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Bridging the digital divide: artificial intelligence as a catalyst for health equity in primary care settings
Get PDFBackground
Health inequalities remain one of the most pressing challenges in contemporary healthcare, with primary care serving as both a gateway to services and a potential source of disparities. Artificial intelligence (AI) technologies offer unprecedented opportunities to address these inequities through enhanced diagnostic capabilities, improved access to care, and personalised interventions.
Objective
This comprehensive narrative review aimed to synthesise current evidence on AI applications in primary care settings, specifically targeting health inequality reduction and identifying both opportunities and barriers for equitable implementation.
Method
Following PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we employed a systematic approach to literature identification, selection, and synthesis across seven electronic databases covering literature from 2020 to 2024. Of 1,247 initially identified studies, 89 met inclusion criteria with 52 providing sufficient data quality for evidence synthesis.
Results
The review identified promising applications such as AI-powered risk stratification algorithms that improved hypertension control in low-income populations, telemedicine platforms reducing geographic barriers in rural communities, and natural language processing tools facilitating care for non-native speakers. However, significant challenges persist, including algorithmic bias that may perpetuate existing inequities, the digital divide excluding vulnerable populations, and insufficient representation in training datasets. Current evidence suggests that whilst AI holds transformative potential for advancing health equity, successful implementation requires intentional co-design with affected communities, robust bias mitigation strategies, and comprehensive digital literacy programmes.
Conclusion
Future research must prioritise equity-centred AI development, longitudinal outcome studies in diverse populations, and policy frameworks ensuring responsible deployment. However, careful consideration of unintended consequences, including potential overdiagnosis, erosion of human clinical judgement, and inadvertent exclusion of vulnerable populations, is essential to prevent AI from exacerbating existing health disparities. The paradigm shift towards equity-first AI design represents a critical opportunity to leverage technology for social justice in healthcare
Reply to Letter to the Editor: Rethinking predictive modeling: Methodological shortfalls in CAD risk stratification.
No full textAI-Driven Advances in Low-Dose Imaging and Enhancement—A Review
Get PDFThe widespread use of medical imaging techniques such as X-rays and computed tomography (CT) has raised significant concerns regarding ionizing radiation exposure, particularly among vulnerable populations requiring frequent imaging. Achieving a balance between high-quality diagnostic imaging and minimizing radiation exposure remains a fundamental challenge in radiology. Artificial intelligence (AI) has emerged as a transformative solution, enabling low-dose imaging protocols that enhance image quality while significantly reducing radiation doses. This review explores the role of AI-assisted low-dose imaging, particularly in CT, X-ray, and magnetic resonance imaging (MRI), highlighting advancements in deep learning models, convolutional neural networks (CNNs), and other AI-based approaches. These technologies have demonstrated substantial improvements in noise reduction, artifact removal, and real-time optimization of imaging parameters, thereby enhancing diagnostic accuracy while mitigating radiation risks. Additionally, AI has contributed to improved radiology workflow efficiency and cost reduction by minimizing the need for repeat scans. The review also discusses emerging directions in AI-driven medical imaging, including hybrid AI systems that integrate post-processing with real-time data acquisition, personalized imaging protocols tailored to patient characteristics, and the expansion of AI applications to fluoroscopy and positron emission tomography (PET). However, challenges such as model generalizability, regulatory constraints, ethical considerations, and computational requirements must be addressed to facilitate broader clinical adoption. AI-driven low-dose imaging has the potential to revolutionize radiology by enhancing patient safety, optimizing imaging quality, and improving healthcare efficiency, paving the way for a more advanced and sustainable future in medical imaging
The relationship between physical function and psychological symptoms in Parkinson’s: Perceptions of People with Parkinson’s and Carers
