Health Insurance Research Articles

Health insurance and clinical outcomes in patients with chronic heart failure in Latin America: an observational study of the Colombian Heart Failure Registry (RECOLFACA).

The effect of the health insurance type on the prognosis of heart failure (HF) patients in Colombia and Latin America is poorly known. We aimed to analyze the characteristics of HF patients that participated in the Colombian Heart Failure Registry (RECOLFACA) as stated by their health insurance type and their relationship with the immediate prognosis of these patients. Patients with HF diagnosis were included in the RECOLFACA registry between 2017-2019. The registry was conducted in 60 centers in Colombia. All-cause mortality was the principal outcome. To evaluate the impact of health insurance on mortality, a Cox proportional hazards regression model was used. The Kaplan-Meier analysis was performed to compare survival probabilities according to insurance type. All statistical analyses were two-tailed and were considered significant with a p value < 0.05. Of the 2,528 participants enrolled in the registry, 99% held details about their health insurance. Of those, 897 patients (35.6%) were covered by public insurance. These patients were significantly younger, with a lower proportion of men, more frequently from rural origin, and lower prevalence of most comorbidities (omitting hypertension, chronic obstructive pulmonary disease (COPD), and Chagas disease) than those with private insurance. Furthermore, patients with public insurance had a worse functional class, as well as a poorer quality of life, and lower frequency of use of implantable devices, while exhibiting similar prescription rates of triple medical therapy for HF. Finally, no differences in short-term mortality were observed between the two groups (HR 1.09; 95% CI 0.79, 1.51). The type of health insurance represents a condition related with relevant differences in the profile of patients with HF in Colombia. Despite this, no significant differences were detected in the short-term prognosis of these patients based on the type of health insurance.

South African Chiropractic Students’ Intentions, Motivations, and Considerations for Emigration: A Cross-Sectional Study

ObjectiveThe purpose of this study was to investigate the emigration intentions of South African senior chiropractic students upon graduation, emphasizing motivations and considerations guiding migration decisions. MethodsA cross-sectional, quantitative, and exploratory approach was employed, utilizing an anonymous and adapted online survey administered to chiropractic students at 2 South African institutions (n = 177) between March 15 and May 19, 2021. Data were analyzed using frequencies, descriptions, and cross-tabulations to identify trends and interrelationships related to students’ intentions to emigrate postqualification. ResultsFindings indicate that 75.5% of South African chiropractic senior students intend to emigrate. Motivations for emigration include improved quality of life and seeking of opportunities. Economic instability in South Africa (SA) (82.7%) and concern for the National Health Insurance implementation (57.7%) serve as a significant push factor, whereas economic stability abroad (85.7%) emerged as a key pull factor. Preferred emigration destinations are primarily developed countries with established chiropractic communities. ConclusionHigh emigration intentions among students were driven by diverse push factors in SA, including economic decline, socio-political climates, and safety concerns, contrasting with pull factors abroad, such as better opportunities, living conditions, and economic stability. Concerns regarding healthcare reforms, particularly the National Health Insurance, are also highlighted. Destinations in order of preference such as the United Kingdom, Canada, and Australia offer valuable insights for policy interventions. Understanding these dynamics is crucial for developing effective retention strategies and addressing socio-economic challenges.

PrEP Use in a US National Sample of Trans Men and Other Transmasculine People Who Have Sex With Men: A Longitudinal Analysis

