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The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical uncertainty in municipal clinics in urban India. As street-level bureaucrats, the municipal doctors occupy two roles simultaneously: medical professional and state agent. They operate under conditions that characterize health systems in low-resource contexts globally: inadequate state investment, weak regulation and low societal trust. The study investigates how, in these conditions, the doctors respond to clinical risk, specifically related to noncommunicable diseases (NCDs).

The analysis draws on year-long ethnographic fieldwork in Pune (2013–14), a city of three million, including 30 semi-structured interviews with municipal doctors.

Interpreting their municipal mandate to exclude NCDs and reasoning their medical expertise as insufficient to treat NCDs, the doctors routinely referred NCD cases. They expressed concerns about violence from patients, negative media attention and unsupportive municipal authorities should anything go wrong clinically.

The study contextualizes street-level service-delivery in weak institutional conditions. Whereas street-level workers may commonly standardize practices to reduce workload, here the doctors routinized NCD care to avoid the sociopolitical consequences of clinical uncertainty. Modalities of the welfare state and medical care in India – manifest in weak municipal capacity and healthcare regulation – appear to compel restraint in service-delivery. The analysis highlights how norms and social relations may shape primary care provision and quality.

Computer-Assisted Learning in Pediatrics Program (CLIPP) and National Board of Medical Examiners Pediatric Subject Examination (NBMEPSE) are used to assess students’ performance during pediatric clerkship. International Foundations of Medicine (IFOM) assessment is organized by NBME and taken before graduation. This study explores the ability of CLIPP assessment to predict students’ performance in their NBMEPSE and IFOM examinations.

This cross-sectional study assessed correlation of students’ CLIPP, NBMEPSE and IFOM scores. Students’ perceptions regarding NBMEPSE and CLIPP were collected in a self-administered survey.

Out of the 381 students enrolled, scores of CLIPP, NBME and IFOM examinations did not show any significant difference between genders. Correlation between CLIPP and NBMEPSE scores was positive in both junior (r = 0.72) and senior (r = 0.46) clerkships, with a statistically significant relationship between them in a univariate model. Similarly, there was a statistically significant relationship between CLIPP and IFOM scores. In an adjusted multiple linear regression model that included gender, CLIPP scores were significantly associated with NBME and IFOM scores. Male gender was a significant predictor in this model. Results of survey reflected students’ satisfaction with both NBMEPSE and CLIPP examinations.

Although students did not perceive a positive relationship between their performances in CLIPP and NBMEPSE examinations, this study demonstrates predictive value of formative CLIPP examination scores for their future performance in both summative NBMEPSE and IFOM. Therefore, students with poor performance in CLIPP are likely to benefit from feedback and remediation in preparation for summative assessments.

The global impact of the COVID-19 pandemic has been well documented, but there is still limited insight into the complex interaction of factors that determine its longer-term effects on the most vulnerable sectors of society. The current study therefore develops an integrated conceptual framework to investigate how consumers' fear of mortality and the perceived risk of severe illness associated with COVID-19 act as critical determinants of consumer food choices and perceived well-being.

An online survey was utilized to collect data from a sample of 407 adult, low-income consumers across Trinidad and Tobago. The PROCESS macro was used to empirically test the hypothesized relationships in a moderated mediation model.

The results confirm that an increase in the perceived risk of severe illness has a significant negative effect on the consumption of healthy foods and perceived well-being. Moreover, consumers' choice of healthy foods mediates the negative relationship between consumers' perceived risk of severe COVID-19 illness and subjective well-being. Finally, the negative relationship between perceived risk of illness and healthy food choice weakens as an individual's fear of pandemic-related mortality increases.

This research integrates multiple related theoretical constructs to provide a more nuanced understanding of the lingering impact that risk perceptions and fear have on consumer food choices and associated well-being among a vulnerable Caribbean population. The changes identified have important implications for researchers interested in consumer food preferences as well as policymakers seeking to promote a healthy lifestyle among individuals coping with psychologically stressful circumstances.

This paper aims to examine the health technology use in health information seeking, communication and personal health information management, as well as in the effects they may have on his relationship with the physician and on the consumption of medical resources.

An online survey was conducted. The questionnaires were distributed via online health discussion forums using Google's survey software with a summary presentation of the study’s objective. The final selection of 362 individuals was made using social media, direct email and collaboration with community groups. The empirical validation of the causal model was conducted using the partial least square approach.

The results show that the use of e-health strengthens the quality of the patient–physician relationship and patient empowerment while increasing the consumption of medical resources.

