Codevelopment and Deployment of a System for the Telemonitoring of Activities of Daily Living Among Older Adults Receiving Home Care Services: Protocol for an Action Design Research Study.

BACKGROUND: Telemonitoring of activities of daily living (ADLs) offers significant potential for gaining a deeper insight into the home care needs of older adults experiencing cognitive decline, particularly those living alone. In 2016, our team and a health care institution in Montreal, Quebec, Canada, sought to test this technology to enhance the support provided by home care clinical teams for older adults residing alone and facing cognitive deficits. The Support for Seniors' Autonomy program (SAPA [Soutien à l'autonomie des personnes âgées]) project was initiated within this context, embracing an innovative research approach that combines action research and design science. OBJECTIVE: This paper presents the research protocol for the SAPA project, with the aim of facilitating the replication of similar initiatives in the future. The primary objectives of the SAPA project were to (1) codevelop an ADL telemonitoring system aligned with the requirements of key stakeholders, (2) deploy the system in a real clinical environment to identify specific use cases, and (3) identify factors conducive to its sustained use in a real-world setting. Given the context of the SAPA project, the adoption of an action design research (ADR) approach was deemed crucial. ADR is a framework for crafting practical solutions to intricate problems encountered in a specific organizational context. METHODS: This project consisted of 2 cycles of development (alpha and beta) that involved cyclical repetitions of stages 2 and 3 to develop a telemonitoring system for ADLs. Stakeholders, such as health care managers, clinicians, older adults, and their families, were included in each codevelopment cycle. Qualitative and quantitative data were collected throughout this project. RESULTS: The first iterative cycle, the alpha cycle, took place from early 2016 to mid 2018. The first prototype of an ADL telemonitoring system was deployed in the homes of 4 individuals receiving home care services through a public health institution. The prototype was used to collect data about care recipients' ADL routines. Clinicians used the data to support their home care intervention plan, and the results are presented here. The prototype was successfully deployed and perceived as useful, although obstacles were encountered. Similarly, a second codevelopment cycle (beta cycle) took place in 3 public health institutions from late 2018 to late 2022. The telemonitoring system was installed in 31 care recipients' homes, and detailed results will be presented in future papers. CONCLUSIONS: To our knowledge, this is the first reported ADR project in ADL telemonitoring research that includes 2 iterative cycles of codevelopment and deployment embedded in the real-world clinical settings of a public health system. We discuss the artifacts, generalization of learning, and dissemination generated by this protocol in the hope of providing a concrete and replicable example of research partnerships in the field of digital health in cognitive aging. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/52284.

Facile Microwave-Assisted Hydrothermal Synthesis of Copper Oxide Nanoneedle Arrays for Practical Biomedical Applications.

INTRODUCTION: Copper oxide nanoneedle arrays (CuO NAs) have been widely used as antibacterial agents and in therapeutic applications because of their unique physicochemical features, low cytotoxicity, low cost, exceptional antibacterial action, and significant interest in biomedicine. Various analytical techniques were used to assess the related phase constitution, optical characteristics, elemental content, and surface morphology. The X-ray diffraction (XRD) patterns and field-emission scanning electron microscopy (FE-SEM) micrographs revealed that the CuO NAs had a monoclinic phase with a nanoneedle-like shape. Our findings may cover the progress of innovative and effective anti-bacterial capabilities based on CuO NAs, which have been shown to be effective against various pathogens, making them ideal options for fighting bacterial infections.  Objective: This research aimed to synthesize CuO NAs using microwave-solvothermal (MW-ST) technology, explore their effectiveness, and assess their biological activity. METHODS: The CuO NAs were synthesized using the MW-ST process, and their properties were assessed using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), field emission scanning electron microscopy (FE-SEM), energy dispersive analysis (EDS), field emission transmission microscopy (FE-TEM), and ultraviolet-visible (UV-Vis) techniques. The biocompatibility of CuO NAs was determined through hemolytic assays, and their bioactivities like antioxidant and anti-inflammatory assays were also determined. RESULTS: The CuO NAs were successfully developed, and various analytical tools were used to characterize and validate their morphology, size, crystallinity, and elemental compositions. It has been shown in in-vitro investigations that a strong anti-inflammatory impact is demonstrated by the inhibition of protein denaturation with low hemolytic potential. As a result, CuO NAs have the potential to be an excellent choice for anti-inflammatory solicitations. CONCLUSION: CuO NAs were synthesized and characterized with various advanced techniques, revealing the formation of nanoneedles-like morphology. Based on the experimental findings, CuO NAs have the potential for anti-microbial, anti-oxidant, anti-inflammatory, and anti-hemolytic activities. However, additional in-vivo testing is essential to properly evaluate their efficiency and safety.

