Previne brasil e financiamento da atenção primária: facilidades e dificuldades de gestores municipais de saúde / Previne Brasil and primary care financing: facilities and difficulties for municipal health managers / Previne Brasil y financiamiento de la atención primaria: facilidades y dificultades para los gestores municipales de salud

Objetivo: compreender as facilidades e dificuldades enfrentadas por gestores municipais de saúde com o novo modelo de financiamento da Atenção Primária à Saúde. Método: estudo qualitativo, tipo Pesquisa Convergente Assistencial, fundamentado na Política Nacional de Atenção Básica. Participaram 77 gestores ou seus representantes, de 47 municípios de uma Macrorregião de saúde de Santa Catarina, Brasil. Foram realizadas três oficinas nas Gerências Regionais de Saúde, em agosto e setembro de 2022. Os dados foram analisados pela análise de conteúdo. Resultados: apresentam-se como facilidades do Previne Brasil informatização, comprometimento dos profissionais, e qualificação do cuidado. Foram descritas como dificuldades falta de informações, sistema informatizado e denominador estimado e, equipe de trabalho. Conclusão: o programa apresenta facilidades que qualificam o processo de trabalho e cuidado à saúde da população. Contudo, persistem dificuldades que devem ser consideradas pela gestão municipal para avanços na atenção integral e no financiamento da Atenção Primária à Saúde.

Objective: understand the facilities and difficulties faced by municipal health managers with the new Primary Health Care financing model. Method: this is a qualitative study, of the Convergent Care Research type, based on the National Primary Care Policy. The participants were 77 managers or their representatives from 47 municipalities in a health Macroregion in Santa Catarina, Brazil. Three workshops were held in the Regional Health Departments in August and September 2022. The data was analyzed using content analysis. Results: Previne Brasil's facilities include computerization, commitment of professionals, and qualification of care. Difficulties were described as lack of information, computerized system and estimated denominator, and work team. Conclusion: the program offers facilities that improve the work process and health care for the population. However, there are still difficulties that must be considered by municipal management in order to make progress in comprehensive care and Primary Health Care financing.

Objetivo: comprender las facilidades y dificultades que enfrentan los gestores municipales de salud con el nuevo modelo de financiamiento de la Atención Primaria de Salud. Método: estudio cualitativo, tipo Investigación Convergente Asistencial, basado en la Política Nacional de Atención Primaria. Participaron 77 gestores o sus representantes, de 47 municipios de una Macrorregión de salud de Santa Catarina, Brasil. Se realizaron tres talleres en las Gerencias Regionales de Salud, en agosto y septiembre de 2022. Los datos fueron analizados mediante análisis de contenido. Resultados: las instalaciones de Previne Brasil incluyen informatización, compromiso de los profesionales y calificación de la atención. Las dificultades fueron descritas como falta de información, sistema informatizado y denominador estimado y equipo de trabajo. Conclusión: el programa presenta facilidades que cualifican el proceso de trabajo y la atención de la salud de la población. Sin embargo, aún hay dificultades que la gestión municipal debe considerar para lograr avances en la atención integral y el financiamiento de la Atención Primaria de Salud.

[The current situation of occupational health in the Internet industry and countermeasures].

As an important force in promoting the transformation and upgrading of the national economy, the occupational health of the Internet industry's employees has received widespread attention. This paper examines the current situation of occupational health risks and management in the Internet industry at home and abroad, and on this basis reveals the physical and mental health problems of Internet industry employees. Combining the existing regulations, policies and standard documents at home and abroad, countermeasures are proposed to improve the relevant laws and regulations and their guidelines, implement relevant job design requirements, build a healthy working environment, optimise the work management system and carry out workplace health promotion, in order to provide ideas to accelerate the improvement of occupational health issues in the Internet industry.

Assessing racial bias in healthcare predictive models: Practical lessons from an empirical evaluation of 30-day hospital readmission models.

