Journal Description
Healthcare
Healthcare
is an international, scientific, peer-reviewed, open access journal on health care systems, industry, technology, policy, and regulation, and is published semimonthly online by MDPI. European Medical Association (EMA) and Ocular Wellness & Nutrition Society (OWNS) are affiliated with Healthcare and their members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE and SSCI (Web of Science), PubMed, PMC, and other databases.
- Journal Rank: JCR - Q2 (Health Care Sciences and Services) / CiteScore - Q2 (Leadership and Management)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 20.3 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the second half of 2024).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for Healthcare include: Trauma Care and European Burn Journal.
Impact Factor:
2.4 (2023);
5-Year Impact Factor:
2.5 (2023)
Latest Articles
Older Adults’ and Professionals’ Attitudes Towards Stair-Fall Prevention Interventions
Healthcare 2025, 13(11), 1324; https://doi.org/10.3390/healthcare13111324 - 2 Jun 2025
Abstract
Background/Objective: Stair falls are a major health concern for older adults, particularly those wishing to age in place. Despite extensive laboratory research on the causes of stair falls and the effectiveness of prevention interventions, there is limited understanding of how acceptable interventions are
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Background/Objective: Stair falls are a major health concern for older adults, particularly those wishing to age in place. Despite extensive laboratory research on the causes of stair falls and the effectiveness of prevention interventions, there is limited understanding of how acceptable interventions are to end-users and key stakeholders in real-world home environments. This study explored older adults’ and professionals’ attitudes toward stair-fall prevention interventions, including intervention acceptability, barriers and facilitators to adoption, and priorities for implementation in home settings. Methods: This study employed a sequential mixed-method design, including a survey of 359 UK community-dwelling older adults (aged 55+), followed by focus groups with 8 older adults and 11 professionals from healthcare and housing backgrounds. Results: Older adults surveyed perceived home stair falls as a significant risk and priority for prevention but demonstrated less awareness of specific interventions to prevent falls. Focus groups with older adults and professionals established barriers and facilitators to the adoption of 10 specific stair-fall prevention interventions. Barriers included a lack of awareness, financial constraints, reluctance to alter home environments and stigma. Facilitators included raising awareness through education, clear guidance on intervention benefits and installation, practical and financial support, personalised approaches, social encouragement, and endorsement by professionals. Focus groups found the most acceptable stair-fall prevention interventions included education and skill training, improved staircase lighting and additional handrails. Conclusions: Interventions that are low-disruption, cost-effective, backed by empirical evidence, and endorsed by trusted professionals are more likely to be accepted and implemented. Further research should focus on targeted educational strategies to overcome barriers to adoption.
Full article
(This article belongs to the Special Issue Holistic Approaches to Aging in Place: Health, Safety, and Community)
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Open AccessArticle
The Association Between Obstructive Sleep Apnea and Oral Function, Using the Korea National Health and Nutrition Examination Survey Data
by
Keon Woo, Junghoon Lee, Chae-Eun Jung, Jungwon Park and Yoonsoo Choy
Healthcare 2025, 13(11), 1323; https://doi.org/10.3390/healthcare13111323 - 2 Jun 2025
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Background: Obstructive sleep apnea (OSA) has been associated with adverse oral function outcomes, yet its association with oral function remains underexplored. This study aims to analyze the association between OSA and oral function problems, and whether these relationships are more pronounced among
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Background: Obstructive sleep apnea (OSA) has been associated with adverse oral function outcomes, yet its association with oral function remains underexplored. This study aims to analyze the association between OSA and oral function problems, and whether these relationships are more pronounced among socioeconomically disadvantaged groups. Methods: Data were derived from the 2022–2023 Korea National Health and Nutrition Examination Survey (KNHANES), including 6349 participants aged 40 and above. OSA risk was assessed using the STOP-Bang questionnaire. Oral function was evaluated through chewing discomfort, speaking discomfort, and dental pain. Complex sample logistic regression was performed, adjusting for demographic, socioeconomic, and health-related covariates. Stratified analyses were conducted to examine whether the association differed across socioeconomic groups. Result: High OSA risk was significantly associated with chewing discomfort (OR: 1.365, 95% CI: 1.121–1.662), speaking discomfort (OR: 1.534, 95% CI: 1.126–2.082), and dental pain (OR: 1.198, 95% CI: 1.006–1.431). Stratified analyses showed stronger associations in low education or income groups. For instance, those in the lowest income group were over five times more likely to report speaking discomfort (OR = 5.207, 95% CI: 2.365–11.462) than those in the highest. Conclusions: OSA risk is significantly associated with impaired oral function, particularly among socioeconomically disadvantaged groups. These findings underscore the need for integrated public health approaches that address both sleep and oral health disparities.
