خفضت جميع المجموعات نفقات العيادات الخارجية. وحقق نموذج WeDoctor فائضًا قدره 37.62 مليون دولار أمريكي، ورفع عائد خدمات مرض السكري في مراكز الرعاية الصحية بنسبة %65 (154577/237805 دولارًا أمريكيًا)، ورفع الرواتب السنوية للأطباء بنسبة %30 (5172/17241 دولارًا أمريكيًا). وأعرب أكثر من ثلاثة أرباع المرضى عن رضاهم وثقتهم بنموذج WeDoctor. إن دمج تمويل الدفع الفردي مع حوكمة الجهة الخارجية، ودعم الذكاء الاصطناعي، يمكن أن يعزز الرعاية الصحية الأولية، ويحد من التكاليف، ويعزز الرعاية التي تركز على المريض. 中国基层医疗卫生比较分散，难以应对非传染性疾病日益严峻的负担。尽管投入较大，仍仅有不到半数的糖尿病患者实现血糖达标。. 天津市 2020-2023 年基层医改推行公私协同模式，由微医采用“按人头付费”制度协助管理社区卫生服务中心。该举措涵盖以下四点：(1) 按月预付的人头付费，覆盖与糖尿病相关的所有门诊服务；(2) 采用人工智能来开展医保费用审核和临床决策支持；(3) 配备专职的健康管理人员负责照护协调；以及 (4) 重构服务内容，新增并发症筛查并纳入数字化用药管理。一项于 2022 年至 2023 年开展的纳入 494945 名糖尿病患者的试点研究，对比了三种诊疗模式：微医联合社区卫生服务中心模式、医院诊疗模式及常规诊疗模式。. 天津市现有 177 家医院和 266 家社区卫生服务中心，服务 1500 万居民。慢性病管理体系分散：卫生健康部门监管诊疗服务标准，医保部门负责管控经费。. 微医联合卫生服务中心模式下的糖尿病就诊人次增长 2.6% (0.7/26.6)；而医院诊疗模式下的就诊人次下降 10.6% (−3.8/35.7)，常规诊疗模式下的就诊人次下降 2.3% (−0.8/34.1)。所有模式下的门诊费用均有所减少。微医模式产生 3762 万美元的结余，卫生服务中心的糖尿病相关收入提升 65%（154577/237805 美元），医生年薪提高 30%（5172/17241 美元）。超过四分之三的患者对微医模式表示满意和信任。. 按人头付费模式与第三方治理及人工智能技术相结合，能够夯实基层医疗卫生服务能力、控制医疗成本，同时提升以患者为中心的服务质量。. Фрагментированная структура первичного медико-санитарного обслуживания в Китае не справляется с растущим бременем неинфекционных заболеваний. Несмотря на существенные инвестиции, гликемического контроля удается достичь менее чем для половины пациентов с диабетом. В рамках реформы, проведенной в Тяньцзине в 2020–2023 годах, была создана модель государственно-частного партнерства, где компания WeDoctor управляла муниципальными центрами здравоохранения по схеме подушевого финансирования. Стратегия включала: (i) ежемесячное предварительное подушевое финансирование, которое покрывало все амбулаторные услуги, связанные с диабетом; (ii) аудит страховых требований и помощь в принятии клинических решений с использованием искусственного интеллекта (ИИ); (iii) назначение специальных координаторов медицинского обслуживания; (iv) изменения в структуре обслуживания, в том числе скрининг осложнений и цифровое управление медикаментозной терапией. В пилотном исследовании с участием 494 945 пациентов с диабетом сравнивались три модели лечения в период с 2022 по 2023 год: помощь на базе муниципальных центров здравоохранения WeDoctor, лечение в больнице и обычное медицинское обслуживание. В городе Тяньцзинь на 15 миллионов жителей приходится 177 больниц и 266 муниципальных центров здравоохранения. Ведение пациентов с хроническими заболеваниями осуществляется фрагментированно: Комиссия по здравоохранению регулирует стандарты оказания помощи, а Бюро страхования контролирует финансирование. Частота посещения медицинских центров компании WeDoctor по поводу диабета возросла на 2,6% (+0,7 при исходных 26,6), однако снизилась на 10,6% (–3,8 при исходных 35,7) для лечения на базе стационара и на 2,3% (–0,8 при исходных 34,1) для обычного медицинского обслуживания. Во всех группах сократились издержки на амбулаторное лечение. Модель WeDoctor обеспечила профицит в размере 37,62 млн долл. США, увеличив доходы медицинских центров от оказания помощи пациентам с диабетом на 65% (+154 577 долл. США при исходных 237 805), а также повысив ежегодную зарплату врачей на 30% (+5172 долл. США при исходных 17 241). Более трех четвертей пациентов выразили удовлетворенность моделью WeDoctor и доверие к ней. Сочетание подушевого финансирования, модели управления силами сторонних организаций и использования искусственного интеллекта может укрепить систему первичной медико-санитарной помощи, оптимизировать издержки и повысить ориентированность медицинской помощи на потребности пациентов.
Social drivers of health (SDOH) impact health outcomes for children with asthma. Advances in geocoding enable better SDOH measurement in research. We aimed to: 1) examine relationship between three SDOH composite indices-Social Vulnerability Index (SVI), Childhood Opportunity Index 3.0 (COI), Area Deprivation Index (ADI)-and asthma patient disposition from emergency room; and 2) determine which index most closely correlates with admission rates. Retrospective cohort study, patients 2-18 years presenting for asthma, defined using computational phenotype requiring: asthma diagnostic code, ≥2 doses nebulized albuterol, and ≥1 systemic steroid dose within 24 h of presentation. Data obtained 2021-2024 from Indiana Network for Patient Care, a state-wide health information exchange. Exposures included three SDOH indices. Mixed effects multinomial logistic regression to evaluate associations with patient disposition and recurrent emergency room encounters. Total 5895 asthma encounters (4485 patients), with 27.85% resulting in admission (57.3% ward, 42.6 ICU). Female gender, chronic illness, "other" preferred language, >1 year since last outpatient visit increased admission likelihood. Black race and preferred language Spanish were associated with lower likelihood (vs. white, English-speaking reference). No SDOH indicator provided superior differentiation of patient disposition. However, census tract-level random effects were meaningful across all three models. Gender, race, language, chronic comorbidity, and preventive healthcare access are associated with emergency and repeat hospital use in pediatric asthma. Geographic context plays a meaningful role in patients' clinical disposition, but the geographic component driving this association is not meaningfully captured by any of the three SDOH indices studied.