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Digital Health Equity in Primary Care: A Critical Review of Socioeconomic Barriers to Chronic Disease Management
Get PDFAbstract
Background: Integrating digital health technologies into chronic disease management has improved access, care continuity, and patient engagement. However, these benefits are unevenly distributed. Structural barriers impede digital engagement among socioeconomically disadvantaged older adults, perpetuating health inequities and constraining the effectiveness of digital innovations in primary care. This review critically examines the impact of unequal access to digital health tools on health outcomes and contributes to the broader discourse on digital health equity.
Methods: A structured analysis was conducted using PubMed and CINAHL to identify original studies published between 2019 and 2024. Search terms were designed to capture research at the intersection of digital health, chronic disease, ageing, and social disadvantage in primary care. Studies were screened using PRISMA guidelines. Inclusion criteria focused on adults aged 65 and over from disadvantaged backgrounds living with chronic conditions. Seven studies were selected for thematic analysis.
Results: The thematic analysis of seven studies revealed key factors shaping digital health outcomes: digital literacy, usability, mobile health, community-based interventions, low-cost tools, governance, and equity. Interventions demonstrated greater effectiveness when culturally tailored, accessible, and supported by training. Nonetheless, enduring structural barriers, including affordability, digital exclusion, and ineffective data governance, have a constrained impact, indicating that digital inequity is profoundly ingrained within the broader social determinants of health.
Conclusion: Equitable digital health implementation necessitates more than mere access; it requires inclusive design, comprehensive professional training, and substantive policy reform. The role of nurses and primary care providers is pivotal in evaluating digital capacity and promoting equitable care delivery. This review offers evidence-based recommendations for equity-focused strategies to enable digital innovations to benefit, rather than exclude, socioeconomically disadvantaged older adults
Multi-functional hybrid energy system for zero-energy residential buildings: Integrating hydrogen production and renewable energy solutions
Get PDFThe increasing global residential energy demand causes carbon emissions and ecological impacts, necessitating cleaner, efficient solutions. This study presents an innovative hybrid energy system integrating wind power and gas turbines for a four-story, 16-unit residential building. The system generates electricity, heating, cooling, and hydrogen using a Proton Exchange Membrane electrolyzer and a compression chiller. Integrating the electrolyzer enables hydrogen production and demonstrates hydrogen's potential as a versatile, clean energy carrier for systems, contributing to advancements in hydrogen utilization. Simulations with Engineering Equation Solver software, coupled with neural network-based multi-objective optimization, fine-tuned parameters such as gas turbine efficiency, wind turbine count, and gas turbine inlet temperature to enhance exergy efficiency and reduce operational costs. The optimized system achieves an energy efficiency of 33.69% and an exergy efficiency of 36.95% and operates at $446.04 per hour, demonstrating economic viability. It produces 51,061 MWh annually, exceeding the building's energy demands and allowing surplus energy use elsewhere. BEopt simulations confirm the system meets residential needs by providing 2.52 GWh of electricity, 3.36 GWh of heating, and 5.11 GWh of cooling annually. This system also generates 10 kg of hydrogen per hour and achieves a CO₂ reduction of 10,416 tons/year. The wind farm (25 turbines) provides most of the energy at 396.7 dollars per hour, while the gas turbine operates at 80% efficiency. By addressing the challenges of intermittent renewable energy in residential Zero-Energy Buildings, this research offers a scalable and environmentally friendly solution, contributing to sustainable urban living and advancing hydrogen energy applications
The obligations and opportunities of 'friendship as method' in youth mentoring research: investigating the intersections with youth work epistemologies
Get PDFDevelopment and Initial Evaluation of a Fine Motor Subscale of a Comprehensive Developmental Scale for Children Aged 18–41 Months
No full textComparative investigation of the transport and deposition of nebulized particles in pediatric mouth-throat airways with tonsil hypertrophy at different severity levels
No full textComparative study of inhaled corticosteroid deposition in pediatric mouth-throat airway with tonsil hypertrophy
No full textSystematic Review of Patients' Perceptions of the Contributing Factors That Led to Falling in Acute Care Hospitals During Their Hospitalisation