Get PDFBackground: People with Parkinson’s (PwP) can experience both physical and psychological symptoms, and understanding the perspectives of people affected is crucial for improved management, and clinical outcomes. Objectives: This online survey aimed to gain a better understanding of the relationship between the subjectively experienced physical and psychological symptoms by PwP and their carers, while also considering the influence of personal roles and past symptom experiences. Methods: A UK-wide survey of 251 PwP and 62 carers was conducted. The survey focused on reported diagnosed and non-diagnosed psychological symptoms experienced, their onset, and the perceived impact of physical and psychological symptoms on one another. Responses were summarised using descriptive statistics. Results: A substantial proportion of respondents reported at least one diagnosed psychological condition (38.5%) or undiagnosed psychological symptoms (44.6%) such as anxiety and depression. Half of respondents reported perceiving a bi-directional interaction between physical and psychological symptoms, with this perception most reported in people with prior experience of psychological symptoms. Our sample shows that while PwP and carers have similar views on the impact of psychological symptoms, carers perceive the impact of physical symptoms to be greater than PwP. Conclusions: PwP and carers appear to perceive an interaction between physical and psychological symptoms in Parkinson’s, noting that psychological symptoms frequently precede Parkinson’s diagnosis but are often under-recognised. Improved awareness of the potential link between physical and psychological symptoms in PwP may help to improve assessment, and onward referral processes to enhance care. Further research may assist in identifying potential disease subtypes and allow the prediction of changes in physical and psychological presentation
Oxysterols and phytosterols in human pathophysiology: Adipocytes in tumour microenvironment promote chemoresistance in triple-negative breast cancer through oxysterols
Get PDFGraphical abstract Adipocytes-derived oxysterols protect TNBC cells from chemotherapy activating LXRα-Pgp axis. Figure generated with Biorender. Abstract Objective Triple-negative breast cancer (TNBC) patients with excess adipose tissue experience poorer disease-free survival than those with a healthy body mass index. Adipocytes store and release cholesterol, which can be hydroxylated to form oxysterols. These cholesterol derivatives activate the liver X receptor (LXR) pathway. This study tested the hypothesis that adipocytes contribute to an imbalanced tumour microenvironment by exposing cancer cells to elevated oxysterols, mimicking chemotherapy exposure conditions and priming for chemoresistance. Methods Tumour tissue microarray from 148 TNBC patients was assessed using immunohistochemistry for CH25H, CYP46A1, CYP27A1, P-glycoprotein (Pgp/ ABCB1) expression and survival outcomes were assessed. Gene expression was compared between tumours from patients (GSE78958) and mouse models (GSE151866) with high versus low adiposity. In vitro, cell lines from lineages found in the tumour microenvironment were evaluated for oxysterol content, secretion, expression of relevant enzymes, and ability to induce ABCB1 expression and drug resistance in TNBC cells. Results In patients, stromal expression of oxysterol-synthesising enzymes correlated with ABCP1 expression in cancer epithelial cells and was associated with shorter disease-free survival. Adipocytes-conditioned media contained significantly higher oxysterol levels than that conditioned by other cell types and induced ABCB1 expression and drug resistance in MDA.MB.468 cells. Obese mice had elevated levels of Abcb1 in tumours compared to lean counterparts. Conclusion Adipocytes secrete oxysterols that promote drug resistance in vitro and correlate with oxysterol: Pgp axis and survival in vivo. Significance statement This study reveals a mechanism by which adipose tissue contributes to drug resistance in ER-negative breast cancers, identifying the oxysterol–Pgp axis as a potential therapeutic target
Barriers to adopting climate change awareness and education in Zimbabwe: a hybrid structural equation modelling and extreme gradient boosting approach
No full textThe study seeks to examine the barriers to climate change awareness and education in Zimbabwe, using a hybrid Structural Equation Modelling (SEM) and Extreme Gradient Boosting (XGBoost). The results revealed a positive link between media coverage, climate data accessibility, environmental education, stakeholder engagement, and technological advancement with the dissemination of information, except for public perception through SEM. The perception of the public had a negative beta value, highlighting the urgent need for education. Dissemination of information was identified as the principal barrier to climate awareness and education using the XGBoost model, whilst climate data accessibility was identified as the least important. Key contributions of the study include uncovering emerging trends, the development of a new theoretical framework, generation of effective and significant insights for policymakers and governments in their quest to improve climate awareness and education, and provision of guidelines for actions to reduce climate change
Project INC: Inclusive Neurodiverse Campuses
Get PDFExecutive Summary
Background
Project INC (Inclusive Neurodiverse Campuses) is a participatory action research project that aims to understand what works for neurodivergent inclusion and belonging on university campuses and to drive positive action. The number of neurodivergent students accessing higher education has risen steadily in the UK and
internationally in recent years. Retention and wellbeing outcomes are known to be poorer for this group of students in comparison with peers. Challenges of access and inclusion for neurodivergent employees in workplace settings,
including universities, are well documented.
Method
Working with a participatory advisory group of neurodivergent students and alumni, we designed a
two-phase study at York St John University. Phase 1
involved flexible, anonymous data collection across a digital and physical campus installation, resulting in 152 contributions from students and staff across the university. In Phase 2, we conducted in-depth accessible interviews with 6 neurodivergent students and 7 neurodivergent members of staff.