OBJECTIVE: Despite increased availability of methodologies to identify algorithmic bias, the operationalization of bias evaluation for healthcare predictive models is still limited. Therefore, this study proposes a process for bias evaluation through an empirical assessment of common hospital readmission models. The process includes selecting bias measures, interpretation, determining disparity impact and potential mitigations. METHODS: This retrospective analysis evaluated racial bias of four common models predicting 30-day unplanned readmission (i.e., LACE Index, HOSPITAL Score, and the CMS readmission measure applied as is and retrained). The models were assessed using 2.4 million adult inpatient discharges in Maryland from 2016 to 2019. Fairness metrics that are model-agnostic, easy to compute, and interpretable were implemented and apprised to select the most appropriate bias measures. The impact of changing model's risk thresholds on these measures was further assessed to guide the selection of optimal thresholds to control and mitigate bias. RESULTS: Four bias measures were selected for the predictive task: zero-one-loss difference, false negative rate (FNR) parity, false positive rate (FPR) parity, and generalized entropy index. Based on these measures, the HOSPITAL score and the retrained CMS measure demonstrated the lowest racial bias. White patients showed a higher FNR while Black patients resulted in a higher FPR and zero-one-loss. As the models' risk threshold changed, trade-offs between models' fairness and overall performance were observed, and the assessment showed all models' default thresholds were reasonable for balancing accuracy and bias. CONCLUSIONS: This study proposes an Applied Framework to Assess Fairness of Predictive Models (AFAFPM) and demonstrates the process using 30-day hospital readmission model as the example. It suggests the feasibility of applying algorithmic bias assessment to determine optimized risk thresholds so that predictive models can be used more equitably and accurately. It is evident that a combination of qualitative and quantitative methods and a multidisciplinary team are necessary to identify, understand and respond to algorithm bias in real-world healthcare settings. Users should also apply multiple bias measures to ensure a more comprehensive, tailored, and balanced view. The results of bias measures, however, must be interpreted with caution and consider the larger operational, clinical, and policy context.

Moving from Principle to Practice: A Researcher's Guide to Co-Leading Engaged Research with Community Partners and Patients with Lived Experience to Reduce Maternal Mortality and Morbidity for Maternal Sepsis.

OBJECTIVES: Maternal mortality and morbidity disproportionately affect birthing people from racialized populations. Unfortunately, researchers can often compound these poor outcomes through a lack of authentic community engagement in research beyond the role of the research subject, leading to ineffective strategies for improving care and increasing equity. This article details the real-life strategies utilized to develop a community-engaged research project of a phased federally funded grant employing community engagement principles of co-leadership and co-creation. It also includes reflections from the researchers and advisory board on promising practices and lessons learned for equitably engaging patients and community partners in research. METHODS: This article details the application of principles of community-engaged research in a federally funded phased research project focused on understanding disparities in maternal sepsis to develop better clinical and community interventions. Specifically, it discusses early steps in the research partnership to create a sustainable partnership with a Community Leadership Board guided by the principles of transparency, respect, compensation, and increasing research justice. RESULTS: TBased on the authors' experience, recommendations are provided for funders, researchers, and institutions to improve the quality and outcomes of communityengaged research. This work adds to community-based participatory and community-engaged research literature by providing concrete and practical steps for equitably engaging in research partnerships with a variety of collaborators. CONCLUSIONS: In conclusion, integrated patient and community co-leadership enhances research by providing insight, access to communities for education and dissemination of information, and identifying critical areas needing change. This report may help others address fundamental principles in this journey.

Psychological wellbeing with music therapy: the moderating role of health awareness, and strategic health management in post Covid-19 era.

