Healthcare

15 pages, 813 KB

Open AccessArticle

Posttraumatic Stress Disorder Symptoms and Alcohol Use Among Korean Firefighters: The Roles of Coping Motives for Drinking and Family Support

by Nayoon Lee and Kyoung-eun Lee

Healthcare 2026, 14(4), 421; https://doi.org/10.3390/healthcare14040421 (registering DOI) - 7 Feb 2026

Abstract

Background/Objectives: This study aimed to analyze the effects of coping motives for drinking, sleep quality, and family support on the relationship between PTSD symptoms and alcohol use among Korean firefighters. Methods: Data from 600 firefighters in a specific region of Korea [...] Read more.

Background/Objectives: This study aimed to analyze the effects of coping motives for drinking, sleep quality, and family support on the relationship between PTSD symptoms and alcohol use among Korean firefighters. Methods: Data from 600 firefighters in a specific region of Korea were collected. Descriptive statistics, correlation coefficients, and bootstrapping were used to analyze the data and PROCESS macro to verify the mediating effect of coping motives for drinking and sleep quality, as well as the moderating effect of family support. PTSD symptoms were measured using the PCL-5 (range = 0–80; probable PTSD ≥ 33; total score: 33.2 ± 15.2) and alcohol use was measured using the AUDIT-K (range = 0–40; risky drinking ≥ 8; total score: 6.8 ± 6.2). Results: PTSD symptom severity was significantly associated with alcohol use, and coping motives for drinking showed a significant indirect association in the relationship between PTSD symptoms and alcohol use. However, sleep quality did not show a significant indirect association, and family support significantly moderated the association between PTSD symptom severity and alcohol use. Conclusions: Findings underscore the importance of addressing coping-motivated drinking and strengthening family support when managing alcohol problems associated with PTSD symptoms in firefighters. Education on adaptive stress-coping alternatives and family-centered support may help prevent alcohol misuse. Full article

(This article belongs to the Section Mental Health and Psychosocial Well-being)

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15 pages, 1123 KB

Open AccessArticle

Psychological Aspects and Implications of Food Addiction and Glucose Control in Type 2 Diabetes: A Pilot Mixed-Methods Study

by David J. Johnson, Laura A. Buchanan, Erin M. Saner, Matthew W. Calkins and Julienne K. Kirk

Healthcare 2026, 14(4), 420; https://doi.org/10.3390/healthcare14040420 (registering DOI) - 7 Feb 2026

Abstract

Background/Objectives: Type 2 diabetes (T2D) affects more than 38 million Americans and remains a leading public health challenge. Behavioral self-management is central to glycemic control but is often undermined by dysregulated and addictive-like eating behaviors. Continuous glucose monitoring (CGM) offers immediate feedback [...] Read more.

Background/Objectives: Type 2 diabetes (T2D) affects more than 38 million Americans and remains a leading public health challenge. Behavioral self-management is central to glycemic control but is often undermined by dysregulated and addictive-like eating behaviors. Continuous glucose monitoring (CGM) offers immediate feedback that may strengthen self-regulation, yet the psychological processes linking CGM use, food addiction (FA), and behavior change are poorly understood. This secondary mixed-methods study examined how CGM-supported group medical visits (GMVs) influence glycemic outcomes and FA symptoms in adults with diabetes. Methods: Adults with T2D participated in a 14-week GMV program integrating CGM review with education on nutrition, physical activity, sleep, stress, and intermittent fasting. Thirteen participants had paired CGM summaries and psychosocial data. Quantitative outcomes included mean glucose, glycemic variability, time-in-range (TIR), and symptoms of food addiction using the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0). Qualitative data came from open-ended surveys analyzed using reflexive thematic analysis. Integration followed a convergent design, merging individual change trajectories with thematic interpretations and case vignettes. Results: Mean glucose decreased by 21 mg/dL and TIR improved by 9 percentage points. Among six participants with baseline FA symptoms, all showed reductions in self-reported mYFAS 2.0 symptom counts. Four moved from mild to no symptoms, one from moderate to no symptoms, and one from severe to no symptoms. Across the full sample, the mean change was a reduction of 1.2 in the mYFAS 2.0 symptom counts per participant. Thematic analysis identified four interrelated psychological mechanisms: enhanced awareness of food–glucose relationships, increased accountability through shared tracking, motivation via gamified self-monitoring, and relief from cognitive burden associated with dietary uncertainty. Conclusions: Integrating CGM feedback into GMVs was associated with improvements in glycemic metrics and reductions in addictive-like eating symptoms in this pilot sample. These findings position CGM as a behavioral intervention tool that complements its traditional monitoring role and highlight the value of combining real-time biofeedback with group-based support in diabetes care. Full article