Findings
Content analysis of the Phase 1 data identified aspects of respondents’ experiences that are important determinants of belonging at university. ‘Meaningful inclusive practice’ captured the importance of: flexibility and choice when learning, inclusion happening by default rather than luck,
validation and being believed. ‘Representation as a shared responsibility’ described how identity spaces and visible acceptance of difference on campus foster inclusion and belonging. ‘Navigating space, time, and transition’ acknowledged the interdependency between physical and sensory spaces and university experience, as well as the
additional cognitive load involved in planning how to navigate transition between spaces and
activities. Using these Phase 1 themes as a framework for
thematic analysis of the Phase 2 interview data, we present a Model of INClusive belonging, which articulates the dynamic, situational, and relational nature of belonging at university for neurodivergent students and staff members as a set of five questions: Can I see it? Can I receive it? Can we talk? Can I exist here? Can I thrive here?
Actions
The actions arising from Project INC so far include: blended neurodiversity training for staff based on the co-produced findings from INC and the wider evidence base; a new sensory room on campus; executive-level commitment to neurodiversity-informed estates design; the inclusion of
neurodiversity as a key dimension of diversity in university EDI strategy; and a move towards more compassionate university communications. Action towards neurodiversity-affirming practice at York St John will continue in response to ongoing dialogue with our neurodivergent student and staff communities
Sustainable Green Marketing Strategies for a Circular Economy in Africa: An Introduction
No full textGreen marketing has emerged as a pathway for fostering sustainable development. However, mixed views are prevalent in developing economies on the role of green marketing as a pathway to deliver transformative and structural changes required to stimulate sustained economic growth. This chapter introduces the evolving discourse on green marketing by highlighting the realities and imperatives necessary to implement sustainable green marketing strategies in developing economies. It calls for a multi-disciplinary approach that integrates the micro and macro perspectives to provide insights into the realities and imperatives that facilitate or inhibit the realisation of the sustainable green marketing agenda in Africa. The contestations associated with the governance and practice of green marketing are introduced. The role of environmental values, norms, beliefs, supply chains and the digital economy in promoting green marketing is acknowledged
Translation, Cultural Adaptation, and Validity of Barnes Language Assessment in Persian Ageing Population: A Preliminary Study
Get PDFIntroduction: As the global population ages, the need for sensitive language assessments for dementia increases. While the Barnes language assessment (BLA) is a valuable tool in English, it has not been translated and validated for Persian-speaking populations. Materials and Methods: This cross-sectional translated and culturally adapted the BLA into Persian (BLA-Per) and evaluated its psychometric properties. The translation process followed the international quality of life assessment protocol. The BLA-Per was administered to 30 healthy older adults and 30 individuals with Alzheimer disease (AD). Test-retest reliability was assessed in the AD group. Statistical data analysis was performed using the SPSS software (version 24) at a significance level of 0.05. Results: Due to significant differences between the patients and cognitively healthy groups regarding age and education years, we used the analysis of covariance to control for these variables’ effects on between-group comparisons. Significant differences in BLA-Per scores were observed between healthy controls and AD patients in 8 out of 14 test components, demonstrating good discriminative validity. Intra-class correlation coefficients for test-retest reliability were above 0.75 for most subtests. Conclusion: The BLA-Per demonstrated good validity and reliability in assessing language impairments in Persian-speaking individuals with AD. Future research should investigate the BLA-Per in larger samples across different age groups and stages of AD
Decoloniality and anti-racist pedagogy: Sport students' experiences of enhancing their racial literacy
Get PDFUndergraduate sports courses can often emphasise colonial biases around 'race' that foster essentialist thinking about ethnic groups and people of colour. This article explores university sports students' experiences of being taught decolonised content delivered through anti-racist pedagogy and the impact this had on their understanding of 'race' and racial inequalities within sports and broader society. Drawing on interviews with fourteen undergraduate students and four alumni from one university in Northern England, the research investigated how these participants engaged with decolonial ideas and anti-racist teaching methods. Through a postcolonial lens, we thematically analyse how such ideas and pedagogy enhanced students' racial literacy by problematising the concept of 'race' and unpacking complexities surrounding discrimination in sports. Centralising student reflections, we found a) students had a limited understanding of 'race' and racial discrimination before attending university, b) students' experiences of being taught theories related to postcolonialism and decoloniality enhanced their understanding of how colonial ideas have instrumentalised thinking about ethnic groups in society and sports, and c) how constructivist anti-racist approaches to pedagogy enabled students to better understand 'race' and the promotion of anti-racist ideas in both society and sports. These findings serve as a timely reminder of the value of sociology and social-justice-themed modules within all sports courses during a period in the UK whereby mainstream sociology university courses are being challenged and withdrawn, and sports courses are increasingly becoming vocation-orientated