The effects of various retention factors on the choice of where rural origin Umthombo Youth Development Foundation health science graduates work.

INTRODUCTION: South Africa has an inequitable distribution of health workers between the public and private sector, with rural areas being historically underserved. As rural background of health workers has been advocated as the strongest predictor of rural practice, the Umthombo Youth Development Foundation (UYDF) has invested in recruiting and training rural-origin health science students since 1999 as a way of addressing staff shortages at 15 district hospitals in northern KwaZulu-Natal Province, South Africa. UYDF's intervention is to support students to overcome their academic, social, and economic challenges and expose them annually to rural health practice. This study investigated the effects of various retention factors on the choice of where rural-origin UYDF graduates worked, namely in rural or urban, public or private settings. METHODS: An online survey was developed containing questions relevant to the retention of health workers and included: personal satisfaction; hospital resources and employment factors; professional development and support; and community integration, as well as the reasons for working where they do. Of the 317 eligible health science graduates invited to participate, 139 (44%) responded. Descriptive statistics were compiled. RESULTS: Forty-nine percent of graduates were working at a rural public healthcare facility (PHCF), followed by 34% at an urban PHCF, and 11% in the private sector. All the respondents, wherever they worked, reported positively on their work, management support, colleagues, and ability to practise their skills. Graduates working at rural PHCFs reported that patient care was sometimes compromised due to lack of equipment or medicines, with staff shortages being greater than at urban PHCFs. All the graduates reported that they had insufficient time to interact with peers regarding difficult cases, while those at rural PHCFs lacked access to senior staff or specialists compared to those working at urban PHCFs or urban private practice. Lack of professional development opportunities was reported by graduates at rural PHCFs as a reason they may leave, while those at urban PHCFs cited the intention to specialise. Graduates no longer working at a rural hospital reported that the lack of funded posts at rural PHCFs was the main reason (39%), followed by the desire to specialise (29.6%). Graduates working at rural PHCFs cited the 'ability to serve their community' and being 'close to family and friends' as the main reason for working where they do, whereas those working at urban PHCFs cited 'good work experience'. CONCLUSION: While nearly half of the rural-origin UYDF graduates surveyed continue to work in rural areas, this is considerably less than previously reported, indicating that rural-origin health workers are affected by retention factors. The lack of funded posts at rural PHCFs is a major barrier to the employment and retention of health workers, and to addressing the unequal distribution of health workers between urban and rural PHCFs. This requires commitment from government and other role players to increase the attraction and retention of health workers in rural areas. Focusing on the recruitment of rural students to become health workers, in the absence of adequate retention policies, is insufficient to adequately address shortages of staff at rural PHCFs, as rural-origin graduates will move from rural PHCFs to facilities where they can access these benefits.

