Traditional Health Care Services Research Articles

Environmental Benefits of Reducing Patient Mobility and Hospitalization

New healthcare management strategies aim to reduce in-person visits and patient hospitalization while ensuring patient safety. These strategies optimize resources, alleviate pressure on healthcare services, and decrease travel and mobility within healthcare environments. This research analyzes the environmental impact and sustainability associated with transportation and mobility in traditional hospital-based healthcare services, which have been relocated to bring healthcare closer to patients. This retrospective study utilizes data from two hospital centers spanning the years 2021 to 2023. The objective is to highlight the environmental benefits and sustainability of providing healthcare in the patient’s environment. The methodology employs life cycle analysis to compare three scenarios: traditional healthcare in hospitals, healthcare provided at the patient’s location through home hospitalization and medical consultations at nearby health centers, and healthcare professionals’ travel using electric vehicles. The results demonstrate that healthcare professionals traveling to the patient’s home or nearby health centers reduce environmental impact across all analyzed impact categories. Promoting home hospitalization, specialized consultations at local health centers, and primary care can effectively reduce unnecessary patient travel and minimize environmental impact, enhancing sustainability. Health policies should prioritize actions to reduce hospital visits, emphasizing prevention over disease treatment. Such practices would not only benefit patients but further promote sustainability and environmental protection.

Efficacy of Digital Health Interventions Used for Adolescent's Sexual Health: An Umbrella Review.

Adolescents face many barriers and challenges associated with sexual and reproductive health (SRH). These barriers can include limited access to youth-friendly healthcare services, lack of information, and stigma. Digital health interventions has the capability to enhance clinical management. This study was performed to investigate the efficacy of digital health interventions used for adolescent's sexual health. This Umbrella Review has reviewed the search engines and databases of PubMed, Web of Science, Scopus, Chochrane Library, Google Scholar in English with the keywords organized into three broad categories: Sexual health and related issues, digital health interventions, and Adolescent, until December 3, 2023. The final analysis was based on a review of 23 full-text articles. The findings of the study clearly demonstrate the effectiveness of digital health interventions in enhancing sexual health outcomes among adolescents. The review identified several significant fields where digital health interventions have been effective, including promoting safer sexual practices, improving sexual health knowledge, and Minimizing high-risk sexual behaviors among adolescents. The assessment also emphasized the potential of digital health interventions to reach a wide audience, particularly those who may not have access to traditional healthcare services. The findings of this research suggest that digital health interventions can be an effective way to promote safer sexual practices, improve sexual health knowledge, and reduce risky sexual behavior among adolescents. The quality of the evidence, however, varied across the studies assessed, highlighting the need for further rigorous study to demonstrate the efficacy of these interventions. PROSPERO CRD42023488296; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023488296.

A Review on Assisted Living Using Wearable Devices.

Forecasts about the aging trend of the world population agree on identifying increased life expectancy as a serious risk factor for the financial sustainability of social healthcare systems if not properly supported by innovative care management policies. Such policies should include the integration within traditional healthcare services of assistive technologies as tools for prolonging healthy and independent living at home, but also for introducing innovations in clinical practice such as long-term and remote health monitoring. For their part, solutions for active and assisted living have now reached a high degree of technological maturity, thanks to the considerable amount of research work carried out in recent years to develop highly reliable and energy-efficient wearable sensors capable of enabling the development of systems to monitor activity and physiological parameters over time, and in a minimally invasive manner. This work reviews the role of wearable sensors in the design and development of assisted living solutions, focusing on human activity recognition by joint use of onboard electromyography sensors and inertial measurement units and on the acquisition of parameters related to overall physical and psychological conditions, such as heart activity and skin conductance.

The Efficacy of Telehealth Versus In-Person Management Delivery in Adult Patients with Obesity.