Introduction: Efforts to improve pre-exposure prophylaxis (PrEP) uptake among gay men, transgender women, and Black cisgender women are evident across the United States, responding to epidemiologic data showing a disproportionate HIV burden in these communities. However, transgender men and other transmasculine people who have sex with men (TMSM)—those assigned female at birth who identify otherwise and have sex with cisgender men—are often excluded from these statistics. This community has unique vulnerabilities and prevention needs. National HIV prevention and planning has yet to include transgender men as a group with increased vulnerability to HIV seroconversion. This study follows a cohort of TMSM to characterize PrEP use longitudinally. Methods: Using data from a prospective US national cohort of TMSM not on PrEP, we analyzed annual PrEP uptake, discontinuation, and other HIV prevention measures over 24 months. We also used generalized estimating equations modeling to assess demographic, healthcare access, gender-affirming, and behavioral factors associated with PrEP uptake over time. Results: Our cohort of 196 TMSM was demographic and regionally diverse. 29% of our sample reported uptake of PrEP in 24 months, with about one-third of users discontinuing within 1 year. Health insurance, having had lower surgery, used post-exposure prophylaxis, or recently having a sexually transmitted infection were associated with increased odds of PrEP use. Conclusion: We found low uptake of PrEP and high discontinuation rates in a US national sample of TMSM over 24 months, despite significant need for HIV prevention. It is vital to increase efforts and investments to support this neglected community.

State of the art of real-life concentration monitoring of rifampicin and its implementation contextualized in resource-limited settings: the Tanzanian case.

The unique medical and socio-economic situation in each country affected by TB creates different epidemiological contexts, thus providing exploitable loopholes for the spread of the disease. Country-specific factors such as comorbidities, health insurance, social stigma or the rigidity of the health system complicate the management of TB and the overall outcome of each patient. First-line TB drugs are administered in a standardized manner, regardless of patient characteristics other than weight. This approach does not consider patient-specific conditions such as HIV infection, diabetes mellitus and malnutrition, which can affect the pharmacokinetics of TB drugs, their overall exposure and response to treatment. Therefore, the 'one-size-fits-all' approach is suboptimal for dealing with the underlying inter-subject variability in the pharmacokinetics of anti-TB drugs, further complicated by the recent increased dosing regimen of rifampicin strategies, calling for a patient-specific methodology. In this context, therapeutic drug monitoring (TDM), which allows personalized drug dosing based on blood drug concentrations, may be a legitimate solution to address treatment failure. This review focuses on rifampicin, a critical anti-TB drug, and examines its suitability for TDM and the socio-economic factors that may influence the implementation of TDM in clinical practice in resource-limited settings, illustrated by Tanzania, thereby contributing to the advancement of personalized TB treatment.

Cancer mortality and geographic inequalities: a detailed descriptive and spatial analysis of social determinants across US counties, 2018–2021

ObjectiveIn the United States, cancer mortality rates continue to decline, yet geographic and racial disparities persist and are particularly evident in the Delta region, characterized by high economic distress and disease burden. We examined cancer mortality patterns by demographic groups across geographic region (Delta vs non-Delta) and investigated the influence of macro-level social determinants of health (SDoH) in cancer death. Study design and methodsThis observational study included cancer death records of individuals aged ≥20 years from 2018 to 2021 in the United States. County-level characteristics were ascertained through the linkage of multiple national administrative and community surveys. We estimated age-standardized mortality rates (ASR) and rate ratios. We calculated the adjusted relative risks by county-level SDoH (geographic region, rurality, household income, income inequality, health insurance, and education) and other factors using age-adjusted multivariate quasi-Poisson regression. ResultsIn 2018–2021, approximately 2.4 million cancer deaths occurred in the United States. We observed important declines in the Black-White disparities, from 16.6% in 2018 (ASR = 289.9 vs 248.6 per 100,000) to 12.1% in 2021 (281.1 vs 250.8) in the Delta region and from 15.9% (254.9 vs 219.9) to 10.7% (240.6 vs 217.3) in the non-Delta region, though Black men in the Delta region remained the highest rate (ASR2021 = 346.9 per 100,000). County-level analyses provided strong evidence of geographic inequality and the role of SDoH, particularly education and income inequality. ConclusionsUnfavorable SDoH are associated with increased cancer death risk. Region-specific health policies and interventions in the Delta region are essential to advance cancer health equity.