Hospitalization and mortality rates of malignant prostatic neoplasms in Brazil: A cross-sectional study from 2008 to 2018

Abstract Prostate cancer (PCa) is a highly prevalent condition among men worldwide, resulting in reduced quality of life and increased costs to health systems due to hospitalization and death. This study aimed to explore and understand the evolution of PCa in Brazil from 2008 to 2018. Data were obtained from the National Health System Department of Informatics (DATASUS) using code C61 for malignant prostatic neoplasms. We presented the hospitalization and mortality rates in a temporal-, regional- and age-dependent manner. From 2008 to 2018, a year-dependent increase in hospital admissions due to PCa was reported in Brazil, in which the Southeast region showed the highest prevalence. Men aged ≥80 and those 70-79 years old had similar hospitalization rates, followed by men aged 60-69, 50-59, 40-49 and 30-39 years old. Similarly, an increase in deaths due to PCa was reported during this period, with the highest rates seen in the Southeast. Men aged ≥80 years had higher mortality rates, followed by those aged 70-79, 60-69, 50-59, 40-49 and 30-39 years old. The results obtained indicate an age- and region-dependent increase in PCa morbidity and mortality in Brazil overtime and may contribute to the ongoing discussion on the role and future perspective of the health care system in Brazil.

Influencia de la renta económica en la mortalidad intrahospitalaria de las personas mayores durante la primera ola de la pandemia por COVID-19: resultados del estudio EDEN-33 / Influence of income on in-hospital mortality in older adults during the first wave of the COVID-19 pandemic: results from the EDEN-33 study

Objetivo: Determinar si el nivel económico durante la primera ola pandémica tuvo una influencia diferente a la esperable en la mortalidad intrahospitalaria de los pacientes mayores atendidos en los servicios de urgencias (SU) de los hospitales públicos españoles. Método: Cincuenta y un SU públicos españoles que participaron voluntariamente y que dan cobertura al 25% de la población incluyeron todos los registros de pacientes de edad $ 65 años atendidos durante una semana del periodo preCOVID (1-4-2019 a 7-4-2019) y una semana del periodo COVID (30-3-2020 a 5-4-2020). Se identificó la renta bruta (RB) asignada al código postal de residencia de cada paciente y se calculó la RB normalizada (RBN) dividiendo aquella por la RB media de su comunidad autónoma. La existencia y fuerza de la relación entre RBN y mortalidad intrahospitalaria se determinó mediante curvas spline cúbicas restringidas (SCR) ajustadas por 10 características basales del paciente. Las OR para cada situación económica se expresó en relación con una RBN de 1 (referencia, renta correspondiente a la media de la comunidad autónoma). La comparación entre periodo COVID y no COVID se realizó mediante el estudio de interacción de primer grado. (AU)

Objective: To determine whether income was associated with unexpected in-hospital mortality in older patients treated in Spanish public health system hospital emergency departments. Methods: Fifty-one public health system hospital emergency departments in Spain voluntarily participated in the study. Together the hospitals covered 25% of the population aged 65 years or older included in all patient registers during a week in the pre-pandemic period (April 1-7, 2019) and a week during the COVID-19 pandemic (March 30 to April 5, 2020). We estimated a patient’s gross income as the amount published for the postal code of the patient’s address. We then calculated the standardized gross income (SGI) by dividing the patient’s estimated income by the mean for the corresponding territory (Spanish autonomous community). The existence and strength of an association between the SGI and in-hospital mortality was evaluated by means of restricted cubic spline (RCS) curves adjusted for 10 patient characteristics at baseline. Odds ratios (ORs) for each income level were expressed in relation to a reference SGI of 1 (the mean income for the corresponding autonomous community). We compared the COVID-19 and pre-pandemic periods by means of first-order interactions. (AU)

Influence of income on in-hospital mortality in older adults during the first wave of the COVID-19 pandemic: results from the EDEN-33 study. / Influencia de la renta económica en la mortalidad intrahospitalaria de las personas mayores durante la primera ola de la pandemia por COVID-19: resultados del estudio EDEN-33.