The results of this research indicate that the internet has transformed the relationship of patients to health, to their doctors and to the health-care system. In this new context, a reconsideration of the status of the patient must be considered by health service providers.

This study aims to explore the empirical correlation between patient flow issues, quality of green health services and patient satisfaction in specialist medical department factors from patients’ perspectives as service consumers.

This research is a type of nonintervention empirical research that uses an open survey to explore the views and experiences of users of specialist medical department services. The targeted population is hospital patients included in the top five national PERSI (Indonesian Hospital Association) Award 2022 Green Hospital Category, with a total number of respondents of 572 people. This study uses the partial least square-structural equation modeling analysis method with the SmartPLS application.

Patient flow problems generally affect the quality of eco-friendly health services, except for the waiting time problem, which affects service quality. It should be understood as a top priority for patients to receive services from medical specialists without risking time as a core service aspect from the patient’s perspective. In addition, all variables in eco-friendly hospital services affect patient satisfaction, except in the case of visits to specialist medical departments, which do not affect medical support services and hospital practices that are responsive to the delivery of care services resulting from medical support services that are inseparable in integrated services as well as health care following medical ethics.

This study has a novelty in understanding the implications of green practice in determining patient satisfaction in medical specialist department as the epicenter of hospital services and the main object of assessment for the quality of hospital services.

The purpose of this paper Computing is a recent emerging cloud model that affords clients limitless facilities, lowers the rate of customer storing and computation and progresses the ease of use, leading to a surge in the number of enterprises and individuals storing data in the cloud. Cloud services are used by various organizations (education, medical and commercial) to store their data. In the health-care industry, for example, patient medical data is outsourced to a cloud server. Instead of relying onmedical service providers, clients can access theirmedical data over the cloud.

This section explains the proposed cloud-based health-care system for secure data storage and access control called hash-based ciphertext policy attribute-based encryption with signature (hCP-ABES). It provides access control with finer granularity, security, authentication and user confidentiality of medical data. It enhances ciphertext-policy attribute-based encryption (CP-ABE) with hashing, encryption and signature. The proposed architecture includes protection mechanisms to guarantee that health-care and medical information can be securely exchanged between health systems via the cloud. Figure 2 depicts the proposed work's architectural design.

For health-care-related applications, safe contact with common documents hosted on a cloud server is becoming increasingly important. However, there are numerous constraints to designing an effective and safe data access method, including cloud server performance, a high number of data users and various security requirements. This work adds hashing and signature to the classic CP-ABE technique. It protects the confidentiality of health-care data while also allowing for fine-grained access control. According to an analysis of security needs, this work fulfills the privacy and integrity of health information using federated learning.

The Internet of Things (IoT) technology and smart diagnostic implants have enhanced health-care systems by allowing for remote access and screening of patients’ health issues at any time and from any location. Medical IoT devices monitor patients’ health status and combine this information into medical records, which are then transferred to the cloud and viewed by health providers for decision-making. However, when it comes to information transfer, the security and secrecy of electronic health records become a major concern. This work offers effective data storage and access control for a smart healthcare system to protect confidentiality. CP-ABE ensures data confidentiality and also allows control on data access at a finer level. Furthermore, it allows owners to set up a dynamic patients health data sharing policy under the cloud layer. hCP-ABES proposed fine-grained data access, security, authentication and user privacy of medical data. This paper enhances CP-ABE with hashing, encryption and signature. The proposed method has been evaluated, and the results signify that the proposed hCP-ABES is feasible compared to other access control schemes using federated learning.

Infection and cross-contamination have been massive concerns in the medical field. This study aims to investigate consumers’ awareness and their choices of endoscopes, which may deter them from the cross-contamination problem.

A discrete choice experiment survey was administered to 166 respondents in Penang, Malaysia. Participants were asked to make hypothetical choices and estimate their preference for endoscopes. The multinomial logit model was used to estimate the assumptions based on the stated preference data collected.

Only two-fifths of respondents are aware of their rights regarding endoscope selection. The findings are consistent with utility theory, where choices are made to maximise personal satisfaction. If given the choice, consumers preferred the single-use endoscope over the reusable or the doctor’s preferred endoscope. Price, insurance coverage and personal income are significant determinants of the consumer’s choice of endoscopes.

This study only investigates subjects living in Penang. Other possible important attributes to endoscope choices, such as environmental and device availability may be considered in future study.

The findings may create awareness among consumers about their rights when choosing medical devices. It may also improve health-care institutions’ (users’) and device manufacturers’ (industry players’) understanding of consumer needs and demands from socioeconomic perspectives.