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Open AccessArticle
Membrane Status and Reliability of Intrapartum Transperineal Ultrasound in Cervical Dilatation Assessment
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George-Alexandru Roșu, Dan-Bogdan Navolan, Adrian Neacșu, Ștefan-Florentin Semeș and Crîngu-Antoniu Ionescu
Healthcare 2025, 13(11), 1322; https://doi.org/10.3390/healthcare13111322 - 2 Jun 2025
Abstract
Background and Objectives: Labor progression evaluation through repeated vaginal examinations remains the primary method of monitoring in delivery rooms globally. Transperineal intrapartum ultrasound has been shown to be reliable for assessing cervical dilatation, with substantial concordance with digital vaginal examinations. However, none of
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Background and Objectives: Labor progression evaluation through repeated vaginal examinations remains the primary method of monitoring in delivery rooms globally. Transperineal intrapartum ultrasound has been shown to be reliable for assessing cervical dilatation, with substantial concordance with digital vaginal examinations. However, none of the analyzed studies investigated the influence of membrane integrity on ultrasound measurements. This study assessed the impact of membrane status on cervical dilatation evaluation via transperineal ultrasound compared to clinical examination, and the extent of agreement based on dilatation level and membrane status. Methods: A nine-month longitudinal observational study was conducted in the Obstetrics and Gynecology Clinic of “Sfântul Pantelimon” Clinical Emergency Hospital (Bucharest, Romania). Patients underwent two clinical examinations and two transperineal ultrasound measurements, one at a dilatation less than 8 cm and the other at a dilatation closer to full dilatation (above 8 cm). Agreement between clinical and ultrasound measurements was analyzed based on membrane integrity and dilatation level. Results: In total, 239 patients were included, and 478 cervical dilatation measurements were obtained. Only the 7–8 cm subgroup exhibited statistically significant differences in accuracy between patients with intact and ruptured membranes. The Pearson correlation results for membrane status were 0.87 (p-value < 0.001) for intact membranes and 0.91 (p-value < 0.001) for ruptured membranes. Both groups show a strong positive correlation, suggesting that ultrasound and clinical measurements tend to increase simultaneously, regardless of membrane status. Conclusions: Transperineal ultrasound is useful for labor monitoring, but its accuracy decreases significantly in advanced labor, especially beyond 8 cm dilatation and in cases with ruptured membranes.
Full article
(This article belongs to the Special Issue Maternal Diseases and Treatment for Mothers and Children)
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Open AccessArticle
Sex-Specific Associations of Total Bilirubin, ALBI, and PALBI with Lung Cancer Risk: Interactions with Smoking and Alcohol
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Jong Won Shin, Nguyen Thien Minh and Sun Ha Jee
Healthcare 2025, 13(11), 1321; https://doi.org/10.3390/healthcare13111321 - 2 Jun 2025
Abstract
Background: Bilirubin is a potent endogenous antioxidant that plays a key role in regulating oxidative stress and inflammation, both closely linked to lung carcinogenesis. This study reinterprets the ALBI (Albumin–Bilirubin) and PALBI (Platelet–Albumin–Bilirubin) indices as composite markers of antioxidant and inflammatory status and
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Background: Bilirubin is a potent endogenous antioxidant that plays a key role in regulating oxidative stress and inflammation, both closely linked to lung carcinogenesis. This study reinterprets the ALBI (Albumin–Bilirubin) and PALBI (Platelet–Albumin–Bilirubin) indices as composite markers of antioxidant and inflammatory status and evaluates their associations with lung cancer risk by sex, including stratified analyses by major lifestyle factors such as smoking and alcohol use. Methods: This study utilized data from the Korean Cancer Prevention Study-II (KCPS-II) cohort, which included 133,630 participants. During a mean follow-up of 13.5 years, 721 incident lung cancer cases were identified. Serum bilirubin and the ALBI and PALBI indices were analyzed by sex, and quartile-based and trend analyses were conducted. Stratified analyses by smoking and alcohol status (never, former, current, ever) and intensity were performed to assess potential effect modification. Cox proportional hazards regression models were used to estimate HRs and 95% CIs. Results: A 1SD increase in total bilirubin and ALBI was inversely associated with lung cancer risk in men (HR: 0.83, 95% CI: 0.75–0.91; HR: 0.86, 95% CI: 0.79–0.94, respectively), whereas PALBI showed a positive association (HR: 1.17, 95% CI: 1.07–1.28). In contrast, in women, total bilirubin and ALBI showed positive associations (HR: 1.19, 95% CI: 1.00–1.40; HR: 1.19, 95% CI: 1.02–1.40, respectively), while PALBI was inversely associated (HR: 0.82, 95% CI: 0.69–0.97). These associations were significant among men who were smokers (former, current, ever) and men who drank alcohol (current, ever), whereas in women, significance was observed only among never drinkers. Stronger interactions were observed in men who were heavy smokers and low-to-moderate drinkers. Conclusions: Bilirubin and the ALBI and PALBI indices exhibit sex-specific and contrasting associations with lung cancer risk, highlighting the need to consider sex-based physiological differences in cancer risk assessment.
Full article
(This article belongs to the Special Issue Healthcare Disparities in Screening, Detection and Treatment of Cancer)
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Open AccessArticle
Prevalence of Multimorbidity Among School-Aged Children in the Yangzhou District of China
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Jinhan Wang, Qian Zhou, Ying Zhang, Zhuoqi Lai, Weiwei Zhu, Jun Jia, Yongquan Yu and Lihong Yin
Healthcare 2025, 13(11), 1320; https://doi.org/10.3390/healthcare13111320 - 2 Jun 2025
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Background: Health issues among school-age children have emerged as a global public health concern. These conditions often do not occur in isolation but tend to cluster, indicating a widespread issue of multimorbidity among this population. This study examined the prevalence and clustering of
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Background: Health issues among school-age children have emerged as a global public health concern. These conditions often do not occur in isolation but tend to cluster, indicating a widespread issue of multimorbidity among this population. This study examined the prevalence and clustering of multimorbidity among school-aged school students in the Yangzhou district. Methods: A repeated cross-sectional analysis was conducted from 2019 to 2024, including 22,512 students aged 6–18 years. Common diseases, under national key monitoring, including myopia, dental caries, obesity, elevated blood pressure, and growth disorders, were assessed. Multimorbidity patterns were identified using association rule mining (Apriori algorithm) with predefined thresholds (support ≥ 2.0%, confidence ≥ 20.0% and lift > 1). Results: The multimorbidity prevalence among school-age students in the Yangzhou district is 53.95%. The most frequent multimorbidity was found in dental caries and myopia, while the most common ternary pattern was found in obesity, dental caries, and myopia. The following gender differences were observed: boys had a higher multimorbidity prevalence (56.4%) compared to girls (51.2%), with boys more likely to exhibit obesity and dental caries, while girls showed a higher prevalence of myopia-related multimorbidity. By educational stage, primary school students showed a multimorbidity rate of 50.3%, junior high showed a rate of 54.6%, and senior high showed a rate of 57.9%, indicating a rising trend across age groups. Patterns of multimorbidity varied but were interrelated. Conclusions: From 2019 to 2024, the prevalence of multimorbidity among school-aged children in Yangzhou remained relatively high, primarily manifesting as co-occurring myopia and other health issues. Patterns of multimorbidity across gender and educational stage varied but were interrelated.
