[Promoting peace in the healthcare sector. What obstacles to overcome?] / La promozione della pace in ambito sanitario. Quali ostacoli da superare?

Modern military strategies, armaments and technologies imply that every war today has a deleterious impact on all determinants of health, with direct and indirect effects that cause physical, mental and social suffering of the exposed population, that extends far beyond the duration of the conflict. The promotion of peace and the prevention of war is therefore clearly one of the professional tasks of health professionals, at least as much as the prevention of other public health risks. Nevertheless, peace promotion and anti-war activities are struggling to take off and spread in the health sector. The article examines two possible factors that stand as obstacles between the realisation of the evil of war, shared by all, and the actual commitment to disarmament and peace, practised by a few. The first of these obstacles is the divergence of views on the methods to choose to prevent conflict. Nonviolence and disarmament or military deterrence? The hypothesis discussed is that the deterrence theory still enjoys a certain credibility even in the medical scientific world although it is far from being an evidence-based strategy. The second obstacle examined is the fear of professionals and their associations of being accused of 'playing politics'. Since war is always a public health catastrophe, when health professionals oppose war, they are only doing their job. However, it is undoubtedly true that preventing war also involves political choices, but this is the case in every other area of public health, which without the use of political and regulatory instruments could not fulfil its task. Lastly, a concrete example of an intervention to promote peace is presented, promoted by several Italian scientific societies in the health field who have succeeded in drawing up a joint declaration in favour of peace and against war, open for subscription also by other scientific societies, journals, associations and foundations in the health sector.

The Value of Smartwatches in the Health Care Sector for Monitoring, Nudging, and Predicting: Viewpoint on 25 Years of Research.

We propose a categorization of smartwatch use in the health care sector into 3 key functional domains: monitoring, nudging, and predicting. Monitoring involves using smartwatches within medical treatments to track health data, nudging pertains to individual use for health purposes outside a particular medical setting, and predicting involves using aggregated user data to train machine learning algorithms to predict health outcomes. Each domain offers unique contributions to health care, yet there is a lack of nuanced discussion in existing research. This paper not only provides an overview of recent technological advancements in consumer smartwatches but also explores the 3 domains in detail, culminating in a comprehensive summary that anticipates the future value and impact of smartwatches in health care. By dissecting the interconnected challenges and potentials, this paper aims to enhance the understanding and effective deployment of smartwatches in value-based health care.

Market concentration of the Brazilian hospital medical supplementary health system.

BACKGROUND: The Brazilian supplementary health market has undergone transformations in recent years due to constant mergers and acquisitions of by large corporations, contributing to the increase in market concentration, especially in the poorest and least developed regions of the country. Thus, given the care it provides and its economic relevance, understanding the fundamentals of these movements, the likely consequences and trends for the health market are relevant, important, and strategic. OBJECTIVE: To understand the general and specific context of Brazilian supplementary health, its scenarios, and trends, with emphasis on the analysis of market concentration and recent mergers and acquisitions. METHODOLOGY: The research is applied, descriptive and exploratory and uses secondary data from various sources, submitted to quantitative data analysis methods. The data are organized into three groups: historical and regulatory documents; industry data; and market. RESULTS: The results show the growing concentration of the market promoted by large publicly traded corporations, the growing relevance of tech startups on the healthcare landscape, the predominant use of the relative valuation model, with implicit multiples for asset pricing and the prevalence of corporate health plans. CONCLUSION: The growing concentration of the system projects a market with fewer options and less competitiveness, since the growth of large operators is evident, in addition to the relevant increase in the number of complaints from users of the system, which signals the growing gap between the expectations of users and the levels of quality care offered. The study also highlights the predominance of corporate health plans, revealing the direct relationship between access to supplementary health services and employability rates. The analysis of M&A operations, in addition to the increase in market concentration, reveals the prevalence of the use of the relative valuation model and implicit multiples for the pricing of traded assets. This denotes the future expectation of wealth generation, at least equivalent to the historical series of the sector, on the part of investors, whose frustration may signal the decreasing attractiveness of resources and M&A operations in the sector in the coming years.

Big data analytics in the healthcare sector: Opportunities and challenges in developing countries. A literature review.