The The relationship of accessibility, ownership of health security and family support with the behavior of III trimester pregnant women in choosing a delivery help

Introduction: One of the aspects that causes the high MMR in Indonesia and in several regions is that the coverage of assistance by health workers is still low. The reason why people decide to give birth to non-health workers (quacks) is because of the low level of education in society, culture, and the economy. Factors that influence the choice of birth attendants include areas where coverage is still not close to health facilities, ownership of health insurance, and family support, which is still the predominant reason mothers do not choose birth attendants by professionals in health facilities. Objective: The general aim of this research is to understand the relationship between accessibility and ownership. Health insurance and family support with the behavior of TMT III pregnant women in choosing birth attendants. Methods: This research method is quantitative research with a cross-sectional design.Result: The chi-square test results show a relationship between accessibility, ownership of health insurance, family support, and the behavior of TMT III pregnant women in choosing birth attendants. Result: The chi-square test results show a relationship between accessibility, ownership of health insurance, family support, and the behavior of TMT III pregnant women in choosing birth attendants. Conclusion: It is hoped that this can increase the role of the community in helping all mothers who are about to give birth to choose professional health workers to assist them in giving birth so that it is hoped that all mothers in labor can be assisted in giving birth through a safe delivery process so that the mother and baby are healthy and safe.

Hospice and Palliative Nurses Association Position Statement: Medical Aid in Dying.

Hospice and Palliative Nurses Association Position Statement: Medical Aid in Dying.

Parental Mental Disorders and Ages of Onset of Severe Mental Disorders in Offspring: A Nationwide Family-link Study

ObjectiveThe current study used a retrospective study design to investigate the association between age of onset of severe mental disorders in offspring and the likelihood of diagnoses of parental mental disorder. MethodWe enrolled 212,333 people with severe mental disorder, including schizophrenia, bipolar disorder (BD), or major depressive disorder (MDD) and 2,123,329 controls matched for age, sex, and demographics from the National Health Insurance Database of Taiwan. Poisson regression models were used to examine the likelihood of diagnoses of five mental disorders in their parents compared to the parents of the controls (reported as odds ratio (OR) with 95% confidence interval), including schizophrenia, BD, MDD, alcohol use disorder (AUD), and substance use disorder (SUD). The study cohort was classified into child-onset, adolescent-onset, and adult-onset groups according to the onset of severe mental disorders in the offspring. ResultThe parents of people with child-, adolescent-, and adult-onset schizophrenia (OR range: 1.73-9.08, all p<0.05) or BD (OR range: 1.97-8.17, all p<0.05) were more likely to be diagnosed with schizophrenia, BD, MDD, AUD, and substance use disorder (SUD) than controls except for AUD in the child-onset group. However, the parents of people with child-, adolescent-, and adult-onset depressive disorder were more likely to be diagnosed with schizophrenia, BD, MDD, AUD, and SUD (OR range: 1.82-4.76, all p<0.05) than controls. Sub-analyses stratified by sex showed different patterns of associations between parental mental disorders and offspring mental disorders. ConclusionNo matter when the severe mental disorder of the offsprings occurred at different onset stages, their parents had a higher likelihood of being diagnosed with schizophrenia, BD, MDD, AUD, and SUD.

Modification of the association between cold spells and cardiovascular disease by changes in natural gas prices: A nationwide time-series study