OBJECTIVES: To determine whether income was associated with unexpected in-hospital mortality in older patients treated in Spanish public health system hospital emergency departments. MATERIAL AND METHODS: Fifty-one public health system hospital emergency departments in Spain voluntarily participated in the study. Together the hospitals covered 25% of the population aged 65 years or older included in all patient registers during a week in the pre-pandemic period (April 1-7, 2019) and a week during the COVID-19 pandemic (March 30 to April 5, 2020). We estimated a patient's gross income as the amount published for the postal code of the patient's address. We then calculated the standardized gross income (SGI) by dividing the patient's estimated income by the mean for the corresponding territory (Spanish autonomous community). The existence and strength of an association between the SGI and in-hospital mortality was evaluated by means of restricted cubic spline (RCS) curves adjusted for 10 patient characteristics at baseline. Odds ratios (ORs) for each income level were expressed in relation to a reference SGI of 1 (the mean income for the corresponding autonomous community). We compared the COVID-19 and pre-pandemic periods by means of first-order interactions. RESULTS: Of the 35 280 patients attended in the 2 periods, gross income could be ascertained for 21 180 (60%), 15437 in the pre-pandemic period and 5746 during the COVID-19 period. SGIs were slightly higher for patients included before the pandemic (1.006 vs 0.994; P = .012). In-hospital mortality was 5.6% overall and higher during the pandemic (2.8% pre-pandemic vs 13.1% during COVID-19; P .001). The adjusted RCS curves showed that associations between income and mortality differed between the 2 periods (interaction P = .004). Whereas there were no significant income-influenced differences in mortality before the pandemic, mortality increased during the pandemic in the lowest-income population (SGI 0.5 OR, 1.82; 95% CI, 1.32-3.37) and in higher-income populations (SGI 1.5 OR, 1.32; 95% CI, 1.04-1.68, and SGI 2 OR, 1.92; 95% CI, 1.14-3.23). We found no significant differences between patients with COVID-19 and those with other diagnoses (interaction P = .667). CONCLUSION: The gross income of patients attended in Spanish public health system hospital emergency departments, estimated according to a patient's address and postal code, was associated with in-hospital mortality, which was higher for patients with the lowest and 2 higher income levels. The reasons for these associations might be different for each income level and should be investigated in the future.

OBJETIVO: Determinar si el nivel económico durante la primera ola pandémica tuvo una influencia diferente a la esperable en la mortalidad intrahospitalaria de los pacientes mayores atendidos en los servicios de urgencias (SU) de los hospitales públicos españoles. METODO: Cincuenta y un SU públicos españoles que participaron voluntariamente y que dan cobertura al 25% de la población incluyeron todos los registros de pacientes de edad 65 años atendidos durante una semana del periodo preCOVID (1-4-2019 a 7-4-2019) y una semana del periodo COVID (30-3-2020 a 5-4-2020). Se identificó la renta bruta (RB) asignada al código postal de residencia de cada paciente y se calculó la RB normalizada (RBN) dividiendo aquella por la RB media de su comunidad autónoma. La existencia y fuerza de la relación entre RBN y mortalidad intrahospitalaria se determinó mediante curvas spline cúbicas restringidas (SCR) ajustadas por 10 características basales del paciente. Las OR para cada situación económica se expresó en relación con una RBN de 1 (referencia, renta correspondiente a la media de la comunidad autónoma). La comparación entre periodo COVID y no COVID se realizó mediante el estudio de interacción de primer grado. RESULTADOS: De los 35.280 registros de pacientes atendidos en ambos periodos, se disponía de la RB en 21.180 (60%): 15.437 del periodo preCOVID y 5.746 del periodo COVID. La RBN de los pacientes incluidos fue discretamente superior en el periodo preCOVID (1,006 versus 0,994; p = 0,012). La mortalidad intrahospitalaria fue del 5,6%, y fue superior durante el periodo COVID (2,8% versus 13,1%; p 0,001). Las curvas SCR ajustadas mostraron una asociación entre nivel económico y mortalidad diferente entre ambos periodos (p interacción = 0,004): en el periodo preCOVID no hubo diferencias significativas de mortalidad en función de la RBN, mientras que en el periodo COVID la mortalidad se incrementó en rentas bajas (OR = 1,82, IC 95% = 1,32-3,37 para RBN de 0,5) y en rentas altas (OR = 1,32, IC 95% = 1,04-1,68 y OR = 1,92, IC 95% = 1,14-3,23 para RBN de 1,5 y 2, respectivamente), sin diferencias significativas entre pacientes con COVID y con otros diagnósticos (p interacción = 0,667). CONCLUSIONES: Durante la primera ola de la pandemia COVID, la RB asignada al código postal de residencia de los pacientes atendidos en los SU públicos españoles se asoció con la mortalidad intrahospitalaria, que aumentó en pacientes de rentas bajas y altas. Las razones de estas asociaciones pueden ser distintas para cada segmento económico y deben ser investigadas en el fututo.