Background: Despite the ongoing efforts to digitalize the healthcare sector in developing countries, the full adoption of big data analytics in healthcare settings is yet to be attained Exploring opportunities and challenges encountered is essential for designing and implementing effective interventional strategies. Objective: Exploring opportunities and challenges towards integrating big data analytics technologies in the healthcare industry in developing countries. Methodology: This was a narrative review study design. A literature search on different databases was conducted including PubMed, ScienceDirect, MEDLINE, Scopus, and Google Scholar. Articles with predetermined keywords and written in English were included. Results: Big data analytics finds its application in population health management and clinical decision-support systems even in developing countries. The major challenges towards the integration of big data analytics in the healthcare sector in developing countries include fragmentation of healthcare data and lack of interoperability, data security, privacy and confidentiality concerns, limited resources and inadequate regulatory and policy frameworks for governing big data analytics technologies and limited reliable power and internet infrastructures. Conclusion: Digitalization of healthcare delivery in developing countries faces several significant challenges. However, the integration of big data analytics can potentially open new avenues for enhancing healthcare delivery with cost-effective benefits.

Materials for 3D printing in healthcare sector: A review.

Additive Manufacturing (AM) encompasses various techniques creating intricate components from digital models. The aim of incorporating 3D printing (3DP) in the healthcare sector is to transform patient care by providing personalized solutions, improving medical procedures, fostering research and development, and ultimately optimizing the efficiency and effectiveness of healthcare delivery. This review delves into the historical beginnings of AM's 9 integration into medical contexts exploring various categories of AM methodologies and their roles within the medical sector. This survey also dives into the issue of material requirements and challenges specific to AM's medical applications. Emphasis is placed on how AM processes directly enhance human well-being. The primary focus of this paper is to highlight the evolution and incentives for cross-disciplinary AM applications, particularly in the realm of healthcare by considering their principle, materials and applications. It is designed for a diverse audience, including manufacturing professionals and researchers, seeking insights into this transformative technology's medical dimensions.

Measurement of Technical Efficiency of the Health-care Sector in Assam: An Application of Nonparametric Method.

SUMMARY: The study has used a nonparametric method to estimate the technical efficiency of health-care sector in the substate level of Assam. The study is based on secondary data for the year 2018-2019. The average constant return to scale technical efficiency score is 0.81, while the average efficiency scores in variable return to scale technical efficiency and scale efficiency (SE) are 0.88 and 0.92 respectively. Moreover, seven (26%) districts are technically efficient. The major cause of inefficiency is the poor management of health-care sector. Four (15%) districts Chirang, Dima Hasao, Baksa, and Udalguri have achieved least efficiency score, while five (19%) districts Kamrup (Rural), Sivasagar, Dibrugarh, Lakhimpur, and Goalpara have the highest potentiality to achieve efficiency level. The study is static in nature. However, it will help the health policymakers to improve management and size of operation of health sector in the state.

Components and entities of post-disaster damage and loss assessment program in healthcare sector: a scoping review.

BACKGROUND: Disasters can cause casualties and significant financial loss. In accordance with the Sendai Framework for Disaster Risk Reduction, areas affected by disasters must be built back better. Accurate post-disaster damage and loss assessments are critical for the success of recovery programs. This scoping review aimed to identify the components and entities of the healthcare sector's post-disaster damage and loss assessment program. METHODS: An comprehensive search for relevant literature was performed using several databases, including the Web of Science, PubMed, Scopus, ProQuest, and Magiran. The search was limited to papers published between 2010 and 2022. In addition, we searched the grey literature for resources related to post-disaster damage and loss assessments. Study selection and data extraction were evaluated by a third reviewer. The main themes were determined through a consensus process and agreement among team members. RESULTS: A total of 845 papers were identified, 41 of which were included in the review. The grey literature search yielded 1015 documents, 23 of which were associated with the study's purpose. The findings were classified into five main themes, 20 subthemes, and 876 codes. The main-themes include the following: Concepts and Definitions; Post-Disaster Damage and Loss Assessment Procedures; Healthcare sector procedures; Assessments Tools, and Methods; Intra-sectoral, Inter-sectoral, and cross-cutting issues. CONCLUSIONS: The existing corpus of literature on post-disaster damage and loss assessment programs within the healthcare sector offers only limited insights into the entities and components involved. It is of great importance that stakeholders have an extensive grasp of these pivotal concepts and principles, as they are fundamental in enabling effective responses to disasters, informed decision-making, and facilitating rehabilitation and reconstruction efforts. Consequently, there is a considerable scope for further investigation in this area. SCOPING REVIEW REGISTRATION NUMBER: https://osf.io/nj3fk .

Post-disaster damage and loss assessment in the Iranian healthcare sector: a qualitative interview study.