Get PDFAim: To examine what patients perceive to be the contributing factors that led to their fall in acute care hospitals during their episode of care in Australia. Design: A systematic review was conducted on inpatient experiences related to their fall during their episode of care in Australian acute care hospitals. Methods: Database and manual searches were undertaken from December 2022 to February 2023, with final analyses completed in August 2023. Three studies with a total of 37 participants were included in the analysis. Various aspects of falls in patients were examined, including factors contributing to falls; the impact of falls on patients' confidence; education about falls prevention measures through brochures and implemented strategies; and patient adherence to the falls prevention plan. Results: Three key perceptions were identified, relating to the cause of falls, person-centred care and falls prevention. Results revealed that many inpatients were unaware of their risks of falling or the steps taken by nursing staff to prevent falls. Furthermore, the quality of nurse–patient relationships affected patients' experience of falls. Conclusion: To promote cooperation and foster patient understanding of risk, it is crucial to involve patients in their falls prevention plan on a daily basis during their episode of care. Implications for the Profession and/or Patient Care: Further research is required on patients' perceptions of their falls during an episode of care within an acute care setting in Australia. The increasing risk of falls, particularly among the ageing population, requires better processes and partnering with consumers using a multidisciplinary approach to person-centred falls prevention strategies. Impact: Falls among patients in healthcare facilities are a major concern. Understanding patient perceptions of the factors contributing to their falls will assist nurses understanding and lead to improvement in communication and falls prevention during their hospital stay. Reporting Method: This work adhered to the PRISMA guidelines. Patient or Public Contribution: No patient or public contribution
Exploring the Management Models and Strategies for Hospital in the Home Initiatives
Get PDFHospital in the Home (HITH) programs are emerging as a key pillar of smart city healthcare infrastructure, leveraging technology to extend care beyond traditional hospital walls. The global healthcare sector has been conceptualizing the notion of a care without walls hospital, also called HITH, where virtual care takes precedence to address the multifaceted needs of an increasingly aging population grappling with a substantial burden of chronic disease. HITH programs have the potential to significantly reduce hospital bed occupancy, enabling hospitals to better manage the ever-increasing demand for inpatient care. Although many health providers and hospitals have established their own HITH programs, there is a lack of research that provides healthcare executives and HITH program managers with management models and frameworks for such initiatives. There is also a lack of research that provides strategies for improving HITH management in the health sector. To fill this gap, the current study ran a systematic literature review to explore state-of-the-art with regard to this topic. Out of 2631 articles in the pool of this systematic review, 20 articles were deemed to meet the eligibility criteria for the study. After analyzing these studies, nine management models were extracted, which were then categorized into three categories, namely, governance models, general models, and virtual models. Moreover, this study found 23 strategies and categorized them into five groups, namely, referral support, external support, care model support, technical support, and clinical team support. Finally, implications of findings for practitioners are carefully provided. These findings provide healthcare executives and HITH managers with practical frameworks for selecting appropriate management models and implementing evidence-based strategies to optimize program effectiveness, reduce costs, and improve patient outcomes while addressing the growing demand for home-based care
From Data to Cultural Response: A Machine Learning–Driven Digital Twin Model for Smart Heritage Precincts in Urban Context
Get PDFIn the context of Smart Cities, Smart Heritage has emerged as a forward-oriented strategy aimed at enhancing the construction, management, accessibility, and sustainability of culturally significant environments. Yet, within Smart Heritage discourse, the distinction between basic digital representations and truly responsive, sensor-informed systems remains underdeveloped. This study addresses this gap by proposing a machine learning–enhanced digital twin simulation framework that enables both real-time and anticipatory heritage interventions. Using Chinatown Melbourne as an urban heritage case study, five open-access urban datasets, pedestrian counting, on-street parking, microclimate conditions, dwelling functionality, and Microlab sensor data (CO₂, sound level, and accelerometer), were evaluated, with three integrated into a pilot simulation model. A key contribution is the inclusion of a conceptual ‘Heritage Layer’ that overlays cultural significance and symbolic meaning across all stages of system logic and design response. The model also incorporates a dedicated machine learning layer, trained on full-year 2024 sensor data, to forecast environmental and behavioural triggers such as crowd build-up. This predictive capability enables the system to shift from reactive monitoring to proactive design interventions aligned with cultural rhythms. A December 2024 simulation validated the frequency and relevance of trigger-based activations. Rather than relying on platform-specific code, the framework is designed for adaptability across construction informatics environments and heritage precincts globally. Findings demonstrate how Smart Heritage systems can bridge environmental sensing, cultural identity, and post-construction evaluation, offering a scalable methodology for digitally responsive, culturally attuned urban heritage management