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Open AccessArticle
Employing the X-Learner Algorithm to Evaluate the Intervention Effects of Physical Activity on Determinants of Elderly Mental Health
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Seungmo Kim and Taeyeon Oh
Healthcare 2025, 13(11), 1319; https://doi.org/10.3390/healthcare13111319 - 2 Jun 2025
Abstract
(1) Objectives: This study aimed to investigate the intervention effects of physical activity and sedentary behavior on the relationship between various influencing factors and mental health outcomes in the elderly. (2) Methods: Complied data collected from a nationwide survey conducted between 2013 and
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(1) Objectives: This study aimed to investigate the intervention effects of physical activity and sedentary behavior on the relationship between various influencing factors and mental health outcomes in the elderly. (2) Methods: Complied data collected from a nationwide survey conducted between 2013 and 2022 were analyzed using the X-Learner algorithm to explore these relationships. (3) Results: The findings indicate that engagement in both high- and moderate-intensity physical activities leads to statistically significant improvements in depression, suicidal ideation, and stress levels compared to non-participation. (4) Conclusions: The study emphasizes the essential role of physical activity in enhancing the mental health of the elderly in South Korea, demonstrating that high- and moderate-intensity exercise can effectively reduce depression, suicidal thoughts, and perceived stress. It also highlights the detrimental effects of prolonged sedentary behavior on the mental health of older adults.
Full article
Open AccessArticle
Job Satisfaction Among Midwives in High-Intervention Birthing Rooms: A Qualitative Phenomenological Study
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Marta Pérez-Castejón, Laura Martínez-Alarcón, Alonso Molina-Rodríguez and Ismael Jiménez-Ruiz
Healthcare 2025, 13(11), 1318; https://doi.org/10.3390/healthcare13111318 - 2 Jun 2025
Abstract
Objectives: To identify the factors influencing the job satisfaction of midwives working in birthing rooms with a medium to high level of obstetric intervention. Methods: A qualitative phenomenological–hermeneutic design based on Heideggerian philosophy was implemented. A study involving 25 participants, midwives, and resident
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Objectives: To identify the factors influencing the job satisfaction of midwives working in birthing rooms with a medium to high level of obstetric intervention. Methods: A qualitative phenomenological–hermeneutic design based on Heideggerian philosophy was implemented. A study involving 25 participants, midwives, and resident nurses (RINs) was conducted. Residents were included to enrich the analysis with their critical perspectives with regard to interventional procedures and exposure to acts of obstetric violence. Convenience sampling was used. Data were collected from four focus groups in three hospitals in the region and one in-depth interview between 30 September 2022 and 23 June 2023. The testimonies were recorded and transcribed verbatim, and data analysis was carried out using an inductive–deductive approach. The triangulation of data and researchers was used to minimise potential bias. Results: The participants highlighted the following key dimensions or areas that contribute to midwives’ job satisfaction in the labour and birthing room: maternal satisfaction, professional competencies, multidisciplinary team, working conditions, and interventions during childbirth. Conclusions: These findings may inform healthcare management strategies to reduce burnout and improve working conditions in maternity care settings.
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(This article belongs to the Section Women's Health Care)
Open AccessArticle
The Efficacy and Safety of a Personalized Protocol Designed to Balance Hemoglobin Levels in Hemodialysis Patients as Led by Nephrology Clinical Nurse Specialists: An Intervention Study
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Ruth Israeli, Gillie Gabay, Sigal Shafran Tikva, Michal Exman, Irit Mor Yosef Levi, Ruth Radiano, Rely Alon, Yulia Lerman and Revital Zelker
Healthcare 2025, 13(11), 1317; https://doi.org/10.3390/healthcare13111317 - 2 Jun 2025
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Background: The ongoing clinical challenge of managing hemoglobin levels in chronic dialysis patients is exacerbated by the gap between growing patient needs and the limited availability of nephrologists. Clinical nurse specialists (CNSs) have been contributing to the successes of modern healthcare systems across
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Background: The ongoing clinical challenge of managing hemoglobin levels in chronic dialysis patients is exacerbated by the gap between growing patient needs and the limited availability of nephrologists. Clinical nurse specialists (CNSs) have been contributing to the successes of modern healthcare systems across Europe, but there is a limited understanding of specific mechanisms by which CNSs can support and improve patient outcomes in renal diseases. Objectives: Responding to previous calls, this intervention study evaluated the role of nephrology CNSs in dialysis patient care. Methods: This intervention study employed erythropoiesis-stimulating agents (ESAs) to investigate whether a personalized, tailored protocol led by nephrology CNSs could improve the hemoglobin balance compared to the conventional standard of care led by nephrologists. Thirty-nine patients who met the inclusion criteria with a preset hemoglobin value between 10.5–12 g/dL completed the study. Results: There were no significant differences in hemoglobin levels between patients managed by nephrologists and those overseen by CNSs. Hemoglobin variability remained unchanged after protocol implementation, while key dialysis quality indicators (e.g., iron saturation, urea reduction) remained within safety limits. Notably, ESA-related medical adjustments were significantly reduced, requiring half as many modifications over 12 study points. Conclusions: A CNS-led personalized protocol effectively maintained dialysis patient parameters within established safety thresholds. These findings reinforce the critical role of CNSs in enhancing the efficiency, effectiveness, and safety of hemoglobin management in this high-risk population. Policy implications are discussed.