BACKGROUND: Accurate post-disaster damage and loss assessment is critical for the success of subsequent recovery programs. A comprehensive and systematic damage and loss assessment process involves evaluating the physical damage and financial impact of an event on individuals, communities, and assets. To ensure effective recovery, the various components and entities included in the program must be developed appropriately and efficiently. This study aimed to identify the components and entities of the Iranian healthcare sector's post-disaster damage and loss assessment program. METHODS: A qualitative study employing purposive sampling and semi-structured individual interviews was conducted with 18 participants between October 2022 and July 2023, with continuing until data saturation was achieved. Data collection involved semi-structured interviews and observational notes with experts, including representatives from the National Disaster Management Organization (NDMO), the Iranian Red Crescent Society, and the Disaster Risk Management Department of the Ministry of Health and Medical Sciences Universities. The interviews were conducted in the workplace of the participants. Thematic analysis, a conventional qualitative method, was employed for the analysis of the data. Following the transcription of the recorded interviews, the initial codes were extracted, reviewed for accuracy, and classified. RESULTS: The results of this study are based on the insights and experiences of a diverse group of qualified experts in their respective fields. The findings were analysed and classification into ten main themes, 29 sub-themes, and 1,058 codes. The main themes were key concepts and principles of assessment; assessment stages; health system measures in assessment; roles and responsibilities; team composition; information and communication; coordination and collaboration; data collection and analysis; assessment tools and methods; and reporting, documentation, and recommendations. CONCLUSION: An understanding of key concepts and principles enables stakeholders to respond effectively to disasters, make informed decisions, and facilitate recovery and reconstruction efforts.

Transforming Health Care Landscapes: The Lever of Radiology Research and Innovation on Emerging Markets Poised for Aggressive Growth.

Advances in radiology are crucial not only to the future of the field but to medicine as a whole. Here, we present three emerging areas of medicine that are poised to change how health care is delivered-hospital at home, artificial intelligence, and precision medicine-and illustrate how advances in radiological tools and technologies are helping to fuel the growth of these markets in the United States and across the globe.

Exploring Industry Payments to Urology Residents: A Longitudinal Analysis Under the Sunshine Act.

OBJECTIVE: To explore the financial interactions between urology residents and the healthcare industry over a 5-year training period, assessing the implications of these interactions on medical education and practice considering the Physician Payments Sunshine Act. DESIGN: Longitudinal analysis of Open Payments data for a single class of urology residents from 2018 to 2023. SETTING: Data were extracted from the CMS Open Payments Database and cross-referenced with residency program information from the American Urological Association (AUA) and the Accreditation Council for Graduate Medical Education (ACGME). PARTICIPANTS: A cohort of 314 urology residents were identified to have matched in 2018, with 173 residents having reported financial interactions through the Open Payments Program (OPP), representing 55% of the cohort. RESULTS: Analysis revealed that $129,632 was disbursed to the 173 residents throughout their surgical training, with a significant majority (approximately three-quarters or around $100,000) allocated for food and beverage. A statistically significant difference in payment amounts was observed between genders, with male residents receiving an average of $869 compared to $454 for female residents. Payments increased progressively with each postgraduate year (PGY) level, peaking in the fifth year. Despite notable disparities in compensation across AUA sections, no statistically significant variation was found (p = 0.21). The study also highlighted the underestimation of industry influence due to discretionary and heterogeneous reporting practices. CONCLUSIONS: The study underscores a significant, yet potentially underreported, financial interaction between urology residents and the healthcare industry, suggesting a deepening relationship as residents progress through their training. The findings call for a more uniform reporting system to enhance transparency and provide a clearer understanding of the industry's role in medical education and practice. Additionally, many residents may not be aware that their financial interactions are being documented and made public, a factor that could influence their professional behavior and expectations.

International aid management in Afghanistan's health sector from the perspective of national and international managers.

