Bulletin of the World Health Organization最新文献

{"title":"The role of mortality surveillance in pandemic preparedness and response.","authors":"Chalapati Rao, Don de Savigny, Emily Atuheire, Samantha Dolan, Daniel Cobos Munoz, Doris Ma Fat, Joy Ebonwu, Mona Sharan, Anthony Ofosu, Debbie Bradshaw, Rob Dorrington, Erin Nichols","doi":"10.2471/BLT.24.292423","DOIUrl":"https://doi.org/10.2471/BLT.24.292423","url":null,"abstract":"<p><p>The coronavirus disease 2019 (COVID-19) pandemic exposed critical limitations in the availability of timely mortality data to inform situational assessments and guide evidence-based public health responses at local, national and global levels. Less than half of the Member States of the World Health Organization (WHO) (73 out of 194) generated the required mortality data. Member States able to meet the sudden demand for real-time data did so through strong public health leadership and strategies for coordinated data acquisition, analysis and dissemination. In most other countries, attempts were made to conduct mortality surveillance but yielded only partial data with limited utility. This experience highlighted the need for a series of strategic shifts to strengthen mortality surveillance programmes in all countries, towards complete recording of deaths and their causes with timely data dissemination. These shifts include modifying systems to enable streamlining of the compilation and use of death records from all sources while meeting the requirements of official registration processes; using electronic protocols for data management and release; and ensuring effective leadership, coordination and data use for public health action. Recently, the Africa Centres for Disease Control and Prevention developed a conceptual framework for strengthening national mortality surveillance and operational guidance for implementation. These activities and resources for improving national mortality surveillance can inform global initiatives to support pandemic preparedness and response programmes. Such initiatives will enable global readiness for early epidemic detection and disease control measure prioritization, while also building routine mortality statistics programmes for population health assessment, health policy and research.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"103 3","pages":"213-222"},"PeriodicalIF":8.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triage systems in low-resource emergency care settings.","authors":"Rob Mitchell, Gerard O'Reilly, Colin Banks, Garry Nou, John Junior McKup, Carl Kingston, Mangu Kendino, Donna Piamnok, Peter Cameron","doi":"10.2471/BLT.23.290863","DOIUrl":"https://doi.org/10.2471/BLT.23.290863","url":null,"abstract":"<p><p>Triage is widely regarded as a core emergency care function, as reflected in the World Health Organization (WHO) <i>Emergency care systems framework</i> and in recent World Health Assembly resolutions. In this article, we explore the evidence supporting triage in low-resource settings, with a focus on the <i>Interagency Integrated Triage Tool</i>. Following its release by WHO in the early stages of the coronavirus disease pandemic, the tool has been implemented across a range of low- and middle-income countries. We report evidence regarding its acceptability and performance from Papua New Guinea in the WHO Western Pacific Region. Data from four single-centre studies suggest that the tool can be reliably and efficiently applied by health workers, and its predictive validity is within the performance range of other triage instruments. The system is highly regarded by emergency care clinicians, and can be implemented with limited digital or in-person training. Although triage has intuitive and widely acknowledged value, recent research has identified a lack of high-quality evidence supporting an association between triage implementation and improved clinical outcomes. Evidence from several pre-post intervention studies suggests that the introduction of triage can reduce waiting times and mortality, but these data may have been subject to confounding and publication bias. Further research is required to establish the performance characteristics of the <i>Interagency Integrated Triage Tool</i> in other countries and contexts, and more rigorously examine the impact of triage implementation on quality of care.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"103 3","pages":"204-212"},"PeriodicalIF":8.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized controlled trials of digital health interventions for rheumatic disease management: a systematic review.","authors":"Anindita Santosa, James Weiquan Li, Tze Chin Tan","doi":"10.2471/BLT.24.292168","DOIUrl":"10.2471/BLT.24.292168","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the adoption, effectiveness and cost-effectiveness of digital health interventions for rheumatic disease management.