The effectiveness of telehealth in managing obesity in Saudi patients is still under investigation. This study compared the effectiveness of telehealth and in-person obesity management programs for adults. This clinical trial involved 62 adults, 29 receiving in-person intervention at the clinic and 33 receiving telehealth via videoconference calls. Anthropometric measurements, biochemical parameters, and dietary and lifestyle habits were assessed at baseline and after 12 weeks. Patients have been educated about goal-setting, healthy eating behaviors, personalized meal plans, and increasing physical activity levels. It showed that 45% and 49% of the in-person and telehealth groups lost more than 5% of their initial body weight. Weight, % body fat, and waist circumference were significantly reduced in the in-person and telehealth groups (p < 0.001). No significant differences between the groups were found in the parameters mentioned above. Within-group analysis showed that light physical activity levels improved in both groups significantly (p < 0.001), and the moderate physical activity level improved significantly among the telehealth group (p < 0.039). No significant differences were observed between the groups regarding physical activity level, blood pressure measurement, and biochemical markers, except for the RBC blood level (p = 0.026). The telehealth group had significantly higher attendance rates for counseling sessions (97% vs. 75% for the in-person group, p < 0.01). Participants' dropout rates were higher for the in-person group 21%, compared to the telehealth group 13%. Telehealth participants' satisfaction regarding the benefits of the obesity management program in losing weight was higher at 87% compared to the in-person group at 76%. In conclusion, applying a telehealth obesity management program can support patients struggling with obesity who may have limited access to traditional healthcare services, while ensuring that telehealth care replicates the quality of in-person care.

Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study.

Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs. This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home. This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework. The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, "Breathing exercises" and "Picking up from the floor," revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested. This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support.

Effectiveness of Telemedicine in Managing Health-Related Issues in the Pediatric Population: A Systematic Review.

Healthcare delivery is made more convenient and effective via telemedicine, which enables physicians to conduct virtual consultations and evaluations with pediatric patients. The purpose of this systematic review was to evaluate the efficacy of telemedicine as compared to physical appointments in the pediatric population. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search for the available literature using pre-specified inclusion and exclusion criteria. These databases provided 968 relevant research articles, which Endnote software screened for duplicates. Fourteen studies were considered relevant for full-text evaluation. After complete text evaluation, only 11 of these articles were found to be relevant. The Newcastle-Ottawa Scale (NOS) was used for the risk of bias assessment of all included studies. Eleven articles in all satisfied the requirements for inclusion and were added to the review. Every study was classified as either a cluster randomized trial (27%) or a randomized controlled trial (RCT) (73%). There were between 22 and 400 participants in each trial. Medical conditions evaluated included obesity (27%), mental health disorders (9%), asthma (18%), otitis media (9%), skin disorders (9%), type 1 diabetes (9%), attention deficit hyperactivity disorder (ADHD) (9%), and pancreatic insufficiency associated with cystic fibrosis (1/11). Telemedicine strategies employed included telemedicine-based screening visits (9%), smartphone-based therapies (27%), phone counseling (18%), and videoconferencing visits between patients and doctors (45%). The outcomes of the telemedicine procedures in every included study were on par with or superior to those of the control groups. Medication adherence, appointment completion rates, life satisfaction, symptom management, and disease progression were all outcomes associated with these findings. Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, healthcare professionals, and caregivers may benefit from using both telemedicine services and traditional in-person healthcare services. To maximize the potential of telemedicine, future research should focus on improving patients' access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use.

Debate: Bridging the gap - role of nonspecialists in child and adolescent mental health care.

The first point of contact for patients and families seeking professional help for health problems is often in nonspecialist community healthcare settings that vary widely across the countries in funding sources, resources and support from specialist services. They typically involve general practitioners, family physicians, general and community paediatricians, and nonphysician health workers such as nurses, social workers and public health professionals. This article discusses the role of nonspecialists in addressing the challenges of limited resources in Child and Adolescent Mental Health (CAMH) care services as healthcare systems struggle to meet the high demand. Stakeholders and decision-makers need to reconsider traditional healthcare models and service delivery. Integrating nonspecialist community care can be a potential solution but is beset with ethical, geopolitical, practical and economic challenges. The urgency and complexity of the issue are highlighted, emphasising the need for global discussion around CAMH care.