PURPOSE: The primary purpose of international aid is to promote economic and social development around the world. International aid plays an important role in Afghanistan's healthcare system. The purpose of this study is to investigate international aid management in Afghanistan's health sector from the perspectives of national and international managers in 2022 and to provide recommendations for the improvement. DESIGN/METHODOLOGY/APPROACH: The study has a cross-sectional design. The study participants were chosen by random sampling. The sample size was determined based on Yaman's formula at 110. The data collection tool was the questionnaire provided by International Health Partnership and Related Initiatives. The data were analyzed in two descriptive (mean and percentage) and analytical formats. Independent t-test, Mann-Whitney, Kolmogorov-Smirnov tests and Variance analysis were used to examine the relationships between demographic variables and the scores of each dimension. FINDINGS: The average scores given to different dimensions of aid management were as following: 1) the donners' support of the national health strategy: 48/68 ± 16.14 (49%), 2) the predictable financing: 50/23 ± 16.02 (50%), 3) foreign aid on budget: 55/39 ± 20.15 (55%), 4) strengthening public financial management system: 38/35 ± 19.06 (38%), 5) strengthening the supply and procurement system: 40.97 ± 19.55 (41%), 6) mutual accountability: 46.50 ± 19.26 (46%), 7) technical support and training: 50.24 ± 17.33 (50%), 8) civil society involvement: 35.24 ± 18.61(35%), 9) private sector participation: 36 ± 17.55 (36%), and in total the average score was 44.52 ± 13.27 (44%). The difference between the scores given by two groups of managers was not significant. No meaningful relationship was observed between the total score and any of the demographic variables, but there was a weak relationship between work and management experience and total score. The correlation coefficient showed a statistically significant relationship between the different dimensions of the questionnaire. To sum up, the performance in all dimensions of aid management hardly reached 50%. Donors' support for the national health strategy was not adequate. There were challenges in evidence-based decision-making, developing national health strategies, control and evaluation, the allocation of resources and use of procurement system. The priorities of donors and government were not always similar and mutual responsibility was lacking. Technical assistance and supporting multilateral cooperation are necessary. ORIGINALITY/VALUE: Most studies on foreign aid focused on its effects on economic growth, poverty and investment and not aid management processes. Without proper aid management, parts of resources are wasted and aims of aid programs cannot be achieved. This study investigates aid management in a developing country from the perspectives of two main stakeholders, international and national managers. RESEARCH LIMITATIONS AND IMPLICATIONS: Data collection coincided with the change of government in Afghanistan. The situation might be different now. Still, this study provides areas for the improvement of aid management in the studied country. Future studies can build upon the findings of this research and conduct in-depth exploration of areas of aid effectiveness and designing detailed programs of improvement. PRACTICAL IMPLICATIONS: Instructions of the Paris Declaration on Aid Effectiveness need to be followed. Particularly, civil society involvement and private sector participation should receive attention. A joint plan for improvement and collaboration of different stakeholders is needed.

Multidisciplinary cancer disease classification using adaptive FL in healthcare industry 5.0.

Emerging Industry 5.0 designs promote artificial intelligence services and data-driven applications across multiple places with varying ownership that need special data protection and privacy considerations to prevent the disclosure of private information to outsiders. Due to this, federated learning offers a method for improving machine-learning models without accessing the train data at a single manufacturing facility. We provide a self-adaptive framework for federated machine learning of healthcare intelligent systems in this research. Our method takes into account the participating parties at various levels of healthcare ecosystem abstraction. Each hospital trains its local model internally in a self-adaptive style and transmits it to the centralized server for universal model optimization and communication cycle reduction. To represent a multi-task optimization issue, we split the dataset into as many subsets as devices. Each device selects the most advantageous subset for every local iteration of the model. On a training dataset, our initial study demonstrates the algorithm's ability to converge various hospital and device counts. By merging a federated machine-learning approach with advanced deep machine-learning models, we can simply and accurately predict multidisciplinary cancer diseases in the human body. Furthermore, in the smart healthcare industry 5.0, the results of federated machine learning approaches are used to validate multidisciplinary cancer disease prediction. The proposed adaptive federated machine learning methodology achieved 90.0%, while the conventional federated learning approach achieved 87.30%, both of which were higher than the previous state-of-the-art methodologies for cancer disease prediction in the smart healthcare industry 5.0.

Examining aid fragmentation and collaboration opportunities in Cambodia's health sector.