Lepromatous Leprosy Manifesting As Chronic Macrocheilia: Report of a Rare Case.

Leprosy is a chronic debilitating disorder caused by the acid-fast bacilli Mycobacterium leprae (M. leprae) and Mycobacterium lepromatosis. These bacilli exhibit a distinctive predilection for the skin and peripheral nerves, although they can potentially impact any system in the body. Lately, there has been a notable reduction in mucosal symptoms, largely attributed to the timely diagnosis and treatment of leprosy. Nonetheless, oral lesions continue to hold significant epidemiological importance due to their crucial role in disease transmission. Oral manifestations, although rare, are frequently encountered in individuals afflicted with multi-bacillary leprosy. Chronic macrocheilia is an exceedingly rare manifestation of the disease, with only a few documented case reports and case studies. This article aims to document an exceptionally uncommon case of lepromatous leprosy with chronic macrocheilia as the sole presenting feature.

Monitoring SARS-CoV-2 Using Infoveillance, National Reporting Data, and Wastewater in Wales, United Kingdom: Mixed Methods Study.

BACKGROUND: The COVID-19 pandemic necessitated rapid real-time surveillance of epidemiological data to advise governments and the public, but the accuracy of these data depends on myriad auxiliary assumptions, not least accurate reporting of cases by the public. Wastewater monitoring has emerged internationally as an accurate and objective means for assessing disease prevalence with reduced latency and less dependence on public vigilance, reliability, and engagement. How public interest aligns with COVID-19 personal testing data and wastewater monitoring is, however, very poorly characterized. OBJECTIVE: This study aims to assess the associations between internet search volume data relevant to COVID-19, public health care statistics, and national-scale wastewater monitoring of SARS-CoV-2 across South Wales, United Kingdom, over time to investigate how interest in the pandemic may reflect the prevalence of SARS-CoV-2, as detected by national testing and wastewater monitoring, and how these data could be used to predict case numbers. METHODS: Relative search volume data from Google Trends for search terms linked to the COVID-19 pandemic were extracted and compared against government-reported COVID-19 statistics and quantitative reverse transcription polymerase chain reaction (RT-qPCR) SARS-CoV-2 data generated from wastewater in South Wales, United Kingdom, using multivariate linear models, correlation analysis, and predictions from linear models. RESULTS: Wastewater monitoring, most infoveillance terms, and nationally reported cases significantly correlated, but these relationships changed over time. Wastewater surveillance data and some infoveillance search terms generated predictions of case numbers that correlated with reported case numbers, but the accuracy of these predictions was inconsistent and many of the relationships changed over time. CONCLUSIONS: Wastewater monitoring presents a valuable means for assessing population-level prevalence of SARS-CoV-2 and could be integrated with other data types such as infoveillance for increasingly accurate inference of virus prevalence. The importance of such monitoring is increasingly clear as a means of objectively assessing the prevalence of SARS-CoV-2 to circumvent the dynamic interest and participation of the public. Increased accessibility of wastewater monitoring data to the public, as is the case for other national data, may enhance public engagement with these forms of monitoring.