Human-Human vs Human-AI Therapy: An Empirical Study

In many nations, demand for mental health services currently outstrips supply, especially in the area of talk-based psychological interventions. Within this context, chatbots (software applications designed to simulate conversations with human users) are increasingly explored as potential adjuncts to traditional mental healthcare service delivery with a view to improving accessibility and reducing waiting times. However, the effectiveness and acceptability of such chatbots remains under-researched. This study evaluates mental health professionals’ perceptions of Pi, a relational Artificial Intelligence (AI) chatbot, in the early stages of the psychotherapeutic process (problem exploration). We asked 63 therapists to assess therapy transcripts between a human client and Pi (human-AI) versus traditional therapy transcripts between therapists and clients (human-human). Therapists were unable to reliably discriminate between human-AI and human-human therapy transcripts. Therapists were accurate only 53.9% of the time, no better than chance, and rated the human-AI transcripts as higher quality on average. This study has potentially profound implications for the treatment of mental health problems, adding tentative support for the use of relational AI chatbots in providing initial assistance for mild to moderate psychological issues, especially when access to human therapists is constrained.

Exploring the lived experiences of women with infertility using traditional healthcare services in Harare urban, Zimbabwe.

Infertility has a significant impact on the lives of women. Therefore, affected women often consider the treatment options available to deal with their condition, including traditional healthcare services (THS). The aim of this phenomenological study was to explore the lived experiences of women with infertility problems who sought help from traditional health practitioners in Harare, Zimbabwe. Data from interviews with five women with infertility was explicated using a simplified version of Hycner (1985) five step explication process. Two major themes and eight sub themes emerged from the findings. The major themes were traditional diagnosis experiences and traditional treatment experiences. Consultation and divination were the diagnosis methods experienced by the women with infertility. The THS offered comprehensive management of infertility through couples therapy, as well as pre- and post-natal therapies, which include lifestyle counselling. The findings also showed that women with infertility commonly receive concurrent treatment, including both allopathic and traditional medicine. This presents an opportunity to explore the convergence of traditional and allopathic approaches in the management of infertility in women.

Psychological, sociocultural, and coping experiences of women with infertility using traditional healthcare services in Harare urban, Zimbabwe: A qualitative study.

This study focused on the psychological, social, and cultural dimensions of infertility among women with infertility in Harare Urban who have utilised traditional healthcare systems to address their infertility problem. It also emphasises their coping strategies for dealing with the challenges encountered along the infertile journey. This was a qualitative study using a phenomenological approach, focusing on the experiences of five women. Data from the interviews was analysed using a simplified version of Hycner's (1985) five-step explication process. The study produced three main themes: psychological experiences, socio-cultural experiences, and coping experiences, along with seven sub-themes. The results showed that women experienced intense distress, sorrow, and self-blame because of their inability to have children, further compounded by the stigma they faced from their families and communities. Women with infertility are subjected to derogatory labels, social contempt, ridicule, and being undervalued, which leads them to develop coping strategies to endure the adverse encounters. These coping mechanisms can have either positive or negative effects on their overall welfare. The exploration of psychological, socio-cultural factors, and coping mechanisms of women with infertility problems' presents a chance to co-create interventions that empower them.