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A Diagnosis or a Trap: Exploring the Psychosocial and Ethical Impacts of Autosomal Dominant Polycystic Kidney Disease Diagnosis
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Mert Türk and Cuma Bülent Gül
Healthcare 2025, 13(11), 1316; https://doi.org/10.3390/healthcare13111316 - 2 Jun 2025
Abstract
Objective: This study aimed to explore the emotional, social, and ethical dimensions of early or presymptomatic diagnosis in individuals with Autosomal Dominant Polycystic Kidney Disease (ADPKD). Methods: A total of 118 participants diagnosed with ADPKD were recruited from a tertiary nephrology
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Objective: This study aimed to explore the emotional, social, and ethical dimensions of early or presymptomatic diagnosis in individuals with Autosomal Dominant Polycystic Kidney Disease (ADPKD). Methods: A total of 118 participants diagnosed with ADPKD were recruited from a tertiary nephrology center in Türkiye. Data were collected via a 22-item structured and open-ended questionnaire. Chi-square and non-parametric statistical tests were used to assess associations between awareness, attitudes, and demographic variables. Results: Although only 10% of participants reported direct disadvantages from their diagnosis, such as difficulties in employment, insurance, or relationships, many voiced concerns about stigma and long-term uncertainties. Genetic awareness was significantly associated with increased likelihood of recommending family screening (p = 0.022), and higher educational attainment correlated with greater disease knowledge (p < 0.01). Despite emotional burden, 71.2% of participants reported adopting lifestyle modifications, and 79.6% expressed willingness to screen their children, though often with ethical hesitation. Conclusions: While early diagnosis of ADPKD may offer clinical benefits, it also introduces complex psychosocial and ethical dilemmas. These findings highlight the importance of integrating patient-centered counseling, clear communication strategies, and supportive policies to ensure informed decision making and mitigate potential harms.
Full article
(This article belongs to the Section Health Assessments)
Open AccessArticle
Serbian Healthcare Students’ Perceptions of and Readiness to Care for People with Intellectual Disabilities: A Cross-Sectional Study
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Dragana Milutinović, Dragana Simin, Katarzyna Ćwirynkało, Monika Parchomiuk, Zdzisław Kazanowski, Agnieszka Żyta and Špela Golubović
Healthcare 2025, 13(11), 1315; https://doi.org/10.3390/healthcare13111315 - 1 Jun 2025
Abstract
Background/Objectives: The perspective from which future healthcare professionals view intellectual disabilities affects how people with intellectual disabilities (PWIDs) are perceived and informs care policies and practices. This study aimed to assess healthcare science students’ perceptions of the rights of PWIDs, the students’ social
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Background/Objectives: The perspective from which future healthcare professionals view intellectual disabilities affects how people with intellectual disabilities (PWIDs) are perceived and informs care policies and practices. This study aimed to assess healthcare science students’ perceptions of the rights of PWIDs, the students’ social distances toward PWIDs in healthcare, and the students’ competence in providing care, exploring differences by study programs and demographics and examining correlations between them. Methods: The convenience sample comprised 221 medical and 120 nursing students. A general questionnaire for obtaining sociodemographic data, the scale of beliefs about the rights of PWIDs in healthcare (BS), the scale of social distance toward PWIDs (SD), and the “self-assessment of competency (CS) to provide care for PWIDs” scale were used as students’ report measures. Results: The students’ scores on the BS, SD, and CS scales revealed that they generally recognized the rights of PWIDs in healthcare but expressed a moderate level of social distance and limited self-perceived competence in providing care. Medical students demonstrated slightly more progressive beliefs regarding the rights of PWIDs than nursing students (r = 0.12), while nursing students reported higher self-assessed competence levels (r = 0.19). A small gender-related difference was observed in social distance, with female students showing more favorable attitudes. Significant positive correlations were found between beliefs about the rights of PWIDs and social distance (p = 0.435; p < 0.01) and between social distance and self-assessed competence (p = 0.234, p < 0.01), suggesting that students who felt more competent tended to report less social distance. Conclusions: This study provides new data for understanding healthcare science students’ perceptions and readiness to care for PWIDs in the healthcare sector in Serbia. Namely, our students had moderately positive beliefs and a moderate social distance toward PWIDs and reported low competence in providing care.
