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Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

The purpose of this paper is to consider one test of a well-functioning housing system – its impact on wellbeing. Exploring one indicator of this, this study aims to track changes in mental and general health across a mix of tenure transitions and financial transactions in three jurisdictions: Australia, the UK and the USA.

Using matched variables from three national panel surveys (Household, Income and Labour Dynamics in Australia, British Household Panel Survey/Understanding Society and Panel Study of Income Dynamics) over 17 years (2000–2017) to capture the sweep of the most recent housing cycle, this study adopts a difference-in-difference random-effects model specification to estimate the mental and general health effects of tenure change and borrowing behaviours.

There is an enduring health premium associated with unmortgaged owner-occupation. Mortgage debt detracts from this, as does the prospect of dropping out of ownership and into renting. A previously observed post-exit recovery in mental health – a debt-relief effect – is not present in the longer run. In fact, in some circumstances, both mental and general health deficits are amplified, even among those who eventually regain homeownership. Though there are cross-country differences, the similarities across these financialised housing systems are more striking.

The well-being premium traditionally associated with owner occupation is under threat at the edges of the sector in all three jurisdictions. In this, there is cross-national convergence. There may therefore be scope to introduce policies to better support households at the edges of ownership that work across the board for debt-funded ownership-centred housing systems.

This paper extends the duration of a previous analysis of the impact of tenure transitions and financial transactions on well-being at the edges of ownership in the UK and Australia. The authors now track households over nearly two decades from the start of the millennium into a lengthy (post-global financial crisis) era of declining housing affordability. This study adds to the reach of the earlier study by adding a general health variable and a third jurisdiction, the USA.

Due to its ability to support well-informed decision-making, business intelligence (BI) has grown in popularity among executives across a range of industries. However, given the volume of data collected in health-care organizations, there is a lack of exploration concerning its implementation. Consequently, this research paper aims to investigate the key factors affecting the acceptance and use of BI in healthcare organizations.

Leveraging the theoretical lens of the “unified theory of acceptance and use of technology” (UTAUT), a study framework was proposed and integrated with three context-related factors, including “rational decision-making culture” (RDC), “perceived threat to professional autonomy” (PTA) and “medical–legal risk” (MLR). The variables in the study framework were categorized as follows: information systems (IS) perspective; organizational perspective; and user perspective. In Jordan, 434 healthcare professionals participated in a cross-sectional online survey that was used to collect data.

The findings of the “structural equation modeling” revealed that professionals’ behavioral intentions toward using BI systems were significantly affected by performance expectancy, social influence, facilitating conditions, MLR, RDC and PTA. Also, an insignificant effect of PTA on PE was found based on the results of statistical analysis. These variables explained 68% of the variance (R²) in the individuals’ intentions to use BI-based health-care systems.

To promote the acceptance and use of BI technology in health-care settings, developers, designers, service providers and decision-makers will find this study to have a number of practical implications. Additionally, it will support the development of effective strategies and BI-based health-care systems based on these study results, attracting the interest of many users.

To the best of the author’s knowledge, this is one of the first studies that integrates the UTAUT model with three contextual factors (RDC, PTA and MLR) in addition to examining the suggested framework in a developing nation (Jordan). This study is one of the few in which the users’ acceptance behavior of BI systems was investigated in a health-care setting. More specifically, to the best of the author’s knowledge, this is the first study that reveals the critical antecedents of individuals’ intention to accept BI for health-care purposes in the Jordanian context.

Health is a human right and a fundamental building block of sustainable development, economic prosperity and poverty reduction. To realize people’s right to health, evaluating the situation of the right and its determinants is necessary. This paper aims to analyze Iran’s conduct in realizing its population’s right to health.

A qualitative case study design involving a structured review of relevant laws, policy documents, reports and academic literature was undertaken. The data were collected from electronic databases and the official Web pages of the United Nations (UN) and Iran’s Government and analyzed by a framework suggested by the UN.