ASSESSING THE NATURE OF PATRONAGE FOR TRADITIONAL MATERNAL HEALTH CARE SERVICES IN SOUTHWESTERN NIGERIA

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The study assessed the nature of patronage for traditional maternal health care services in Southwestern Nigeria. These were in view of providing information on the nature of patronage of traditional maternal health care services (TMHCs) in Nigeria, thus assisting in meeting the 2030 target of the Sustainable Development Goals (SDGs). &lt;strong&gt;Methods:&lt;/strong&gt; The study adopted a descriptive research design method approach. The study population was comprised of all pregnant women and nursing mothers attending TMHCs in Southwestern. The sample size consisted of 1020 pregnant women and nursing mothers. A self-designed questionnaire was used to gather information from the respondents. Data collected were analysed using frequency count, percentage, mean, standard deviation and ANOVA. &lt;strong&gt;Results:&lt;/strong&gt; It showed that respondents patronized centre owned by a tradition and culture 351(41.1%), respondents attended their preferred TMHCs on Wednesdays (738), and respondents were introduced to using TMHCs by their in-laws, religious leaders and friends, respectively. However, a large number of the respondents agreed that they use TMHCs because of the passionate care shown towards them (28.9%), spiritual reasons (26.6%), belief in the efficacy of service (30.2%), accessibility (29.7%) and offer of good and quality service (31.2%). Also, the study shows that there is a significant influence of the husband's age (df=3,870, F=5.909, p&amp;lt;0.05), husband's income (df=4,869, F=3.747, p&amp;lt;0.05) and husband's education level (df=3,870, F=64.70, p&amp;lt;0.05) on the reasons for patronizing TMHCs in the study area. &lt;strong&gt;Conclusion:&lt;/strong&gt; The study concluded that nature patronage is a contributing factor to the high usage of TMHCs, which encourages maternal mortality in Nigeria.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0528/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Generative artificial intelligence in healthcare from the perspective of digital media: Applications, opportunities and challenges

IntroductionThe emergence and application of generative artificial intelligence/large language models (hereafter GenAI LLMs) have the potential for significant impact on the healthcare industry. However, there is currently a lack of systematic research on GenAI LLMs in healthcare based on reliable data. This article aims to conduct an exploratory study of the application of GenAI LLMs (i.e., ChatGPT) in healthcare from the perspective of digital media (i.e., online news), including the application scenarios, potential opportunities, and challenges. MethodsThis research used thematic qualitative text analysis in five steps: firstly, developing main topical categories based on relevant articles; secondly, encoding the search keywords using these categories; thirdly, conducting searches for news articles via Google ; fourthly, encoding the sub-categories using the elaborate category system; and finally, conducting category-based analysis and presenting the results. Natural language processing techniques, including the TermRaider and AntConc tool, were applied in the aforementioned steps to assist in text qualitative analysis. Additionally, this study built a framework, using for analyzing the above three topics, from the perspective of five different stakeholders, including healthcare demanders and providers. ResultsThis study summarizes 26 applications (e.g., provide medical advice, provide diagnosis and triage recommendations, provide mental health support, etc.), 21 opportunities (e.g., make healthcare more accessible, reduce healthcare costs, improve patients care, etc.), and 17 challenges (e.g., generate inaccurate/misleading/wrong answers, raise privacy concerns, lack of transparency, etc.), and analyzes the reasons for the formation of these key items and the links between the three research topics. ConclusionsThe application of GenAI LLMs in healthcare is primarily focused on transforming the way healthcare demanders access medical services (i.e., making it more intelligent, refined, and humane) and optimizing the processes through which healthcare providers offer medical services (i.e., simplifying, ensuring timeliness, and reducing errors). As the application becomes more widespread and deepens, GenAI LLMs is expected to have a revolutionary impact on traditional healthcare service models, but it also inevitably raises ethical and security concerns. Furthermore, GenAI LLMs applied in healthcare is still in the initial stage, which can be accelerated from a specific healthcare field (e.g., mental health) or a specific mechanism (e.g., GenAI LLMs’ economic benefits allocation mechanism applied to healthcare) with empirical or clinical research.

The Feasibility and Efficacy of Warrior Health and Fitness: A 3-Month Fitness and Nutrition Program for Veterans.