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Open AccessArticle
Pilot Study About the Importance of the Active Role of Roma Students: Improving the Health of Bulgarian Children from the Roma Minority Group Through Nutrition and Probiotics
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Bozhidarka Radoslavova Hadzhieva, Marin Kostadinov Baltov, Daniela Ivova Taneva, Atanas Denev Luizov, Milen Ventsislavov Dimitrov and Valentina Boyanova Petkova-Dimitrova
Healthcare 2025, 13(11), 1314; https://doi.org/10.3390/healthcare13111314 - 1 Jun 2025
Abstract
Background/Objective: The priority task of each country is to ensure the protection of and improvement in its people’s health. One of the key aspects of health is related to food culture, consuming foods that ensure growth and normal development in a person and
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Background/Objective: The priority task of each country is to ensure the protection of and improvement in its people’s health. One of the key aspects of health is related to food culture, consuming foods that ensure growth and normal development in a person and also prevent diseases. The consumption of foods that contain essential nutrients and functional foods, which include those containing probiotics, is the basis of a healthy diet. Methods: A structured anonymous interview was conducted with 90 parents from the Roma minority group to assess the nutritional culture of children from these families. The knowledge of Roma parents about probiotics, as well as their attitudes to apply them to their children, was examined. The survey was based on a questionnaire that was distributed among the respondents, Roma students, under the guidance of a mentor. Roma students study health specialties and are also participants in a Scholarship Programme. Results: We have established that the daily diet of children from this minority group consists of foods containing hydrogenated fats and sugar, which was indicated by 53.3% of respondents, and only 28.9% of respondents noted that their children consume fresh fruit every day. We have established that less than half of the children (35.6%) consume yoghurt daily as a source of valuable probiotics. We applied a nonparametric Kruskal–Wallis test and found statistically significant differences in the respondents’ knowledge of probiotics (χ2 = 16.186, p = 0.001): those receiving secondary specialized education were better informed, but education has not affected their knowledge of the health benefits of probiotics (χ2 = 5.462, p = 0.141). Children from minority groups tend to eat unhealthy foods. Conclusions: The role of Roma students studying health specialties as participants in the Scholarship Programme is to assist parents in forming a nutritional culture in their children. Roma students, due to their ethnic and cultural proximity and potential to be health professionals, contribute to sustainable health improvements among the Roma community as a whole.
Full article
(This article belongs to the Section Healthcare Quality and Patient Safety)
Open AccessArticle
Cultivating Self-Compassion to Improve Social Workers’ Professional Quality of Life in Primary Healthcare
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Polyxeni Mangoulia, Nektarios Tsokas, Evmorfia Koukia, Foteini Malli, Evdokia Missouridou, Chrysoula Dafogianni, Maria Kyranou and Evangelos C. Fradelos
Healthcare 2025, 13(11), 1313; https://doi.org/10.3390/healthcare13111313 - 1 Jun 2025
Abstract
Background/Objectives: Although self-compassion practice has been increasingly popular in the literature in recent years, the area of social work knows very little about it. To be self-compassionate is to treat oneself with love and respect. The aim of this study was to investigate
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Background/Objectives: Although self-compassion practice has been increasingly popular in the literature in recent years, the area of social work knows very little about it. To be self-compassionate is to treat oneself with love and respect. The aim of this study was to investigate the relationship between social workers’ professional quality of life (compassion satisfaction, secondary traumatic stress, and burnout) and self-compassion. Methods: This cross-sectional descriptive study consisted of 177 social workers in primary healthcare (PHC) in Greece. The Self-Compassion Scale (SCS), the Professional Quality of Life Scale (ProQOL-5), and the participants’ personal, demographic, and professional information were all included in an electronic questionnaire that they had to fill out. Results: This study’s findings show that, although 43.2% of participants exhibited high levels of self-compassion, burnout and secondary traumatic stress were at low-to-moderate levels among the participants. Apart from the secondary traumatic stress and humanity dimensions, both the dimensions and the overall self-compassion scale showed a strong relationship with the aspects of professional quality of life. Burnout and secondary traumatic stress were significantly reduced, and compassion fulfilment were increased in environments that were supportive, socially supportive, work-related, hobby-filled, and religious. Conclusions: The integration of self-compassion into a comprehensive and methodical approach to employee wellness has the potential to enhance the physical and mental health of workers in healthcare environments.
Full article
(This article belongs to the Special Issue Health Risks in the Work Environment: Assessment and Improvement)
Open AccessSystematic Review
Effects of Exercise on Balance Function in People with Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Xingyue Wang, Zhuying Chen, Yin Liang, Hao Su, Tongling Wang, Yuanyuan Lv and Laikang Yu
Healthcare 2025, 13(11), 1312; https://doi.org/10.3390/healthcare13111312 - 1 Jun 2025
Abstract
Objectives: This study sought to evaluate the impact of exercise on balance function in individuals with knee osteoarthritis (KOA) and determine the most effective exercise protocols for balance enhancement. Methods: A systematic literature search was performed across five major electronic databases
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Objectives: This study sought to evaluate the impact of exercise on balance function in individuals with knee osteoarthritis (KOA) and determine the most effective exercise protocols for balance enhancement. Methods: A systematic literature search was performed across five major electronic databases (PubMed, Web of Science, EBSCO, Cochrane, Scopus) until 13 September 2024. Statistical synthesis was conducted using weighted mean differences (WMDs) with 95% confidence intervals under a random-effects model. Results: Analysis of 22 studies revealed significant improvements in balance function following exercise interventions. Outcomes measured by the Berg balance scale (BBS, WMD, 2.65, p < 0.00001) and timed up and go test (TUG, WMD, −0.59, p < 0.0001) demonstrated clinically relevant enhancements in KOA populations. Subgroup analyses revealed that multicomponent training (WMD, 6.25, p = 0.003), interventions lasting ≥ 8 weeks (WMD, 4.92, p = 0.002), sessions ≥ 60 min (WMD, 7.42, p = 0.002), frequency ≥ 3 times per week (WMD, 2.83, p = 0.0005), weekly time ≥ 180 min per week (WMD, 7.42, p = 0.002), and patients < 60 years (WMD, 6.71, p = 0.002) were associated with greater improvement in BBS. Conclusions: Exercise significantly improved balance function in KOA patients, with multicomponent training emerging as the most effective intervention. Based on the findings of this meta-analysis, clinicians should recommend that KOA patients engage in exercise at least three times per week, with each session lasting at least 60 min, to achieve a total weekly time of 180 min. These recommendations are particularly relevant for patients less than 60 years, who may experience greater benefits from exercise interventions.