</p><p><strong>Methods: </strong>Between 25 May 2024 and 2 June 2024, we systematically searched PubMed®, Scopus, ClinicalTrials.gov, the Global Observatory for eHealth and the World Bank Open Knowledge Repository for randomized controlled trials (RCTs) evaluating digital health interventions for rheumatic disease management. We included studies published between 2000 and 2024 that reported on adoption rates and efficacy. Two reviewers independently screened the studies, extracted data and categorized the digital interventions according to the World Health Organization's classification of digital health interventions.</p><p><strong>Findings: </strong>Of the 455 unique records identified, 21 RCTs met the inclusion criteria. Most digital health interventions (15 studies) focused on individual-centric interventions, such as targeted communication, personal health tracking, educational tools and wearable devices. Studies in high-income countries implemented advanced, integrated digital interventions combining individual-focused approaches with health worker interventions and data services using telemedicine platforms and decision support systems. In contrast, studies in low- and middle-income countries adapted accessible technologies such as mobile messaging and telephone-based education. Many telehealth, wearable technologies and educational interventions significantly improved disease control, patient adherence, knowledge and self-efficacy. Of the five studies assessing cost-effectiveness, all found digital interventions to be cost-effective.</p><p><strong>Conclusion: </strong>Digital health interventions show promise for managing rheumatic diseases. Tailoring these interventions to local infrastructure and emphasizing patient engagement are crucial for successful adoption. Future research should focus on standardizing evaluation methods, addressing digital divides and enhancing provider support and data services.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"103 2","pages":"136-147"},"PeriodicalIF":8.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards an inclusive digital health ecosystem.","authors":"Yao Xie, Kayode Philip Fadahunsi, Carol Kelleher, Derjung M Tarn, Audrey Grace, John O' Donoghue","doi":"10.2471/BLT.24.292020","DOIUrl":"10.2471/BLT.24.292020","url":null,"abstract":"","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"103 2","pages":"170-173"},"PeriodicalIF":8.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing digital health to achieve equitable and efficient health systems.","authors":"Viroj Tangcharoensathien, Alain Labrique, Divya Lakhotia, Rapeepong Suphanchaimat, Walaiporn Patcharanarumol","doi":"10.2471/BLT.24.293051","DOIUrl":"10.2471/BLT.24.293051","url":null,"abstract":"","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"103 2","pages":"82-82A"},"PeriodicalIF":8.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In this month's Bulletin.","authors":"","doi":"10.2471/BLT.25.000225","DOIUrl":"https://doi.org/10.2471/BLT.25.000225","url":null,"abstract":"","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"103 2","pages":"81"},"PeriodicalIF":8.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence, recessionary pressures and population health.","authors":"Jo-An Occhipinti, Ante Prodan, William Hynes, John Buchanan, Roy Green, Sharan Burrow, Harris A Eyre, Adam Skinner, Ian B Hickie, Mark Heffernan, Yun Ju Christine Song, Goran Ujdur, Marcel Tanner","doi":"10.2471/BLT.24.291950","DOIUrl":"10.2471/BLT.24.291950","url":null,"abstract":"<p><p>Economic and labour policies have a considerable influence on health and well-being through direct financial impacts, and by shaping social and physical environments. Strong economies are important for public health investment and employment, yet the rapid rise of generative artificial intelligence (AI) has the potential to reshape economies, presenting challenges beyond mere temporary market disruption. Generative AI can perform non-routine cognitive tasks, previously unattainable though traditional automation, creating new efficiencies. While this technology offers opportunities for innovation and productivity, its labour-displacing potential raises serious concerns about economic stability and social equity, both of which are critical to health. Job displacement driven by generative AI could worsen income inequality, shrink middle-class opportunities and reduce consumer demand, triggering recessionary pressures. In this article, we propose the existence of an AI-capital-to-labour ratio threshold beyond which a self-reinforcing cycle of recessionary pressures may emerge, and which market forces alone cannot correct. Traditional responses to such pressures, like fiscal stimulus or monetary easing, may be ineffective in addressing structural disruptions to labour markets caused by generative AI. We call for a proactive global response to harness the benefits of generative AI while mitigating risks. This response should focus on reorienting economic systems towards collective well-being, as emphasized in the World Health Assembly resolution <i>Economics of health for all</i> and the United Nations' Global Digital Compact. Integrated strategies that combine fiscal policy, regulation and social policies are critical to ensuring generative AI advances societal health and equity while avoiding harm from excessive job displacement.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"103 2","pages":"155-163"},"PeriodicalIF":8.