BACKGROUND: Cambodia's health sector faces significant challenges exacerbated by aid fragmentation, where development aid is dispersed among numerous small, uncoordinated projects. This study examines the distribution of health sector aid among Cambodia's principal donors to identify priorities, overlaps, and potential collaboration opportunities, addressing the urgent need for aid efficiency and alignment with national health priorities. METHODS: Utilizing OECD datasets and the Herfindahl-Hirschman Index (HHI) for the years 2010-2021, this study quantifies aid fragmentation within Cambodia's health sector. It analyzes aid allocations from the top five donors-United States, Australia, South Korea, Japan, and Germany-across various health projects and initiatives, evaluating the extent of fragmentation and identifying areas for potential donor collaboration. RESULTS: This study's findings highlight a pervasive issue of aid fragmentation within Cambodia's health sector, evident through the sector's low HHI score. This indicates a widespread distribution of aid across numerous small-scale initiatives, rather than targeted, unified efforts. A notable example includes Japan and Korea, which exhibit lower HHI scores, indicating a more pronounced fragmentation in their aid allocation. These countries' contributions are spread across various sectors without a dominant focus, contrasting with the United States' significant dedication to infectious disease control. However, beyond this specific area, the US's aid distribution across other priority health areas shows signs of fragmentation. This scattered approach to aid allocation, even amidst instances of focused support, illustrates the overarching challenge of aligning donor contributions with the holistic needs of Cambodia's health infrastructure. CONCLUSIONS: This investigation highlights the critical need for enhanced collaboration and strategic harmonization among international donors to mitigate aid fragmentation in Cambodia's health sector. It underscores the importance of adopting integrated and priority-aligned aid strategies to improve the efficiency and impact of health aid. By fostering synergistic partnerships and harmonizing donor efforts, there is a potential to create a more cohesive support framework that resonates with Cambodia's comprehensive health requirements and contributes to sustainable health outcomes. Such harmonization not only aligns with Sustainable Development Goal 3 by optimizing health services and outcomes but also strengthens global partnerships under Sustainable Development Goal 17, fostering a unified approach to international development.

Enhancing Human Health and Wellbeing through Sustainably and Equitably Unlocking a Healthy Ocean's Potential.

A healthy ocean is essential for human health, and yet the links between the ocean and human health are often overlooked. By providing new medicines, technologies, energy, foods, recreation, and inspiration, the ocean has the potential to enhance human health and wellbeing. However, climate change, pollution, biodiversity loss, and inequity threaten both ocean and human health. Sustainable realisation of the ocean's health benefits will require overcoming these challenges through equitable partnerships, enforcement of laws and treaties, robust monitoring, and use of metrics that assess both the ocean's natural capital and human wellbeing. Achieving this will require an explicit focus on human rights, equity, sustainability, and social justice. In addition to highlighting the potential unique role of the healthcare sector, we offer science-based recommendations to protect both ocean health and human health, and we highlight the unique potential of the healthcare sector tolead this effort.

A systematic review of leadership styles in healthcare sector: Insights and future directions.

In light of the ongoing global health crisis, the significance of leadership within the healthcare sector has intensified. Given this consideration, the significance of appropriate leadership styles cannot be overstated. The objective of this paper is to critically review published studies on leadership elements in the healthcare sector. Using Bibliometrix R package and VOS viewer, we conducted bibliometric and network analyses on publications retrieved from the Web of Science (WOS) database, with content analysis integrated throughout the paper to deepen understanding. Ultimately, 243 articles were identified as relevant. The findings revealed transformational leadership emerges as the most extensively discussed leadership style. 91% of the articles' theme focus on quantitative research methods. This study synthesizes the influencing factors of the three most frequently discussed leadership styles-transformational, authentic, and ethical leadership-emphasizing the importance of job satisfaction and organizational citizenship behavior. And provides direction for future research through thematic analysis.

[Personnel shortages in the healthcare sector-will de-economization solve or exacerbate the problem?] / Personalmangel im Gesundheitswesen ­ Löst oder verstärkt die Entökonomisierung das Problem?

The healthcare industry has long complained about an acute shortage of skilled workers. Vacancies can often only be filled by skilled workers from abroad. While rural areas are increasingly experiencing a shortage of personnel, many urban centers continue to have an oversupply and a sufficient number of young doctors. Hospitals do not expect the situation to improve in the future. Hospitals are trying to counteract the negative development of the job situation in nursing staff. Government intervention can limit the economically motivated adjustment of resource utilization. The demand for staff will not fall as a result of de-economization.

Business cycles and healthcare employment.

Is healthcare employment recession-proof? We examine the long-standing hypothesis that healthcare employment is stable across the business cycle. We explicitly distinguish between negative aggregate demand and supply shocks in studying how healthcare employment responds to recessions, and show that this response depends largely on the type of the exogenous shock triggering the recession. First, aggregate healthcare employment responds procyclically during demand-induced recessions but remains stable during supply-induced recessions. Second, healthcare utilization drops significantly during demand-induced recessions, explaining the decline in healthcare employment during these periods. Finally, there is significant heterogeneity in the employment responses of the healthcare sub-sectors. While healthcare employment in most sub-sectors responds procyclically during recessions caused by both negative demand and supply shocks, it responds countercyclically in nursing-dominant sectors. Importantly, by isolating the recessionary impact of negative aggregate demand shocks from supply shocks on healthcare employment, we provide new empirical evidence that healthcare employment, in general, is not recession-proof.