Full article
(This article belongs to the Special Issue Exercise Interventions and Testing for Effective Health Promotion)
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Open AccessArticle
Association Between Sarcopenia and Buttock Pain Among Middle-Aged and Older Chinese People: Evidence from the China Health and Retirement Longitudinal Study
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Jian Jin, Huibin Long, Huiwen Zhang, Chuanhui Zhang and Jianhao Lin
Healthcare 2025, 13(11), 1311; https://doi.org/10.3390/healthcare13111311 - 31 May 2025
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Background: Sarcopenia and buttock pain are highly prevalent in older adults and exert profound negative effects on quality of life. Little is known about the association between sarcopenia and buttock pain. Methods: This study performed cross-sectional and longitudinal analyses based on prospective cohort
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Background: Sarcopenia and buttock pain are highly prevalent in older adults and exert profound negative effects on quality of life. Little is known about the association between sarcopenia and buttock pain. Methods: This study performed cross-sectional and longitudinal analyses based on prospective cohort study data from the 2015 and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS). A total of 12,884 community-dwelling adults aged ≥45 years were included in the cross-sectional analysis, and 10,511 of these participants, free of buttock pain at baseline, were further investigated to assess incident buttock pain. Sarcopenia status was categorized as non-sarcopenia, possible sarcopenia, and sarcopenia according to the 2019 Asian Working Group for Sarcopenia and the 2021 Chinese consensus criteria. Logistic regression models adjusted for sociodemographic and health-related covariates were performed to estimate associations between sarcopenia status and buttock pain. Results: After adjusting for covariates, possible sarcopenia, but not sarcopenia, was associated with prevalent buttock pain (OR 1.23, 95% CI 1.03–1.48). After 5 years of follow-up, participants with sarcopenia were more likely to develop incident buttock pain (OR 1.37, 95% CI 1.03–1.81). Among sarcopenia components, poor physical performance was linked to prevalent pain (OR 1.25, 95% CI 1.05–1.50) and low handgrip strength predicted incident pain in males (OR 1.31, 95% CI 1.07–1.60). Appendicular muscle mass was not independently associated with either prevalent or incident buttock pain. Conclusions: In middle-aged and older Chinese adults, sarcopenia is an independent risk factor for incident buttock pain. Early screening and interventions of sarcopenia may help to mitigate the burden of buttock pain and its associated disability.
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Open AccessArticle
Comparison of Frontal Sinus Dimensions with Different Skeletal Classes and Vertical Patterns: A Retrospective Study
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Alessandro Nota, Iuliia Kashtelianska, Francesco Manfredi Monticciolo, Laura Pittari, Simona Tecco and Attilio Castaldo
Healthcare 2025, 13(11), 1310; https://doi.org/10.3390/healthcare13111310 - 31 May 2025
Abstract
Background: The aim of this work is to compare the size of the frontal sinus and the different skeletal classes and divergence patterns of the subjects. Methods: This study retrospectively includes lateral radiographs performed on a total of 200 adults (78 M, 122
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Background: The aim of this work is to compare the size of the frontal sinus and the different skeletal classes and divergence patterns of the subjects. Methods: This study retrospectively includes lateral radiographs performed on a total of 200 adults (78 M, 122 F; mean age 29.2 ± 8.0 years). Subject inclusion criteria were an age of 18–45 years, presence of both frontal sinuses, and good general health with no hormonal system disorders that may affect the growth and pneumatization of the frontal sinuses. Four different parameters of the frontal sinus were evaluated: length, width, perimeter, and area. In order to calculate the variables inherent to the sagittal and vertical skeletal pattern, two independent nominal variables were considered: skeletal class (ANB°) and mandibular divergence (SN^MP°). Results: The statistical analysis showed that there is a statistically significant difference between the frontal sinus dimension and the three skeletal classes. Subjects in group 3 presented significantly higher mean dimensional values. In the analysis of sinus size variables with skeletal divergence, significant results were found for the width value, which resulted in higher average values in group c. Conclusions: The present study shows a statistically significant difference in frontal sinus size among different skeletal classes and divergence patterns. This result suggests that, in future studies, it should be analyzed whether the dimensional analysis of the frontal sinus could be associated with skeletal class III malocclusion.