Veterans are at risk for mental and physical health problems but may not seek traditional health care services. Wellness-based interventions, including exercise and nutrition, have been associated with improvements in physical and mental health among this population. This study explores the acceptability, feasibility, and efficacy of a 3-month health and fitness program for veterans. Participants in 2 time-based cohorts from 2019 to 2023 (cohort 1: n = 261; cohort 2: n = 256) were cleared by a physician to participate. Participants then completed a fitness test and self-reported surveys (e.g., quality of life, sleep, and pain) before and after the 3-month program. Participants were recruited to participate at one of three sites: Boston, MA Fort Myers, FL, or Tampa, FL. The 3-month program consisted of weekly, supervised group fitness and one-on-one sessions, nutritional consultations, yoga, and other wellness activities. Primary program outcomes were measured by fitness assessments, self-report surveys, program completion, and program satisfaction. Fitness assessments included measures of weight, body mass index, grip strength, waist to hip ratio, body fat, lean mass, fat mass, heart rate, and blood pressure (BP). Self-report measures included quality of life, depression, loneliness, sleep quality, pain intensity, and pain interference. In cohort 1, significant improvements were found for measures of weight (P = .01), left-handed grip strength (P < .01), body fat percent (P < .01), and quality of life (P < .01). In cohort 2, significant improvements were found for measures of waist:hip ratio (P = .02), right and left-handed grip strength (P < .01), body mass index (P = .02), body fat percent (P < .01), and quality of life (P = .02). For both cohorts, pain intensity (cohort 1: P = .01, cohort 2: P < .001) and pain interference (cohort 1: P = .02, cohort 2: P < .001) increased significantly. These data suggest that a 3-month health and fitness program for veterans is acceptable and feasible and may improve physical and mental health outcomes. Considerations for program retention and assessment completion are discussed.

"There's always something, and then there's more": a qualitative examination of how virtual peer led self-management can create community around the evolving SCI experience.

Self-management programs for spinal cord injury (SCI) are a growing adjunct to traditional healthcare services aiding individuals with SCI in learning and managing symptoms and medical care. A benefit of self-management programs is that they can be facilitated by peers, offering a unique lived experience of adjusting to and managing SCI. While a growing body of literature highlights the effectiveness of peer led programs, there is limited understanding of how individuals engage with peer programs or critical components of peer support. The current study seeks to understand how individuals engaged with peers in the context of a self-management program. Secondary qualitative analysis of online forum posts resultant from a peer led self-management course for SCI. Content analysis revealed several themes of how participants engaged with members of the group, including skill building, resource sharing, and problem solving. A process level theme of emotional connection to others living with similar SCI-related challenges was defined as "bearing witness." Participants commented frequently that groups were the first time they engaged with a community with lived experience, and shared experience was frequently highlighted in the responses from individuals as one of the most unique and important aspects of the intervention. Themes identified suggest that bearing witness was a critical component of peer led intervention. While self-management content provided structure for engagement and discussion, participants report that connectedness and shared experience made content more impactful and relevant. Future research should examine if alignment of peer and participant experience increases the impact of interventions and explore if this theme is important for other chronic medical populations.

DIGITAL HEALTH TOOLS FOR BREASTFEEDING MOTHERS: A COMPARATIVE REVIEW BETWEEN NIGERIA AND THE US

This comparative review evaluates and compares the impact and adoption of mobile apps and digital platforms, including Babyroo, in supporting breastfeeding mothers in Nigeria and the US. Breastfeeding is crucial for infant health and development, yet many mothers face challenges and require support. Digital health tools, such as mobile apps and online platforms, offer a promising solution to provide information, guidance, and support to breastfeeding mothers. Nigeria and the US were chosen for comparison due to their different healthcare systems, cultural norms, and levels of technological adoption. The review examines the features, accessibility, and effectiveness of digital health tools, particularly Babyroo, in supporting breastfeeding mothers in both countries. The findings reveal that digital health tools play a significant role in supporting breastfeeding mothers in both Nigeria and the US. Babyroo, in particular, offers a range of features such as breastfeeding tips, tracking tools, and online communities for mothers to connect and share experiences. However, the adoption of these tools varies between the two countries. In Nigeria, where access to healthcare services is limited, digital health tools like Babyroo can bridge the gap and provide essential support to breastfeeding mothers. In contrast, in the US, where healthcare services are more accessible, digital health tools serve as a supplement to traditional healthcare services, offering convenience and additional resources for breastfeeding mothers. Overall, the review highlights the potential of digital health tools, such as Babyroo, in supporting breastfeeding mothers globally. However, it also emphasizes the importance of context-specific approaches and the need for further research to understand the impact and effectiveness of these tools in different cultural and healthcare settings.&#x0D; Keywords: Digital Health, Tools, Breastfeeding, Mothers, Comparative.