Epigenetics in Neurological and Psychiatric Disorders: A Comprehensive Review of Current Understanding and Future Perspectives.

The burgeoning field of epigenetics offers transformative insights into the complex landscape of neurological and psychiatric disorders. By unraveling the intricate interplay between genetic, epigenetic, environmental, and lifestyle factors, this comprehensive review highlights the multifaceted nature of mental health. The exploration reveals the potential of epigenetic modifications to revolutionize our understanding, diagnosis, treatment, and prevention of these disorders. Emphasizing the importance of multidisciplinary collaborations, large-scale studies, technological advancements, and ethical considerations, the review asserts the promise of epigenetics as a vital tool for personalized medicine, early intervention, and public health strategies. While acknowledging the challenges in a still-emerging field, the review paints an optimistic picture of epigenetics as a groundbreaking approach that can reshape mental healthcare, offering hope for those affected by neurological and psychiatric conditions. The future trajectory of the field relies on interdisciplinary efforts, ethical diligence, innovative technologies, and translating scientific insights into real-world applications, thereby unlocking the vast potential of epigenetics in mental health.

Evaluating Health Disparities in Radiology Practices in New Jersey: Exploring Radiologist Geographical Distribution.

OBJECTIVE: This study aimed to determine if a disproportionate number of radiologists practice in high-income versus low-income counties in New Jersey (NJ), identify which vulnerable populations are most in need of more radiologists, and discuss how these relative differences can ultimately influence health outcomes. METHODS: The NJ Health Care Profile, a database overseen and maintained by the Division of Consumer Affairs, was queried for all actively practicing radiologists within the state of NJ. These results were grouped into diagnostic and interventional radiologists followed by further stratification of physicians based on the counties where they currently practice. The median household income and population size of each county for 2021 were obtained from the US Census database. The ratio of the population size of each county over the number of radiologists in that county was used as a surrogate marker for disparities in patient care within the state and was compared between counties grouped by levels of income. RESULTS: Of the 1,186 board-certified radiologists actively practicing within the state of NJ, 86% are solely diagnostic radiologists and 14% are interventional radiologists. About 44% of radiologists practice within counties that are within the top one-third of median household income in NJ, 25% practice within counties in the middle one-third, and 31% practice within counties in the bottom one-third. CONCLUSIONS: There is a disproportionate number of radiologists practicing in high-income counties as opposed to lower-income counties. A contradiction to this trend was noted in three low-income counties: Essex, Camden, and Atlantic County, all of which exhibited low numbers of individuals per radiologist that rivaled those of higher-income counties. This finding is a concrete measure of successful radiologist recruitment efforts within these counties during the past few years to combat the increased prevalence of disease and associated complications that historically marginalized communities tend to disproportionately exhibit. Other low-income counties should look to what Essex, Camden, and Atlantic County have done to increase radiologist recruitment to levels that rival those of high-income areas.

Challenges of medical commodity availability in public and private health care facilities in the Upper East Region of Ghana: a patient-centered perspective.

This article is a patient-centered comparison of medical ccommodities availability in public and private health care facilities in the Upper East (UER) of Ghana to determine if significant differences existed. A concurrent mixed method strategy was used where both quantitative and qualitative data were simultaneously collected, independently analysed and triangulated at the intepretation stage. Quantitative data were collected using a systematic sampling method where a total of 1500 patients (750 from public and 750 from private) health care facilities responded to the interviwer-administered questionnaires for this study. Exploratory factor analysis (EFA) was applied as a construct validation tool while a T-test was computed to compare if a significant difference existed between both type of patients. Qualitative data were collected from selected patients and heads of public and private healthcare facilities using an interview guide. The qualitative data were analysed using content analysis. The results indicated significant differences existed in the availability of medical commodities, frequency of medicine stock-outs, seasonality of medicine stock-outs, patients' reaction to medicine stock-outs and communication about the medicine stock-outs to patients of private and public facilities. The biggest difference between the two groups of patients was how communication of medicines stock-outs was communicated to them.Health care facility managers in the region must focus seriously on training staff on how to improve communication of medicines stock-outs to patients.