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(This article belongs to the Special Issue Therapeutic Advances in Craniofacial Disorders and Orthodontics in Growing and Adult Population)
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Open AccessArticle
Eliciting Distributive Preferences in Health Care Resource Allocation: A Person Trade-Off Study
by
Nan Fang, Chang Su and Jing Wu
Healthcare 2025, 13(11), 1309; https://doi.org/10.3390/healthcare13111309 - 30 May 2025
Abstract
Background/Objectives: While a preference for an equal distribution of health gains is common, there are situations where individuals may opt to concentrate health gains for a select few. This study investigates how distributive preferences, defined as societal valuations of alternative allocations of fixed
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Background/Objectives: While a preference for an equal distribution of health gains is common, there are situations where individuals may opt to concentrate health gains for a select few. This study investigates how distributive preferences, defined as societal valuations of alternative allocations of fixed total health benefits, vary with the magnitude of individual health gains. Methods: Using the person trade-off (PTO) method, we conducted an online survey with a nationally representative sample of Chinese adults (N = 500). The respondents evaluated five allocation programs differing in both individual health gain magnitude and number of beneficiaries. Distributive preferences are classified into five distinct types: diffusion, concentration, maximization, extreme egalitarianism and extreme inequality seeking. Threshold regression analysis identified critical transition points in preference patterns. Results: Non-maximizing tendencies were dominant (79% of the respondents). The health gain threshold was estimated to be 4.6 years (95% CI: [4.28, 4.85]): below this threshold, respondents tend to allocate smaller benefits to more patients (diffusion preference); above the threshold, people are inclined to allocate larger benefits to fewer patients (concentration preference). The income level and self-reported health status of the participants were identified as potential factors influencing distributive preferences. Conclusions: This study provides the first quantitative evidence from China that distributive preferences exhibit a non-linear shift based on the magnitude of health benefits. The identified 4.6-year threshold provides policymakers with an empirically based instrument to strike a balance between efficiency and the reduction in inequality in resource allocation. These findings advocate for incorporating social value weights into health technology assessments, especially for interventions that offer substantial individual benefits.
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(This article belongs to the Special Issue Healthcare Economics, Management, and Innovation for Health Systems)
Open AccessReview
Hypersensitivity Reactions to Iodinated Contrast Media: A Narrative Review of Current Evidence and Clinical Challenges
by
Francesca Losa, Giovanni Paoletti, Linda Borgonovo, Federica Buta, Stefania Merli, Serena Nannipieri, Marta Piantanida, Carlo Maria Rossi, Giada Sambugaro, Mona-Rita Yacoub, Vincenzo Patella, Giorgio Walter Canonica, Enrico Heffler and Maria Teresa Costantino
Healthcare 2025, 13(11), 1308; https://doi.org/10.3390/healthcare13111308 - 30 May 2025
Abstract
Background/Objectives: Hypersensitivity reactions (HSRs) to iodinated contrast media (ICM), both immediate and non-immediate, pose clinical challenges despite using low-osmolality agents. This review aims to summarize current diagnostic approaches, cross-reactivity patterns, and the debated role of premedication. Methods: A narrative review was conducted using
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Background/Objectives: Hypersensitivity reactions (HSRs) to iodinated contrast media (ICM), both immediate and non-immediate, pose clinical challenges despite using low-osmolality agents. This review aims to summarize current diagnostic approaches, cross-reactivity patterns, and the debated role of premedication. Methods: A narrative review was conducted using PubMed (2014–2024), selecting studies on ICM-related HSRs, focusing on skin and in vitro testing, drug provocation tests (DPTs), cross-reactivity, and premedication. Results: Skin tests show limited sensitivity, especially for non-immediate reactions. Cross-reactivity among ICMs is common but unpredictable. DPTs are the diagnostic gold standard but lack standardized protocols. Premedication is frequently used, though its efficacy remains uncertain. Conclusions: The management of ICM hypersensitivity is limited by diagnostic gaps and insufficient evidence on premedication. Standardized protocols and prospective studies are needed to improve patient safety and guide clinical decisions.
Full article
(This article belongs to the Special Issue Allergy and Immunology in Healthcare)
Open AccessSystematic Review
Objective and Subjective Factors Influencing Breast Reconstruction Decision-Making After Breast Cancer Surgery: A Systematic Review
by
Valentini Bochtsou, Eleni I. Effraimidou, Maria Samakouri, Spyridon Plakias and Aikaterini Arvaniti
Healthcare 2025, 13(11), 1307; https://doi.org/10.3390/healthcare13111307 - 30 May 2025
Abstract
Background/Objectives:Breast reconstruction (BR) following mastectomy plays a critical role in post-cancer care by offering both physical and psychological benefits. Despite advancements in techniques and shared decision-making (SDM), BR uptake remains inconsistent. This systematic review aims to synthesize evidence on objective (medical and
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Background/Objectives:Breast reconstruction (BR) following mastectomy plays a critical role in post-cancer care by offering both physical and psychological benefits. Despite advancements in techniques and shared decision-making (SDM), BR uptake remains inconsistent. This systematic review aims to synthesize evidence on objective (medical and socioeconomic) and subjective (psychological and personal) factors influencing BR decision-making among women undergoing mastectomy for breast cancer. Methods: A systematic search was conducted across PubMed, ScienceDirect, OVID, and Google Scholar, identifying peer-reviewed studies published between January 2013 and 25 July 2024. Eligible studies examined determinants of BR decisions in women undergoing therapeutic mastectomy, excluding perspectives of non-patient stakeholders and post-decision outcomes. The risk of bias and study quality were assessed using the Quality Appraisal for Diverse Studies (QuADS) tool. This review was registered in PROSPERO (CRD42023456198) and followed PRISMA guidelines. Results: Twenty-seven studies comprising 994,528 participants across 16 countries met the inclusion criteria. The objective factors included age, comorbidities, insurance coverage, physician recommendations, and healthcare access. The subjective factors encompassed body image concerns, self-esteem, fear of recurrence, and emotional readiness. Younger age, private insurance, and active physician counseling were associated with increased BR uptake, while older age, lack of information, and financial or logistical barriers reduced uptake. Regional disparities were noted across healthcare systems. Conclusions: BR decisions are influenced by complex, interrelated clinical, psychological, and systemic factors. Integrating SDM tools, enhancing patient education, and addressing healthcare inequities are essential for supporting informed and equitable BR decision-making. Future research should prioritize longitudinal studies and policy interventions to improve access to and patient satisfaction with BR outcomes.