The research offers insights into consumer rights and awareness of health-care services. Ultimately leading to better policy to protect consumers’ rights and safety.

This study contributes to the rare literature on consumer rights toward medical devices, in particular, the consumer’s awareness of the choice of endoscopes.

Patient-centric exchanges, a major type of Health Information Exchange (HIE), empower patients to aggregate and manage their health information. This exchange model helps patients access, modify and share their medical information with multiple healthcare organizations. Although existing studies examine patient engagement, more research is required to investigate patients' attitudes and willingness to play an active role in patient-centered information exchange. The study's main objective is to develop a model based on the belief-attitude-intention paradigm to empirically examine the effects of patients' attitudes toward engagement in care on their willingness to participate in patient-centric HIE.

The authors conducted an online survey study to identify the antecedents and consequences of patients' attitudes toward engagement in care. To empirically test the research model, the authors collected data from a national sample (n = 357) of individuals in the United States. The data were analyzed using structural equation modeling (SEM).

The proposed model categorizes the antecedents to patients' attitudes toward engagement in patient-related and healthcare system factors. The results show that patient-related factors (perceived health literacy and perceived coping ability) and health system factors (perceived experience with the healthcare organization and perceived patient-provider interaction) significantly shape patient attitude toward care management engagement. The results indicate that patients' attitudes toward engaging in their healthcare significantly contribute to their willingness to participate in medical information sharing through patient-centric HIE initiatives. Moreover, the authors’ findings also demonstrate that the link between patient engagement and willingness to participate in HIE is stronger for individuals who perceive lower levels of privacy and security concerns.

The authors validate the proposed model explaining patients' perceptions about their characteristics and the healthcare system significantly influence their attitude toward engaging in their care. This study also suggests that patients' favorable attitude toward engagement can bring patient-centric HIE efforts onto a path to success. The authors’ research attempts to shed light on the importance of patients' roles in adopting patient-centric HIE initiatives. Theoretical and practical contributions of this study are noticeable since they could result in a deeper understanding of the concept of patient engagement and how it may affect healthcare services in an evolving digital world. The authors’ findings can help healthcare organizations provide public citizen-centric services by introducing user-oriented approaches in healthcare delivery systems.

The main aim of this article is to broaden the notion of strategic intent in public relations. It also develops an understanding of the social value of what can be defined as the first modern health communication campaign in Europe based on strategic intents and the development of modernity.

The study is based on both historical research and empirical material from the Norwegian tuberculosis campaign from 1889 up to 1913, when Norwegian women achieved suffrage. The campaign is analysed in the framework of modernity and social theory. The literature on lobbying and social movements is also used to develop a theoretical framework for the notion of strategic intent.

The study shows that strategic intent can be divided into two layers: (1) the implicit strategic intent is the real purpose behind the communication efforts, whereas (2) the explicit intent is found directly in the communication efforts. The explicit intent may be presented as a solution for the good of society at the right political moment, giving an organisation the possibility to mobilise for long-term social changes, in which could be the implicit intent.

The distinction between explicit and implicit strategic intent broadens our understanding on how to make long-term social changes as well as how social and political changes occur in modern societies. The article also gives a historical account of what is here defined as the first modern health communication campaign in Europe and its social value.

The purpose of this paper is to explore the reintegration process of Wounded, Injured or Sick Employees (WISE) of the Dutch Military Armed Forces.

The research method is an exploratory, qualitative case study. A purposive sampling was drawn, including 10 WISE, and 6 reintegration stakeholders. A total of 16 interviews were conducted to explore the individual, organisational and socio-environmental factors that influence reintegration of WISE.

Findings show the importance of involvement and participation of members of the social environment in the reintegration process. Findings show that the complexity of the plethora of WISEs' injuries and disabilities requires a more person-centric reintegration approach with personalized-customized provisions, rather than a policy-driven approach to the reintegration, in order to enhance the reintegration experience and to arrive at beneficial individual and organisational reintegration outcomes.

This cross-sectional study on a limited sample of WISE and reintegration stakeholders does not allow for making inferences about the long-term effects of the reintegration process on reintegration outcomes of the wider population of WISE. Future longitudinal research, encompassing a larger sample, could examine the long-term career, organisational and societal implications of reintegration of WISE within and outside the Military Armed Forces.

This paper presents a “Wounded Warrior Workplace Reintegration Program”, aimed at deriving beneficial outcomes for all stakeholders involved in the reintegration trajectory.

This paper contributes to the literature by presenting a Model of Occupational Reintegration of WISE that considers the factors at an individual, social-environmental, and institutional level as determinants of successful reintegration.