Telemedicine in diabetic eye care: A meta-analysis of its effectiveness in underserved populations

Telemedicine has emerged as a promising tool in diabetic eye care, particularly for underserved populations facing barriers to accessing traditional healthcare services. This meta-analysis aims to evaluate the effectiveness of telemedicine interventions in managing diabetic eye conditions within underserved communities. Through a systematic review of existing literature, encompassing diverse telemedicine approaches such as remote screening, teleconsultation, and telemonitoring. These studies were conducted across various regions with underserved populations, including rural areas, low-income urban neighborhoods, and underserved ethnic groups. The meta-analysis revealed significant improvements in several key outcome measures. Firstly, telemedicine interventions led to increased rates of early detection of diabetic retinopathy and other diabetic eye complications, facilitating timely intervention and preventing progression to more severe stages of the disease. Secondly, telemedicine facilitated better access to specialist care, overcoming geographical barriers and reducing the burden of travel for patients. Thirdly, telemedicine interventions were associated with improved patient compliance with follow-up appointments and treatment regimens, leading to better long-term management of diabetic eye conditions. Moreover, subgroup analyses revealed that telemedicine was particularly effective in reaching vulnerable populations such as elderly individuals, those with limited mobility, and ethnic minorities, thereby addressing disparities in healthcare access. Telemedicine holds great promise as an effective tool for diabetic eye care in underserved populations, offering a scalable and cost-effective approach to improving access to timely screening, diagnosis, and management of diabetic eye conditions. Further research and implementation efforts are warranted to optimize telemedicine interventions and ensure equitable access to quality eye care for all.

Secure Sharing of Electronic Medical Records Based on Blockchain

As network technology advances and more people use devices, data storage has become a significant challenge due to the explosive growth of information and the threat of data leaks. In traditional medical institutions, most medical data is stored centrally through cloud computing technology in the institution’s data center. This centralized storage method has many security risks, and once the central server is attacked, it will lead to the loss of medical data, which will lead to the leakage of patients’ private data. At the same time, electronic medical records are the most critical data in the current medical field. In the traditional centralized healthcare service system (HSS), there are data leakage problems and tampering with electronic medical records due to human factors. At the same time, each hospital is built independently, resulting in the current centralized healthcare service system having a data silo problem, making it difficult to share medical data between institutions securely. With the increase in the number of users in the system, the electronic medical record data in the system also increases gradually, resulting in the increasing overhead of decryption calculation. Therefore, this paper proposes a blockchain-based access control scheme with multiparty authorization to ensure the security of electronic medical records. The scheme uses an SM encryption algorithm to encrypt the medical data in the system. It adds the patient’s signature to ensure the confidentiality and security of the data, and the encrypted electronic medical records (EMRs) are stored in the InterPlanetary File System (IPFS) to realize the distributed storage of EMR. In addition, role-based multiauthorization access control is implemented through smart contract-based to ensure the security of EMR. We have analyzed the security of this paper’s solution and compared its performance with the existing schemes based on other cryptographic algorithms. The experimental results show that the proposed solution significantly improves the secure sharing of EMR and provides system performance.

"It has to be better, otherwise we will get stuck." A Review of Novel Directions for Mental Health Reform and Introducing Pilot Work in the Netherlands.