BACKGROUND: Psychological problems are common among the people of every community. These psychological issues are leading people to mental health issues. Human well-being is required to be improved appropriately for the better health of the public. The objective of this research is to determine the influence of music therapy on the sustainable psychological well-being of the Chinese community. Furthermore, this research determines that moderating role of health awareness and strategic health management between music therapy and sustainable psychological well-being. METHOD: The research used a sample of 384 collected with a random sampling method. For data collection, a cross-sectional method was adopted to collect data on a Likert scale questionnaire. The Health Awareness Scale, Music Therapy Scale, Sustainable Health Management Scale and Sustainable Psychological Wellbeing Scale was used in this research. RESULTS: The findings of the research highlighted that there is a significant and positive influence of music therapy on the sustainable psychological well-being of the Chinese community. This research also concluded that there is a significant and positive moderating role of health awareness and strategic health management between music therapy and sustainable psychological well-being. The findings of this research are new and novel in the literature on psychological well-being. CONCLUSION: This research has some theoretical and practical implications to advance the literature and practice for sustainable psychological well-being respectively. In clinical practice, music therapy can be effectively used to improve the psychological well-being of individuals with sustainability. The information related to health awareness and practice for strategic health management is also necessary for the clinical patients to improve their psychological well-being.

Assessing the lived experiences of females with phenylketonuria in their health management.

Introduction: The present study is a mixed-methods exploratory study aiming to understand the lived experiences of females with phenylketonuria (PKU) in managing their health. The study aims to identify what individual, interpersonal, and environmental factors serve as facilitators and inhibitors, and how PKU intrudes on different realms of health. Methods: Attendees of Emory's Metabolic Camp and female users of Medical Nutrition Therapy for Prevention (MNT4P) were recruited. Participants were administered the Illness Intrusiveness Ratings Scale (IIRS) survey and qualitatively interviewed. The IIRS survey was analyzed using descriptive statistics and the interviews were coded and assessed using inductive and deductive analysis. Results: In total, 25 participants were included in analysis (adults, n = 20; adolescents, n = 5). In the IIRS survey, diet had the highest average impact score of 5.74 (SD = 2.05) and religious expression had the lowest average impact score of 1.74 (SD = 1.65). The most salient themes that arose from the qualitative interviews were related to concerns of pregnancy (n = 25), interactions with health care providers relative to PKU care (n = 23) and independent of PKU care (n = 21), social support (n = 21) and isolation (n = 12), financial issues (n = 22), and illness intrusiveness on general health management (n = 22). Discussion: Adolescent and adult female participants with PKU identified significant concerns in individual, interpersonal, and environmental factors affecting the management of their health. Additionally, the illness intrusiveness of PKU impacted their physical, mental, and gynecological health. Future research should further assess the unique challenges faced by females with PKU and potential interventions to better address these barriers.

Effectiveness of hypertonic saline infusion in management of traumatic brain injury: an updated systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: This study aimed to find out the efficacy of using Hypertonic saline solution (HSS) over mannitol in the management of TBI by comparing their performance in improving different outcomes. METHODS: Electronic databases were searched for randomized controlled trials (RCTs) assessing the impact of HSS vs. mannitol on ICP in patients who suffered TBI. Outcomes of interest were mortality, neurologic functional outcomes, risk ratio (RR) of successful ICP treatment, reduction in ICP after 30-60 and 90-120 min, improvement in cerebral perfusion pressure (CPP) at 30-60 and 90-120 min, and also treatment failure. Evaluations were reported as RR or mean difference (MD) with 95% confidence intervals (CIs) using weighted random-effects models. RESULTS: The analysis included 624 patients from 15 RCTs. HSS infusion had a significant impact on the improvement of CPP at 30-60 min [MD = 5.54, 95% CI (3.04, 8.03),p < 0.001] compared to mannitol. However, results yielded no significant difference between HSS and mannitol in terms of mortality, neurologic functional outcomes, successful ICP treatment, reduction in ICP after 30-60 min and 90-120 min, improvement in CPP at 90-120 min, and treatment failure. CONCLUSION: HSS and mannitol are both effective treatments for elevated ICP due to TBI. However, further research is required to derive a better comparison.

Digital twin-driven prognostics and health management for industrial assets.

As a facilitator of smart upgrading, digital twin (DT) is emerging as a driving force in prognostics and health management (PHM). Faults can lead to degradation or malfunction of industrial assets. Accordingly, DT-driven PHM studies are conducted to improve reliability and reduce maintenance costs of industrial assets. However, there is a lack of systematic research to analyze and summarize current DT-driven PHM applications and methodologies for industrial assets. Therefore, this paper first analyzes the application of DT in PHM from the application field, aspect, and hierarchy at application layer. The paper next deepens into the core and mechanism of DT in PHM at theory layer. Then enabling technologies and tools for DT modeling and DT system are investigated and summarized at implementation layer. Finally, observations and future research suggestions are presented.