A Review of the Effect of COVID-19-Related Lockdowns on Global Cancer Screening.

COVID-19 lockdowns have led to significant disruptions in preventative health services worldwide. This review aims to assess the impact of COVID-19 lockdowns on worldwide preventive cancer screening participation. Major medical databases were searched using the keywords 'lockdown,' 'cancer,' and 'screening or diagnosis,' and relevant articles were evaluated against inclusion and exclusion criteria. The final review consisted of 38 studies. The impact of COVID-19 on screening uptake was categorized based on cancer type. All types of screening had decreased participation during or around the lockdown period. Racial and socioeconomic disparities, provider-related barriers, and patient attitudes about service disruptions during the pandemic were also highlighted in this review. Future research should focus on data from low- and middle-income countries to obtain a more comprehensive picture of the problem. Policy interventions that adopt self-screening or different screening intervals can also be considered to reduce impacts in future crises. Insights from existing studies and future research will allow for more proactive measures to manage future disruptions.

Spatial Health Predictors for Depressive Disorder in Manhattan: A 2020 Analysis.

Background Urban cores often present extreme disparities in the distribution of wealth and income. They also vary in health outcomes, especially regarding mental welfare. Dense urban blocks agglomerate many residents of various backgrounds, and extreme differences in income, commerce, and health may lead to variations in depressive disorder outcomes. More research is needed on public health characteristics that may affect depression in dense urban centers. Methods Data on 2020 public health characteristics for Manhattan Island was collected using the Centers for Disease Control's (CDC's) PLACES project. All Manhattan census tracts were used as the spatial observations, resulting in [Formula: see text] observations. A cross-sectional generalized linear regression (GLR) was used to fit a geographically weighted spatial regression (GWR), with tract depression rates as the endogenous variable. Data on the following eight exogenous parameters were incorporated: the percentage without health insurance, the percentage of those who binge drink, the percentage who receive an annual doctor's checkup, the percentage of those who are physically inactive, the percentage of those who experience frequent mental distress, the percentage of those who receive less than 7 hours of sleep each night, the percentage of those who report regular smoking, and the percentage of those who are obese. A Getis-Ord Gi* model was built to locate hot and cold spot clusters for depression incidence and an Anselin Local Moran's I spatial autocorrelation analysis was undertaken to determine neighborhood relationships between tracts.  Results Depression hot spot clusters at the 90%-99% confidence interval (CI) were identified in Upper Manhattan and Lower Manhattan using the Getis-Ord Gi* statistic and spatial autocorrelation. Cold spot clusters at the 90%-99% CI were in central Manhattan and the southern edge of Manhattan Island. For the GLR-GWR model, only the lack of health insurance and mental distress variables were significant at the 95% CI, with an adjusted R-2 of 0.56. Noticeable inversions were observed in the spatial distribution of the exogenous coefficients across Manhattan, with a higher lack of insurance coefficients observed in Upper Manhattan and higher frequent mental distress coefficients in Lower Manhattan. Conclusion The level of depression incidence does spatially track with predictive health and economic parameters across Manhattan Island. Additional research is encouraged on urban policies that may reduce the mental distress burden on Manhattan residents, as well as investigations of the spatial inversion observed in this study between the exogenous parameters.

Morocco's Healthcare System: Achievements, Challenges, and Perspectives.

Despite progress in recent years, access to quality medical care remains a significant issue, particularly in rural areas. The unequal distribution of resources, inadequate funding, healthcare worker shortages, and the rise of non-communicable diseases pose substantial challenges. However, implementing universal health coverage and improving key health indicators demonstrate notable achievements. To further enhance the healthcare system, perspectives such as addressing resource disparities, increasing funding and the healthcare workforce, managing non-communicable diseases, embracing digital technologies, strengthening public healthcare, and focusing on prevention and health education are proposed. These perspectives offer a global vision for improving Morocco's healthcare system's efficiency, inclusiveness, and quality, ultimately ensuring equitable access to healthcare services for all citizens.