BackgroundAlthough the association between low ambient temperature and cardiovascular disease (CVD) is well-established, the effect of winter energy prices on this association remains unknown. AimThis ecological study aimed to investigate whether changes in natural gas prices (NGP), which account for a significant portion of winter energy prices in Korea, affect the association of cold spells with hospital admissions and mortality due to CVD. MethodsData from the National Health Insurance Service and Statistics Korea were used to determine the daily number of hospital admissions and mortality rates associated with CVD. From January 2012 to February 2017, the NGP continually increased by 24.1%. From January 2012 to December 2014 the NGP continually decreased by 32.6% owing to the Korea Gas Corporation’s management decisions, independent of external socioeconomic factors. We investigated the differences in the associations between cold spells and CVD-related outcomes in price-increasing and price-decreasing periods using a Poisson regression with a distributed lag nonlinear model. Cold spells were assessed on two consecutive days at the 5th percentile of the temperature for each region. ResultsThe meteorological factors and air pollution levels were similar between the two periods. The association between cold spells and hospital admissions due to CVD was stronger during the price-increasing period than during the price-decreasing period [ratio of cumulative relative risk (RRR) = 1.71, 95% confidence interval (CI): 1.31–2.22]. The difference in the association with mortality due to CVD between the two periods was not significant, although the point estimate remained >1 (RRR = 1.11, 95% CI: 0.90–1.38). ConclusionsChanges in energy prices may modify the cold spell-related CVD risk, possibly by inducing behavioral changes to manage energy expenditure. Policymakers should take into account the potential public health implications of changes in energy prices, alongside their economic effects.

Impact of COVID-19 pandemic on Carbon Ion Radiotherapy in Japan: a Japanese National Registry Study

PurposeThis study aimed to investigate the impact of the COVID-19 pandemic on carbon ion radiotherapy (CIRT) in Japan by evaluating patient numbers and treatment trends from 2019–2022. Patients and MethodsData from five CIRT facilities were analyzed, encompassing a total of 13,224 patients treated over the 4-year period. Patient demographics, cancer types, treatment protocols, and adherence to national health insurance coverage were examined. The study period was divided into unaffected (2019), significantly affected (2020–2021), and post-stabilization (2022) phases, corresponding to progression of the pandemic. For monthly analysis, the period during which a state of emergency was declared by the Japanese government was defined as the pandemic period. ResultsProstate cancer comprised the majority of CIRT cases (62.4%), followed by hepatocellular carcinoma, bone and soft tissue tumors, locally advanced pancreatic cancer, and non-squamous cell carcinoma of the head and neck. Despite the pandemic, the annual reduction in CIRT patients remained <5%, suggesting treatment continuity. Analysis of monthly treatment figures revealed a significant reduction in the number of patients with non-prostate cancers treated during the state of emergency, while a reduction in the number of prostate cancer treatments was observed approximately 6 months later. Although the number of COVID-19 patients continued to increase after 2022, the number of patients receiving CIRT increased after the state of emergency was declared. ConclusionAlthough there was a reduction in monthly CIRT patient numbers during the COVID-19 pandemic, yearly analysis revealed that this amounted to <5%.

Implementing Primary Care Reform in France: Bargaining, Policy Adaptation, and the Maisons de Santé Pluriprofessionnelles

Context: The organization of primary care in France has long remained a secondary issue on the political agenda. The government began to address the difficulties of care access and coordination in the 2000s, when a seemingly viable solution emerged from the field: the maisons de santé pluriprofessionnelles (MSPs). In a corporatist system and a predominantly private sector, the government chose an incentive-based contractual policy to encourage providers to join these structures. This article analyzes the implementation of this policy, which depends on private providers’ commitment. Methods: The article offers a comparative case study of six MSPs. Data were collected through semistructured interviews, observation sessions, and document analysis. Findings: First, the article shows that the emergence of MSPs has only been possible thanks to an unprecedented alliance between general practitioners, the state, and the health insurance fund. Second, it argues that MSP policy implementation relies on a complex bargaining process between private providers and public authorities that enables the former to shape it to their local needs. Conclusions: MSP implementation experiences raise questions both about the understanding of medical corporatism in France and the assimilation of policy changes and local variation through policy implementation.