Does integrated health management within a county medical consortium improve rural type 2 diabetic patients' self-management behavior and quality of life? An empirical analysis from Eastern China.

BACKGROUND: Levels of self-management behaviors (SMB) and quality of life (QoL) are suboptimal in Chinese adults with type 2 diabetes (T2D), especially in rural China. Integrated health management within a county medical consortium, featuring multi-level teams of doctors, nurses, and other professionals offering follow-up services such as check-ups, assessments, treatment, and health education, is promising in improving this. This study aimed to assess the effect of integrated health management within a county medical consortium on the SMB and QoL of rural T2D patients in China. METHODS: Based on a survey conducted on the county medical consortium in Eastern China, this study initially employed propensity score matching (PSM), a nonparametric technique, to precisely estimate the average treatment effect on the treated (ATT) of integrated health management on SMB and QoL in rural T2D patients. Subsequently, quantile regression was also performed to estimate the relationship between the implementation of integrated health management, sociodemographic factors, follow-up services (offered during integrated health management) and both SMB and QoL. RESULTS: The ATT values for SMB and QoL, representing the net effect of integrated health management within a county medical consortium on SMB and QoL, were significantly positive. They ranged from 4.34 to 4.67 for SMB and from 0.89 to 1.06 for QoL, respectively, based on the four different PSM modalities. The results of quantile regression also revealed a statistically significant positive association between the implementation of integrated health management and both SMB (coef. = 4.15) and QoL (coef. = 1.54). These findings suggest that integrated health management within a county medical consortium can effectively improve SMB and QoL in rural T2D patients. Furthermore, frequency of follow-up service and health behavior guidance were positively associated with SMB and QoL. Conversely, on-call follow-up services, medication guidance and follow-up services at medical institutions were negatively correlated with SMB or QoL. CONCLUSIONS: The study highlights the effectiveness of integrated health management within a county medical consortium in improving SMB and QoL among individuals with T2D in rural China. The findings offer invaluable insights for the advancement of chronic disease management in rural areas of developing countries.

[Recruitment, selection and retention of health professionals in indirect management and private management entities]. / Captación, selección y retención de profesionales sanitarios en entidades de gestión indirecta y de gestión privada. Informe SESPAS 2024.

The recruitment and retention of professionals in indirectly managed and privately managed health care institutions is governed by a different regulatory framework than in directly managed institutions. That legal framework is the Workers' Statute, which contains its own regulatory elements in terms of bargaining power and general basic conditions, among others. The regulatory framework of the Workers' Statute allows for a broad capacity for management, negotiation and agreement in the field of human resources management, and specifically in the processes of recruitment, selection and retention, but for some years now basic legislation and interventions by public control bodies have been incorporated which have modified this discretionarily for indirect management entities, bringing them closer and closer to the system of administrative management for civil servants/statutory employees, and consequently limiting the capacity for decision making and adaptation typical of business/private management. This article attempts to explain the similarities and differences between the different areas of management and to explore the weaknesses and opportunities of each of them in terms of recruitment, selection, and retention policies, offering a specific reflection on the selection of executives and managers, as well as an analysis and assessment of the retention of professionals in healthcare institutions.

Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review.

Background: The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people. Methods: Based on the framework of the scoping review methodology of Arksey and O'Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature. Results: Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results. Conclusion: In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.

Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial.

BACKGROUND: Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one's own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. OBJECTIVE: The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. METHODS: We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). RESULTS: The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D̄=1.11; t311=5.73, P<.001; PMS or PMDD: D̄=1.20; t115=3.76, P<.001) and menstrual health awareness (D̄=3.97; t311=7.71, P<.001), health and well-being (D̄=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D̄=-7.08; t115=-5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D̄=1.01; t311=5.08, P<.001), communication about health (D̄=0.93; t311=2.41, P=.002), menstrual cycle stigma (D̄=-0.61; t311=-2.73, P=.007), and fear of unplanned pregnancies (D̄=-0.22; t311=-2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D̄=-1.67; t144=-2.49, P=.01). CONCLUSIONS: These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. TRIAL REGISTRATION: OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq.