Identifying Patient Perceptions of Inequality in Public Health Care Services: Evidence From a Single Indian Administrative District.

Purpose: Assessment of patient experiences is an essential step to revamp patient-centered care and identify systemic effectiveness as part of universal health coverage. This paper analyzes the variation of health care at different levels of the public health care system in India by measuring patients' experience with the care they have received in the Alipurduar district of India. Methods: From May 2021 to April 2022, stratified sampling technique was applied to collect primary data from 450 patients having different health problems from different levels of the public health care system. In addition, Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results were used to evaluate patient experience, with the reliability of questions measured by Cronbach's alpha. Collected data were categorized with the help of exploratory factor analysis; after which, analysis of variance and post-hoc tests were applied to understand specific variations in patient experiences. Results: This study identified that the services delivered in the health centers were not suitable (6.160 out of 10) to fulfill the needs of the patients. Among the three domains of health care services - namely, proficiency, tangibility, and information - the experience of patients significantly varied (P<0.001) when comparing primary, secondary, and tertiary levels of the public health care system. Conclusions: Patients receiving services from the centers under the tertiary level have expressed lesser satisfaction than those patients who have received care at primary or secondary levels because of excessive patient load, inadequate manpower, and other infrastructure deficits at the tertiary level.

The Transformation of The Indian Healthcare System.

The Indian healthcare system is a diverse and complex network of public and private sectors that provide a wide range of medical services to India's 1.4 billion inhabitants. Despite undergoing significant changes over the years, the system continues to face multiple challenges. These challenges include inadequate infrastructure, a shortage of healthcare professionals, urban-rural disparities, limited health insurance coverage, insufficient public healthcare funding, and a fragmented healthcare system. India is grappling with a growing burden of non-communicable diseases, which poses a significant challenge to its healthcare system. The Indian government has initiated multiple programs to improve the healthcare system. The National Health Mission improves the availability of medical equipment and supplies. This also promotes community participation and engagement in healthcare decision-making and service delivery. The Ayushman Bharat scheme is a health insurance program that provides coverage of up to INR 5 lakhs per family per year for secondary and tertiary care hospitalization. The Indian healthcare system is also witnessing multiple healthcare innovations, ranging from low-cost medical devices to innovative healthcare delivery models. The country's healthcare regulatory system is evolving to ensure patient safety, promote high-quality care, and control costs. Furthermore, India has emerged as a leading destination for medical tourism due to the relatively low cost of medical procedures, the availability of skilled doctors, and advanced technology. Factors such as cost-effective treatment, advanced technology, a wide range of specialities, alternative medicine, English language proficiency, and ease of travel have contributed to India's growing medical tourism industry. The Indian healthcare system has made significant progress in recent years. The positive transformation of the Indian healthcare system involves a range of changes and initiatives. Despite challenges, the continued investment in healthcare and innovation provides reasons to be optimistic about the future of healthcare in India.

Saudi Arabia Health Systems: Challenging and Future Transformations With Artificial Intelligence.

The healthcare system in Saudi Arabia is facing several challenges, including an aging population, an increase in chronic diseases, and a shortage of healthcare professionals. To address these challenges, the government is taking proactive steps, including expanding healthcare infrastructure, promoting the use of technology, improving the quality of healthcare services, and emphasizing the importance of preventive healthcare. In addition, the adoption of artificial intelligence (AI) solutions can play a crucial role in transforming the healthcare system by improving efficiency, reducing costs, and enhancing the quality of care. However, the adoption of AI solutions comes with challenges such as the need for high-quality data and the development of regulations and guidelines. The government needs to continue to invest in healthcare and AI solutions to build a more efficient and effective healthcare system that benefits all citizens.