Iran’s law and policies intend to combat health inequalities and to provide an adequate standard of living for everyone, particularly disadvantaged groups and individuals. However, not all laws and policies protecting disadvantaged groups are adequately implemented. There are disparities in health status and access to health care among different socio-economic groups. International economic sanctions and government policies decreased people’s ability to access the necessities of life including health care. Moreover, social determinants of health, such as cultural beliefs regarding women’s rights have not been addressed sufficiently in the country’s laws.

This study includes a broad range of subjects and provides an overview of the health-care system of Iran. However, more detail is needed to describe every aspect of the right to health. It was not feasible to address them all in this paper and needs more research. In addition, as with the majority of qualitative studies, the design of the current study is subject to limitations. Firstly, the research quality of narrative reviews is dependent on the researcher’ skills and more easily can be influenced by his/her personal biases. Second, the rigor is more difficult to maintain, assess and demonstrate. Nevertheless, narrative studies often complement quantitative studies and are informative.

To fulfill the right to health, Iran should improve affordability and quality of care and the situation of the determinants of health. The gaps in people’s access to health care need to be identified, and all necessary means and scarce resources be allocated to remove access barriers and to improve the situation of disadvantaged people. The adoption of relatively low-cost targeted programs, the proper management of resources and the prevention of unnecessary costs are suggested.

The study explores how Taiwan’s electronic health data systems can be used to build algorithms that reduce or eliminate medical errors and to advance precision medicine.

This study is a narrative review of the literature.

The body of medical knowledge has grown far too large for human clinicians to parse. In theory, electronic health records could augment clinical decision-making with electronic clinical decision support systems (CDSSs). However, computer scientists and clinicians have made remarkably little progress in building CDSSs, because health data tend to be siloed across many different systems that are not interoperable and cannot be linked using common identifiers. As a result, medicine in the USA is often practiced inconsistently with poor adherence to the best preventive and clinical practices. Poor information technology infrastructure contributes to medical errors and waste, resulting in suboptimal care and tens of thousands of premature deaths every year. Taiwan’s national health system, in contrast, is underpinned by a coordinated system of electronic data systems but remains underutilized. In this paper, the authors present a theoretical path toward developing artificial intelligence (AI)-driven CDSS systems using Taiwan’s National Health Insurance Research Database. Such a system could in theory not only optimize care and prevent clinical errors but also empower patients to track their progress in achieving their personal health goals.

While research teams have previously built AI systems with limited applications, this study provides a framework for building global AI-based CDSS systems using one of the world’s few unified electronic health data systems.

This study aims to investigate the key factors that influence the behavioural intention of doctors to adopt the knowledge sharing driven blockchain technology in government hospitals. The study is based on the Unified Theory of Acceptance and Use of Technology 2, with the addition of trust as an independent variable and knowledge sharing as a mediating variable between trust and behavioural intention.

The data for the study was collected through a correlation and cross-sectional study using a survey, with a sample of 322 responses being used for the final analysis. The initial analysis of the data was conducted using SPSS v.26, followed by a partial least squares structural equation modelling (PLS-SEM) analysis using SmartPLS v.3.9 to test the validity and reliability of the measures and to examine the hypothesized relationships.

The results supported the proposed framework. The results of PLS-SEM indicate that all proposed pathways support the model. In particular, the results of the study reveal that performance expectation, effort expectation, social influence, facilitation conditions and trust are drivers of blockchain adoption and have a significant impact on the behavioural intention of clinicians in hospitals. Furthermore, the study found that knowledge sharing mediated the relationship between trust and behavioural intention.

The present study sheds light on the challenges facing blockchain technology, such as privacy and trust concerns and proposes a more sustainable approach based on knowledge management to enhance the effectiveness of blockchain technology and overcome these challenges.