Enhancing interpretability in random forest: Leveraging inTrees for association rule extraction insights

The random forest model is a powerful supervised learner, recognized for its ability to learn the pattern within data with superior predictive accuracy. However, it is a black box model because it lacks interpretability. This study addressed the interpretable challenge by employing the inTree framework. The rules were extracted from each decision tree in a random forest model, and the association rules were determined through measured matrix support and confidence to reveal the frequent variable interactions for predicting unemployment. This approach provided insight into the relationships between specific variables and unemployment outcomes. The developed method used data set from the integrated labor force survey (ILFS) 2020/2021 in Zanzibar. Zanzibar’s unemployment rate consistently increased across surveys conducted in 2006, 2014, and 2020/2021. Results have shown that the rules that most predict unemployment for individuals are female and lack of health insurance and secondary education level, female and youth age group and lack of health insurance and secondary education level with a high confidence level. This study provides practical insights for Zanzibar’s government to develop effective interventions, programs, and policies. Improving the interpretability of the random forest model enhances decision-making to address unemployment challenges.

Evaluating the Impact of Data Protection Compliance on AI Development and Deployment in the U.S. Health sector

This paper evaluates the impact of data protection Compliance on artificial intelligence development and deployment in the U.S. Health sector. As AI technologies develop quickly, worries about data security and privacy have increased, especially in delicate industries like healthcare. HIPAA, or the Health Insurance Portability and Accountability Act, and CCPA, or California Consumer Privacy Act, are two important U.S. laws that are examined in this paper along with their comparison to the European Union's General Data Protection Regulation, or GDPR. The intersection of AI and data protection regulations is also examined. The analysis emphasizes the necessity for privacy-by-design principles and the development of openness and accountability, and it shows how these policies affect AI developers, healthcare providers, and other stakeholders. Through an analysis of the opportunities and obstacles posed by the CCPA and HIPAA, the paper offers useful guidance for managing the regulatory environment and promoting innovation in AI development. The study reports that observing data protection rules is not only required by law but also strategically crucial for fostering public confidence and guaranteeing the moral application of AI in healthcare. The paper finally concludes that maintaining a sustainable growth of AI applications in the U.S. healthcare industry requires striking a balance between technological advancement and stringent data privacy procedures and compliance as AI continues to advance.

Geographical health inequalities in India: the impact of the COVID-19 pandemic on healthcare access and healthcare inequality.

With an emphasis on spatial health disparities, this study examines how COVID-19 has affected healthcare access and inequality in India. The study developed the Healthcare Access Index (HAI) and Healthcare Inequality Index (HII) to assess the pandemic's effects on healthcare. The study addresses spatial health disparities in healthcare access and inequality, filling gaps in the literature. The final aim of the study is to offer policy suggestions to lessen healthcare inequities in India, particularly in the context of COVID-19. The study incorporates secondary data from publicly accessible databases such as the National Family Health Survey, Niti-Ayog and Indian Census databases and employs a quantitative research design. The impact of the COVID-19 pandemic on healthcare access and healthcare inequality in India is examined using the HAI and the HII. The five dimensions of healthcare access - availability, accessibility, accommodation, cost and acceptability - were used in developing the HAI. The study uses a panel data analysis methodology to examine the HAI and HII scores for 19 states over the pre-COVID-19 (2015) and post-COVID-19 (2020) periods. In order to investigate the connection between healthcare access, healthcare inequality and the COVID-19 pandemic, the analysis employs statistical tests such as descriptive statistics, correlation analysis, factor analysis and visualization analysis. According to the study, COVID-19 impacted healthcare access and inequality in India, with notable regional inequalities between states. The pandemic has increased healthcare disparities by widening the gap between states with high and low HII ratings. Healthcare access is closely tied to healthcare inequality, with lower levels of access being associated with more significant levels of inequality. The report advises governmental initiatives to lessen healthcare disparities in India, such as raising healthcare spending, strengthening healthcare services in underperforming states and enhancing healthcare infrastructure. For Indian healthcare authorities and practitioners, the study has significant ramifications. In light of the COVID-19 pandemic, there has been a main focus on addressing geographic gaps in healthcare access and inequality. The report suggests upgrading transportation infrastructure, lowering out-of-pocket costs, increasing health insurance coverage and enhancing healthcare infrastructure and services in underperforming states. The HAI and the HII are tools that policymakers can use to identify states needing immediate attention and appropriately spend resources. These doable recommendations provide a framework for lowering healthcare disparities in India and enhancing healthcare outcomes for all communities. The study's originality resides in establishing the HAI and HII indices, using panel data analysis and assessing healthcare inequality regarding geographic disparities. Policy choices targeted at lowering healthcare disparities and enhancing healthcare outcomes for all people in India can be informed by the study's practical consequences.