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health workers' adoption of digital health technology in low- and middle-income countries: a systematic review and meta-analysis.","authors":"Minmin Wang, Kepei Huang, Xiangning Li, Xuetong Zhao, Laura Downey, Sondus Hassounah, Xiaoyun Liu, Yinzi Jin, Minghui Ren","doi":"10.2471/BLT.24.292157","DOIUrl":"10.2471/BLT.24.292157","url":null,"abstract":"<p><strong>Objective: </strong>To conduct a systematic review and meta-analysis of the facilitators of and barriers to the acceptance and use of digital health technology by health workers in low- and middle-income countries.</p><p><strong>Methods: </strong>We searched several databases for relevant articles published until 25 April 2024. We extracted data on four unified theories of acceptance and use of technology factors (performance expectancy, effort expectancy, social influence and facilitating conditions) and six additional factors (attitude, habit, incentive, risk, trust and self-efficacy); how these affected the outcomes of behavioural intention and actual use; and the strength of association if reported. We conducted a meta-analysis of the quantitative studies.</p><p><strong>Findings: </strong>We reviewed 36 publications, 20 of which were included in our meta-analysis. We observed that performance expectancy was the most frequently reported facilitator (in 21 studies; 58.3%) and that lack of facilitating conditions was the most cited barrier (10; 27.8%). From our meta-analysis, trust (<i>r</i> = 0.53; 95% confidence interval, CI: 0.18 to 0.76) and facilitating conditions (<i>r</i> = 0.42; 95% CI: 0.27 to 0.55) were the leading facilitators of behavioural intention and actual use, respectively. We identified concerns with performance expectancy (<i>r</i> = -0.14, 95% CI: -0.29 to 0.01) as the primary barrier to both outcomes.</p><p><strong>Conclusion: </strong>Our approach of clustering the facilitators of and barriers to the acceptance and use of digital health technology from the perspective of health workers highlighted the importance of creating an enabling ecosystem. Supportive infrastructure, tailored training programmes and incentive policies should be incorporated in the implementation of digital health programmes in low- and middle-income countries.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"103 2","pages":"126-135F"},"PeriodicalIF":8.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of digital HIV services in Guangzhou's primary health-care system, China.","authors":"Jun Wang, Yu-Zhou Gu, Yong-Heng Lu, Ju-Shuang Li, Ye-Fei Luo, Yan-Shan Cai, Zhi-Gang Han, Chun Hao","doi":"10.2471/BLT.24.291921","DOIUrl":"10.2471/BLT.24.291921","url":null,"abstract":"<p><strong>Objective: </strong>To describe changes in access to voluntary human immunodeficiency virus (HIV) counselling and testing services following the implementation of a mini-application (app) at primary health-care facilities across Guangzhou, China.</p><p><strong>Methods: </strong>In 2018, the Guangzhou Center for Disease Control and Prevention and the Lingnan Community Support Center co-developed WellTest, a mini-app within the WeChat environment, to address voluntary counselling and testing service needs. The mini-app provides on-demand information for clients, links them to health services, and allows users to provide feedback on health-care quality and share test results with partners. We retrieved data from the National HIV/AIDS Prevention and Control Information System and the app backend to assess adoption and service use after implementation of WellTest in primary health-care facilities in December 2018.</p><p><strong>Findings: </strong>Between 2018 and 2023, WellTest adoption at primary health-care facilities increased from 1.5% (2/134) to 90.1% (172/191). The annual number of visits for voluntary HIV counselling and testing services at these facilities rose from 7376 to 20 002, representing 83.6% of all 23 930 voluntary HIV counselling and testing visits in 2023, compared with 36.6% (7376/20 129) in 2018. The proportion of newly diagnosed HIV infections at primary health-care facilities increased from 21.7% (187/862) to 50.4% (239/474).</p><p><strong>Conclusion: </strong>The increased access to HIV services in Guangzhou's primary health-care facilities highlights the value of digital health interventions in addressing service delivery gaps and meeting the needs of providers and clients. Expanding such interventions has the potential to strengthen decentralized health care and disease screening in low-resource settings.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"103 2","pages":"99-109"},"PeriodicalIF":8.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging teleradiology with artificial intelligence.","authors":"","doi":"10.2471/BLT.25.020225","DOIUrl":"https://doi.org/10.2471/BLT.25.020225","url":null,"abstract":"<p><p>Can teleradiology supported by artificial intelligence (AI) boost overall radiology capacity in resource-constrained settings? Gary Humphreys reports.</p>","PeriodicalId":9465,"journal":{"name":"Bulletin of the World Health Organization","volume":"103 2","pages":"86-87"},"PeriodicalIF":8.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}