The significance of this paper lies in the limited literature examining the relationships between blockchain technology and knowledge management processes. Furthermore, a hypothetical framework that includes the knowledge sharing process as a mediating variable between trust and behavioural intention to adopt blockchain technology has not been presented or developed in any previous studies, particularly in the context of Iraq. Thus, this work is novel and unique in its approach.

Poor mental health in men and women is attributable to disparities in physical traits, social roles, power and health-seeking behaviours. This study aims to examine the gender differences in mental health among Pakistan and German university students and focuses on their right to seek mental health care.

Data on depression, anxiety and stress symptoms, as well as positive mental health (PMH), resilience, social support and life satisfaction, were gathered from Pakistani and German students.

In contrast to the Pakistani group, where no such gender differences were seen, women in Germany reported higher degrees of stress, anxiety and depression, as well as a lower level of overall good mental health. In comparison to German men and women, Pakistani women scored equally high on resilience. While gender had no bearing on life happiness in either Pakistan or Germany, women in both countries perceived more social support than men did.

The study’s strengths include its large sample size and battery of mental health measures. The results of partial weak measurement Invariance (MI) on the stress subscale underlined the importance of using MI in cross-cultural studies. The validity of a direct comparisons on sum score between different language versions or country samples shall be cautious. Still, there are limitations. Firstly, the authors did not differentiate gender and biological sex, and there was no group of non-binary gender. Pakistani (N = 1,840) and German (N = 7,890) students were in unequal numbers. Again, only university students were sampled, so the results cannot be generalised to older (probably less educated) populations. Self-reported data that mainly obtained via online survey were the third limitation. This design is cost-effective and easy to administer for cross-cultural survey research. However, social desirability and memory bias are common in self-report inventories. Fourthly, although English is an official language in Pakistan and the medium of instruction in education, the authors recommend future study to use questionnaires that have been translated and validated into Urdu (Pakistan’s national language) and investigate gender differences in a general population. Fifthly, this is a cross-sectional survey; the authors were not able to explore the causality or risk factors that contribute to the poor mental well-being in Pakistan students in general or the relatively worse mental health in German women. Future studies may investigate the mechanism behind the phenomena observed in this study with longitudinal or experimental design. Last but not least, Germany and Pakistan differ in so many different aspects from culture, religions and history to social structure and economic status, which make it hard to claim whether the observed differences were due to national differences, cultural differences, economic differences, gender inequality differences or other effects. It would be helpful for future studies to include more country samples with clear definitions of different “culture” aspects for a better understanding of gender differences in other countries and in different mental well-being constructs.

The current study is the first attempt to compare the gender difference patterns in positive and negative mental health between European and South Asian counties and focuses on gender-specific approaches. Although Pakistani university students reported in general worse mental well-being, the differences between the two genders in mental health (e.g. depression, anxiety, general PMH) were not as pronounced as in the German student sample. Gender comparisons in these mental health constructs would help to improve protective factors against mental illness and to develop appropriate management programmes based on cultural differences. The results suggest that the gender differences found in western countries cannot always be directly translated into the South Asian cultural framework. Our results also highlight the importance of improving the general situation of Pakistan (students) instead of focusing on one gender. At the same time, in Germany, prevention and intervention plans are more warranted for women. It could be that once the general situation in Pakistan is improved, the gender-related differences in mental health will be clearly observed.

These findings imply the significance of cultural context when inferring gender variations in mental health. Moreover, it supports the advancement of comprehensive policies to reduce gender-related mental health inequalities and focuses on the equal rights of men and women to get mental health care.

When the factors affecting health expenditures are examined in the literature, it is seen that one of the most important factors is income. In this context, the purpose of this study is to investigate the relationship between out-of-pocket health expenditures and disposable personal income and revealing the income elasticity of health expenditures.

Therefore, short/long-term coefficients were obtained by analyzing Westerlund (2007) co-integration analysis and pooled mean group (PMG) regression methods for 22 European Union (EU) member states during the period 2003–2017. In addition, a comparison of the long-term coefficients for each country was obtained with augmented mean group (AMG) estimator.