Does targeted information impact consumers’ preferences for value-based health insurance? Evidence from a survey experiment

Abstract Objectives Value-based insurance design (VBID) aims to direct consumers’ preferences by incentivizing the use of high-value care and discouraging the use of low-value care. However, consumers often have limited knowledge of health insurance and the health insurance system, possibly distorting their preferences. In this study, we aim to investigate the impact of specific information treatments on consumers’ preferences for VBID. Methods We implemented an information experiment as part of a representative survey on health insurance literacy and preferences for VBID within Switzerland’s choice-based health insurance system. Preferences for VBID were measured through a discrete choice experiment. Cross-sectional data on 6,033 respondents aged 26–75 were analyzed using descriptive statistics and mixed logit regressions. Results Respondents showed strong preferences for their current health insurance instead of VBID alternatives. A general description of current regulations on cost-sharing, drug disbursement, and monthly premiums significantly increased preferences for VBID (p &lt; 0.01). Pointing respondents specifically to VBID further reduced the opposition against VBID plans. At the same time, there is evidence for anchoring effects in copayments after receiving the information treatments, irrespective of the value of the care. Conclusions The results of this study highlight that individuals are susceptible to provided information about health insurance when building their preferences for VBID. One potential explanation is limited health insurance literacy, implying that tailored communication strategies may be needed to improve insurance decision-making. JEL Classification I11, I13.

Pediatric Scaphoid Nonunions: Does Insurance Status Play a Role?

Objective: There are no studies that evaluate the effects that insurance or socioeconomic status may have on treatment and outcomes of scaphoid nonunions in children. We evaluated whether there is an association between insurance status and (1) time from injury to hand surgeon evaluation, (2) time from specialist evaluation to surgery, and (3) postoperative outcomes of scaphoid fracture nonunions in children. Methods: A chart review was performed for patients who underwent surgical treatment of scaphoid fracture nonunion from January 2015 and April 2021 at a large tertiary care pediatric hospital. Underinsured patients were defined as those with no medical insurance or Medicaid/state-funded insurance. Results: There were 21 privately insured patients and 17 patients who were underinsured. There was no difference in age, race, or fracture characteristics between the two groups. The mean time between injury and hand surgeon evaluation was 192 SD 195 days for the privately insured group compared with 155 SD 205 days for the underinsured group (P = 0.57). The mean time between specialist evaluation and surgical treatment was 35 SD 54 days for the privately insured group and 31 SD 31 days for the underinsured group (P = 0.82). Union was achieved in 80% of patients with private insurance compared with 88% of underinsured patients after primary surgery (P = 0.67). There was no difference detected in the proportion of patients who had residual pain (15% vs 19%), range of motion deficits (38% vs 40%), strength deficit (6% vs 7%), and return to activity (94% vs 93%) between privately insured and underinsured patients, respectively (P = 1.00). Conclusions: There was no difference in time from injury to specialist evaluation, time from evaluation to surgery, or postoperative outcomes based on insurance status for pediatric patients with scaphoid fracture nonunions. Although insurance status was not associated with access to care for pediatric scaphoid fracture nonunions at our institution, this information may not be generalizable to other populations, including patients who sustain primary scaphoid fractures and who have not yet developed nonunions. Level of Evidence: Level III—retrospective cohort study.