The current state of mental health care in the Netherlands faces challenges such as fragmentation, inequality, inaccessibility, and a narrow specialist focus on individual diagnosis and symptom reduction. A review suggests that in order to address these challenges, an integrated public health approach to mental health care that encompasses the broader social, cultural, and existential context of mental distress is required. A Mental Health Ecosystem social trial seeks to pilot such an approach in the Netherlands, focusing on empowering patients and promoting collaboration among various healthcare providers, social care organizations, and peer-support community organizations, working together in a regional ecosystem of care and committed to a set of shared values. In the ecosystem, mental health problems are examined through the prism of mental variation in context whilst scaling up the capacity of group-based treatment and introducing a flexible and modular approach of (2nd order) treatment by specialists across the ecosystem. The approach is to empower naturally available resources in the community beyond professionally run care facilities. Digital platforms such as psychosenet.nl and proud2bme.nl, which complement traditional mental health care services and enhance public mental health, will be expanded. The capacity of recovery colleges will be increased, forming a national network covering the entire country. GEM will be evaluated using a population-based approach, encompassing a broad range of small-area indicators related to mental health care consumption, social predictors, and clinical outcomes. The success of GEM relies heavily on bottom-up development backed by stakeholder involvement, including insurers and policy-making institutions, and cocreation. By embracing a social trial and leveraging digital platforms, the Dutch mental health care system can overcome challenges and provide more equitable, accessible, and high-quality care to individuals.

Long-Term Efficacy of primary care combining a mobile healthcare application with human coaching

Abstract Background Chronic diseases have become a global burden, and digital self-healthcare using mobile devices has gained importance in managing these conditions. However, barriers to implementing mobile self-management healthcare applications in current primary care system, and previous research has focused on short-term effects. This study aims to evaluate the long-lasting effect of combining human coaching with mobile self-management healthcare applications for chronic disease patients in primary healthcare services. Methods The study recruited 178 patients with chronic diseases from participating primary care clinics. The intervention group (N = 128) received a 12-week mobile self-management healthcare application service combined with traditional primary care, while the control group (N = 50) received only traditional healthcare. The Noom application was used, with two weekly human coaching sessions by a nutritionist. A telephone survey on weight changes was conducted one year after the intervention. Results The intervention group showed a greater weight loss compared to the control group during the intervention period (Intervention: -1.29 ± 2.94 vs Control: -0.38 ± 1.72, P-value 0.002). Although there was no statistically significant difference in additional weight change between the two groups during the follow-up period, the difference in weight loss during the intervention period was maintained (Intervention: -2.16 ± 5.54 vs Control: -1.06 ± 3.24, P-value: 0.008). Additionally, among the intervention group continuously for 1 year using the health management application, the average weight loss was higher than the other groups. Conclusions Combining a mobile self-management healthcare application with human coaching has long-lasting effects and can be effective in primary healthcare services. This suggests that such an approach has the potential to be a treatment option in current primary healthcare systems, but further large-scale long-term studies are needed. Key messages • This study suggests that using mobile self-management healthcare apps with human coaching can be an effective long-term treatment option for chronic disease patients in primary healthcare services. • The combination of the two methods may provide better outcomes than traditional healthcare services alone.

Peer-delivered point-of-care testing and linkage to treatment for hepatitis C virus infection among marginalized populations through a mobile clinic in Copenhagen, Denmark

BackgroundGlobally, many people with hepatitis C virus (HCV) infection are marginalized and have very limited access to traditional healthcare services, including HCV testing and treatment. Models of care attuned to the needs of the marginalized population at risk are needed. This study aimed to evaluate the testing and treatment uptake of a community-based, peer-led model of care offering point-of-care testing. MethodsIn this interventional cohort study, people at risk of HCV infection were recruited between May 2019 and December 2021 at a community-based, peer-led mobile clinic. During a single visit, participants were offered a point-of-care HCV antibody test, and, if antibodies were detected, an additional RNA test. Participants with detectable HCV RNA were linked with peer-assisted referral to a ‘fast-track’ clinic at a major hospital. The primary outcomes were the number of people engaged in testing and the proportion who initiated treatment and achieved a sustained virologic response (SVR). ResultsWe tested 728 individuals. Of those, 208 (29%) were positive for HCV antibodies, and 114 (15%) were HCV RNA detectable. Of the 114, 80 (70%) initiated treatment, and 79 (99%) achieved SVR. The main reason for not initiating treatment was non-Danish citizenship with no legal access to health care. ConclusionThis study found that a peer-led point-of-care service is a model of care that can engage marginalized groups in HCV testing and linkage to treatment.