The results of the AMG and PMG tests show that the long-term coefficients between disposable personal income and health expenditures are 0.83 and 0.97, respectively. These results imply that there is a significant relationship between the variables, and that health care should be categorized in the group of normal goods. However, the fact that the long-term coefficient is very close to 1, despite being classified in the category of necessity goods, requires more care to be taken in evaluating whether health services are luxury goods or necessity goods.

The use of second generation econometric tests on both cross-sectional dependence and heterogeneity demonstrates the value of the study. On the other hand, obtaining similar results by investigating the relationship between variables using different appropriate econometric models reveals the importance of the methodology used in this study. It reveals important details in terms of the literature regarding the long-term and short-term results obtained in this study.

The sudden COVID-19 epidemic in 2019 has frustrated China's overall economy, and the implementation and development of the National Fitness Program has encountered huge obstacles. At a new historical starting point, in order to realize the dream of becoming a powerful country in sports, it is necessary to transform the successful experience gained since the reform and opening up into regular understanding and systematic theories, so as to make a theoretical response to the new contradictions and challenges faced in development and give full play to the National Fitness has comprehensive values and multiple functions in improving people's health, promoting people's all-round development, promoting economic and social development and demonstrating the country's cultural soft power.

Taking the topic of national fitness as an example, this paper sets out from the three dimensions of knowledge input, knowledge output and knowledge production, using citation analysis, social network analysis, co-word analysis and cluster analysis, to measure the characteristics and knowledge structure of interdisciplinary knowledge exchange.

China's national fitness is still in the primary development stage, and the strong boost of the national top-level policy is the biggest driving force of its development, driven by the policy together with the settlement of many major events, constantly improving and enriching the wings. The main body of knowledge production on the topic of national fitness is mainly colleges and universities, with low participation of government and enterprises, high degree of cooperation among authors, obvious interdisciplinary characteristics and strong application of research themes.

This study provides a strong theoretical basis for the promotion of the Healthy China strategy. Especially under the influence of COVID-19, this paper can contribute to the comprehensive value and multimodal functions of national fitness in improving the health of people, promoting economic and social development and demonstrating the soft power of national culture.

Adopting digital technology could facilitate the public health response to the COVID-19 pandemic. Some analysts argue that countries that adopted digital technology in their health sector have managed to control the virus better (Whitelaw et al., 2020). For instance, countries with more comprehensive contact tracing have significantly lower fatality rates (Yalaman et al., 2021). Moreover, World Health Organization (WHO) believes this technology is a crucial enabler for countries to meet the current challenge (WHO. Regional Office for the Western Pacific & University of Melbourne, 2021). In this regard, this study aims to quantitatively find the relationship between the technological advancement of countries and COVID-19 health outcomes, using seven technological indices that measure technological advancement.

The authors used the multiple linear regression method to answer the research questions. The first analysis focuses on a cross section of all countries worldwide, and the second focuses on European countries for which weekly death statistics exist after the pandemic.

The findings support those countries with more technological abilities managed to control the virus’s mortality better, as evidenced by the negative link between the mortality rate of COVID-19 and the technological factors at the national level. Results also reveal that technology adoption decreases the death risk due to COVID-19 in countries with more elderly people. The authors may argue that technological advancement positively correlates with the number of deaths and diagnosed cases because the authors can better collect data or because the virus spreads due to higher economic and business activities. However, such technological advancement significantly decreases the death risk (lower mortality rate in the first analysis and lower mortality rate for elderly people in the second analysis).

Three important conclusions could be made from the results: a lower mortality rate is generally expected for countries adopting advanced technology; technological advancement significantly decreases the death risk for elderly people; and a higher technology adoption level does not necessarily result in fewer diagnosed cases of/death due to COVID-19.

Although some studies have focused on e-health applications in the public health response to the COVID-19 pandemic, no studies, to the best of the authors’ knowledge, have tried to quantify its efficacy, most especially on the global level.