Full article
(This article belongs to the Section Women's Health Care)
Open AccessArticle
Selected Moral Issues and the Stress Experienced by Paediatric Nurses
by
Anna Stefanowicz-Bielska, Magdalena Słomion, Agnieszka Olińska, Małgorzata Rąpała, Julia Behling and Joanna Stefanowicz
Healthcare 2025, 13(11), 1306; https://doi.org/10.3390/healthcare13111306 - 30 May 2025
Abstract
Background/Objectives: The high sensitivity of paediatric nurses directly influences the quality of nursing care provided to patients. The purpose of this study is to present the most frequent issues faced by paediatric nurses in their everyday work and their responses to difficult
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Background/Objectives: The high sensitivity of paediatric nurses directly influences the quality of nursing care provided to patients. The purpose of this study is to present the most frequent issues faced by paediatric nurses in their everyday work and their responses to difficult situations at work, define the actions applied when a difficult situation occurs, and assess the level of stress and other factors influencing the level of stress experienced by paediatric nurses. Methods: This study was conducted using an original survey form and a standardised psychological questionnaire based on the Perceived Stress Scale (PSS-10) for paediatric nurses. Results: The study involved 416 paediatric nurses and indicated a medium level of stress among the nurses. The median stress level, calculated as the sum of answers to questions based on the PSS-10, was 18 (16.0 ÷ 20.0), and the mean was 17.9 (min–max = 1–30). The median Sten score was 6 (5.0 ÷ 7.0), and the mean Sten score was 5.94 (min–max = 2–9). Nurses aged 21–30 years, who live in a city, have a Bachelor of Science in Nursing or a Master of Science in Nursing, and work ≥ 61 h a week and 161–250 h a month experience a higher level of stress. Factors such as choosing which child to help first, spending a great deal of time filling out medical documentation, obtaining a sick child’s consent to perform nursing procedures which the child does not understand, involving the minor in decision-making, impolite or offensive behaviour from a sick child or their parents, ineffective nursing and treatment methods, providing care against the opinion/views of a sick child or their parents, difficulties in or a lack of understanding of the situation of a sick child and their family, performing nursing procedures that can cause the child pain, and the inability to fulfil a sick child’s request increase the level of stress experienced by paediatric nurses. When a difficult situation occurs at work occurs, the nurses usually meet and talk about the situation with someone close (72.4%) or engage in other activities to avoid thinking about the situation (66.6%). They consult a psychologist/psychotherapist very rarely (9.6%) and a psychiatrist extremely rarely (4.6%). Conclusions: Polish paediatric nurses were found to experience a medium level of stress. Since paediatric nurses are exposed to stress, providing them with psychological care is important. The level of perceived stress is dependent on the nurse’s age, place of residence, and education, as well as weekly and monthly working durations. Paediatric nurses experience many difficult situations in their everyday work that influence their stress levels. Management should pay special attention to difficult workplace situations faced by paediatric nurses and implement regular actions to reduce the levels of stress experienced.
Full article
Open AccessReview
Unraveling Rising Mortality: Statistical Insights from Japan and International Comparisons
by
Hiroshi Kusunoki
Healthcare 2025, 13(11), 1305; https://doi.org/10.3390/healthcare13111305 - 30 May 2025
Abstract
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Since the onset of the COVID-19 pandemic, Japan has experienced a significant rise in mortality, with excess deaths surpassing historical projections. Statistical data indicate a sharp increase in mortality rates from 2021 onward, attributed to COVID-19, aging demographics, cardiovascular diseases, and malignancies. Preliminary
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Since the onset of the COVID-19 pandemic, Japan has experienced a significant rise in mortality, with excess deaths surpassing historical projections. Statistical data indicate a sharp increase in mortality rates from 2021 onward, attributed to COVID-19, aging demographics, cardiovascular diseases, and malignancies. Preliminary 2024 data suggest continued excess mortality, fueling public debate. This review analyzes national and municipal mortality trends using official Japanese statistics and comparative data from South Korea, the U.S., and the EU. Findings reveal a sharp mortality rise post-2021 in Japan and South Korea, while Western nations experienced peak deaths in 2020, followed by declines. The review explores contributing factors, including potential vaccine-related adverse effects, declining healthcare access, pandemic-induced stress, and demographic shifts. Notably, older adults’ reluctance to seek medical care led to delayed diagnoses, treatment interruptions, and preventable deaths. Although some argue that declining COVID-19 vaccination rates in 2023 may have contributed to rising mortality in 2024, available data suggest a multifactorial causation. Japan’s rapidly aging population, coupled with increasing mortality and declining birth rates, presents profound social and economic challenges. A nuanced approach, avoiding simplistic causal claims, is crucial for understanding these trends. This review highlights the need for a sustainable societal framework to address demographic shifts and improve healthcare resilience. Future pandemic strategies must balance infection control measures with mitigating unintended health consequences to ensure a more adaptive and effective public health response.
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