Prioritization criteria in policies and management of human resources for health: a proposal for a validated methodology.

Objective: To create and validate criteria for prioritizing problems related to policies and management of the health workforce. Methods: This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research. Results: Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results. Conclusions: The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.

Health Consequences Management in a Multi-Hazard Context: A Systematic Review of the Coincidence of Flood and the COVID-19 Pandemic.

OBJECTIVES: The co-occurring flood and coronavirus disease (COVID-19) increase the consequences for health and life. This study examined the strategies to manage the health consequences of the co-occurring flood and COVID-19, with a specific focus on these 2 challenges. METHODS: This review included all the studies published in peer-reviewed journals between January 1980 and June 2021. Several electronic databases were searched, including Scopus, Web of Science, and PubMed. Mixed Methods Appraisal Tools (MMT), version 2018, assessed the articles retrieved through a comprehensive and systematic literature search. Descriptive and thematic analyses were carried out to derive strategies for managing the health consequences of the simultaneous flood and COVID-19. RESULTS: Among 4271 identified articles, 10 were eligible for inclusion. In total, 199 strategies were identified in this review for managing the multi-hazard health consequences of flooding and COVID-19, which were classified into 9 categories and 25 subcategories. The categories included policy making and decision making, coordination, risk communication, logistics, planning, preparedness measures, response measures, social and humanitarian support, and actions of local communities and non-governmental organizations. CONCLUSIONS: Managing a multi-hazard and reducing its health consequences requires various actions. Flood management must be needed, and flood-affected people and their health should be protected.

The association between population health management tools and clinician burnout in the United States VA primary care patient-centered medical home.

BACKGROUND: Technological burden and medical complexity are significant drivers of clinician burnout. Electronic health record(EHR)-based population health management tools can be used to identify high-risk patient populations and implement prophylactic health practices. Their impact on clinician burnout, however, is not well understood. Our objective was to assess the relationship between ratings of EHR-based population health management tools and clinician burnout. METHODS: We conducted cross-sectional analyses of 2018 national Veterans Health Administration(VA) primary care personnel survey, administered as an online survey to all VA primary care personnel (n = 4257, response rate = 17.7%), using bivariate and multivariate logistic regressions. Our analytical sample included providers (medical doctors, nurse practitioners, physicians' assistants) and nurses (registered nurses, licensed practical nurses). The outcomes included two items measuring high burnout. Primary predictors included importance ratings of 10 population health management tools (eg. VA risk prediction algorithm, recent hospitalizations and emergency department visits, etc.). RESULTS: High ratings of 9 tools were associated with lower odds of high burnout, independent of covariates including VA tenure, team role, gender, ethnicity, staffing, and training. For example, clinicians who rated the risk prediction algorithm as important were less likely to report high burnout levels than those who did not use or did not know about the tool (OR 0.73; CI 0.61-0.87), and they were less likely to report frequent burnout (once per week or more) (OR 0.71; CI 0.60-0.84). CONCLUSIONS: Burned-out clinicians may not consider the EHR-based tools important and may not be using them to perform care management. Tools that create additional technological burden may need adaptation to become more accessible, more intuitive, and less burdensome to use. Finding ways to improve the use of tools that streamline the work of population health management and/or result in less workload due to patients with poorly managed chronic conditions may alleviate burnout. More research is needed to understand the causal directional of the association between burnout and ratings of population health management tools.

Exploring Secondary School Athletic Trainers' Perspectives in Managing Mental Health Situations.