Diagnostic Challenges in Hematological Malignancies in Nigeria and their Impact on Treatment Outcome

Haematological magnificence constitutes a major public health disease burden globally due to the degree of mortality and morbidity they cause. Aim: This review was aimed at exploring and reporting some of the difficulties that hinder early/accurate diagnosis and management of haematological malignancies in Nigeria emphasizing a single centre experience and to further highlight how they affect treatment outcome. Methodology: Google scholar, Pubmed and African Journals online sites were explored in July 2024. Relevant articles were selected. The most senior consultant haematologist in the single centre in South South Nigeria being studied was interviewed and account was documented. Results: The difficulties encountered in the prompt/proper diagnosis and management of haematological malignancies reported by the studies and the clinician interviewed include, visiting orthopaedic and other specialists as well as herbalists and spiritualists for several months before reporting to the haematology clinic, mis – and/or missed diagnosis due to inadequate diagnostic equipment and techniques like use of morphological studies alone for Rowmanawsky stained blood picture examination and histological diagnosis without cytogenetics, immunophenotyping, polymerase chain reaction fluorescent insitu hybridization, poverty, cultural and religious beliefs. Poor treatment outcome as a result of these challenges were also reported. Conclusion: Enlightenment campaigns on the benefits of early diagnosis and prompt presentation to the hospital should be encouraged. Provision of up-to-date advanced technologies for early/accurate diagnosis and sub classification of haematologiacl malignancies should be made in main health facilities across the country. Diagnosis and treatment of haematological malignancies should be built into the National Health Insurance scheme to strengthen the system in this regard.

Social innovation in access to healthcare: community-based health insurance among Senegalese migrants in Spain

Social innovation in access to healthcare: community-based health insurance among Senegalese migrants in Spain

A 25-Year Retrospective of Health IT Infrastructure Building: The Example of the Catalonia Region

Over the past decades, health care systems have significantly evolved due to aging populations, chronic diseases, and higher-quality care expectations. Concurrently with the added health care needs, information and communications technology advancements have transformed health care delivery. Technologies such as telemedicine, electronic health records, and mobile health apps promise enhanced accessibility, efficiency, and patient outcomes, leading to more personalized, data-driven care. However, organizational, political, and cultural barriers and the fragmented approach to health information management are challenging the integration of these technologies to effectively support health care delivery. This fragmentation collides with the need for integrated care pathways that focus on holistic health and wellness. Catalonia (northeast Spain), a region of 8 million people with universal health care coverage and a single public health insurer but highly heterogeneous health care service providers, has experienced outstanding digitalization and integration of health information over the past 25 years, when the first transition from paper to digital support occurred. This Viewpoint describes the implementation of health ITs at a system level, discusses the hits and misses encountered in this journey, and frames this regional implementation within the global context. We present the architectures and use trends of the health information platforms over time. This provides insightful information that can be used by other systems worldwide in the never-ending transformation of health care structure and services.

A multilevel analysis of factors associated with wasting in children one to two years old in Hamadan city

AbstractThe study aimed to identify risk factors for childhood wasting in 1–2 year-olds in Hamadan city, focusing on this age group due to infection and malnutrition risks. Unlike previous cross-sectional studies on children under 5 years old, this longitudinal study tracked weight-to-height changes over time. Data were analyzed from 455 mother-child pairs, aged 1–2 years, collected from health centers and recorded in the Integrated Electronic Health System (SIB). The weight-for-height index, an ordinal response with three categories (wasting, normal, and overweight), was measured several times. A two-level longitudinal ordinal model was used to identify factors associated with wasting. The analysis of data from 230 girls and 225 boys identified several factors associated with wasting: lower birth weight (Adjusted Odds Ratio (AOR) = 0.77), age 12–15 months (AOR = 1.15), lack of health insurance (AOR = 3.09), mother-child residence (AOR = 3.80), maternal height (AOR = 0.92), and age at pregnancy &lt; 24 years (AOR = 4.71). The results of this study showed that most of the factors contributing to childhood wasting can be controlled and prevented. Therefore, implementation of targeted policies and appropriate interventions for mothers before, during, and after pregnancy could reduce the burden of childhood wasting.