BACKGROUND: Most people believe that student-athletes experience fewer difficulties related to mental health than non-sport participants. However, several studies have shown high depression levels or emotional difficulties in adolescent athletes. Most secondary school students have access to athletic trainers in their schools. Secondary school athletic trainers (SSATs) are medical professionals who can provide health care for student-athletes, and they could be appropriate supporters in providing mental health management in secondary schools. However, there are no studies that have addressed their preparedness and confidence level to manage potential risk factors and mental health disorders. This study aims to ascertain preparedness and confidence levels from SSATs' perspectives in handling mental health disorders using a survey based on the mental health management guidelines and consensus statement. METHODS: This is a cross-sectional study design. The research team created an online survey questionnaire based on the National Athletic Trainers' Association (NATA) Mental Health Guidelines for Secondary School and Interassociation Recommendation: A Consensus Statement. Utilizing the NATA Research Survey Service, the online survey was emailed to SSATs who self-categorized as secondary school athletic trainers in the NATA membership system. (n = 171, 65% completion rate). SPSS was used to analyze the survey data. RESULT: This study found that 29.2% of SSATs reported they have policies or guidelines regarding mental health disorders management for minors. The most frequent policy was mandatory reporting in cases in which an individual is being abused or neglected (80.5%). The highest confidence area was aligned with the most frequent policy. The least frequent policy was considering unique stressors and triggers with student-athletes to recognize the potential mechanisms that may cause a mental illness or exacerbate an existing mental illness (58.5%). Even though the least frequent policy was not aligned with the least confidence area, it was the second lowest confidence level. This study identified significant differences between two different employment structures: school-based employment and hospital-based employment structures. Policies were more common in school-based employment than in hospital-based employment structures. CONCLUSION: This study demonstrated the gap between organizational and individual preparation. The majority of SSATs respondents expressed moderate to high confidence in their ability to manage mental health disorders, despite the lack of mental health policies or procedures in their secondary schools. This study recommends that SSATs create guidelines or procedures in the areas where they are least confident and prepared to offer mental health management for minor student-athletes. They can use the interassociation recommendations and the NATA guidelines for mental health care to close the gap.

Flexible self-powered bioelectronics enables personalized health management from diagnosis to therapy.

Flexible self-powered bioelectronics (FSPBs), incorporating flexible electronic features in biomedical applications, have revolutionized the human-machine interface since they hold the potential to offer natural and seamless human interactions while overcoming the limitations of battery-dependent power sources. Furthermore, as biosensors or actuators, FSPBs can dynamically monitor physiological signals to reveal real-time health abnormalities and provide timely and precise treatments. Therefore, FSPBs are increasingly shaping the landscape of health monitoring and disease treatment, weaving a sophisticated and personalized bond between humans and health management. Here, we examine the recent advanced progress of FSPBs in developing working mechanisms, design strategies, and structural configurations toward personalized health management, emphasizing its role in clinical medical scenarios from biophysical/biochemical sensors for sensing diagnosis to robust/biodegradable actuators for intervention therapy. Future perspectives on the challenges and opportunities in emerging multifunctional FSPBs for the next-generation health management systems are also forecasted.

An Economic Analysis for the Use of Artificial Intelligence in Screening for Diabetic Retinopathy in Trinidad and Tobago.

This is a systematic review of 25 publications on the topics of the prevalence and cost of diabetic retinopathy (DR) in Trinidad and Tobago, the cost of traditional methods of screening for DR, and the use and cost of artificial intelligence (AI) in screening for DR. Analysis of these publications was used to identify and make estimates for how resources allocated to ophthalmology in public health systems in Trinidad and Tobago can be more efficiently utilized by employing AI in diagnosing treatable DR. DR screening was found to be an effective method of detecting the disease. Screening was found to be a universally cost-effective method of disease prevention and for altering the natural history of the disease in the spectrum of low-middle to high-income economies, such as Rwanda, Thailand, China, South Korea, and Singapore. AI and deep learning systems were found to be clinically superior to, or as effective as, human graders in areas where they were deployed, indicating that the systems are clinically safe. They have been shown to improve access to diabetic retinal screening, improve compliance with screening appointments, and prove to be cost-effective, especially in rural areas. Trinidad and Tobago, which is estimated to be disproportionately more affected by the burden of DR when projected out to the mid-21st century, stands to save as much as US$60 million annually from the implementation of an AI-based system to screen for DR versus conventional manual grading.