(This article belongs to the Special Issue Psychosocial Aspects in Chronic Conditions: Implications for Clinical Practice and Healthcare Delivery)

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16 pages, 1080 KB

Open AccessArticle

Exploring Coaches’ Strategies for Enhancing Athlete Happiness: A Q-Method Study of Subjective Psychosocial Perspectives

by Yavuz Öntürk, Vlad Adrian Geantă, Ahmet Yavuz Karafil, Esin Yilmaz, Vasile Emil Ursu and Borko Katanić

Healthcare 2026, 14(4), 419; https://doi.org/10.3390/healthcare14040419 (registering DOI) - 7 Feb 2026

Abstract

Background/Objectives: Coaches substantially influence athletes’ psychological well-being, yet the specific strategies they use to enhance happiness remain insufficiently understood. Given the established contribution of happiness to motivation, resilience, and long-term sport engagement, identifying these strategies and the perceptual patterns underlying them is [...] Read more.

Background/Objectives: Coaches substantially influence athletes’ psychological well-being, yet the specific strategies they use to enhance happiness remain insufficiently understood. Given the established contribution of happiness to motivation, resilience, and long-term sport engagement, identifying these strategies and the perceptual patterns underlying them is essential. This study examined coaches’ subjective viewpoints regarding happiness-oriented strategies and identified the psychosocial orientations that structure these perspectives. Methods: Q methodology was applied using a 30-item Q set developed from interviews and expert review. Thirty professional coaches (≥5 years of experience) ranked the items according to perceived importance. By-person factor analysis and z-score interpretation were used to derive shared viewpoints. Results: Two coherent factors emerged. Factor 1 (59% variance) reflected a group-oriented psychosocial support approach, emphasizing team cohesion, positive feedback, social support, and mental resilience. Factor 2 (9% variance) represented an individual-centered, empathy-driven orientation, characterized by value affirmation, personalized communication, and emotional sensitivity. Distinct z-score patterns underscored clear contrasts between collective and individualized strategies. Conclusions: Coaches promote athlete happiness through two complementary orientations: collective psychosocial support and individualized psychological sensitivity. These findings extend self-determination theory and positive psychology by demonstrating how relatedness, competence, and individualized care are operationalized within coaching practice. The results offer practical guidance for integrating well-being into coach education and organizational policies. Full article

(This article belongs to the Special Issue Psychology of Health, Sport, and Exercise)

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27 pages, 994 KB

Open AccessSystematic Review

Analysis of the Multifactorial Risks of Postpartum Urinary Incontinence: A Systematic Review

by Nikoleta Tsinisizeli, Anastasia Bothou, Kleanthi Gourounti, Anna Deltsidou, Aikaterini Lykeridou and Giannoula Kyrkou

Healthcare 2026, 14(3), 418; https://doi.org/10.3390/healthcare14030418 - 6 Feb 2026

Abstract

Introduction: Urinary incontinence (UI) is one of the most common pelvic floor disorders after childbirth and depends on hormonal changes, anatomical damage that occurs after childbirth, muscle and connective tissue weakness, fascia and nerves. UI is distinguished into three subtypes, including stress [...] Read more.

Introduction: Urinary incontinence (UI) is one of the most common pelvic floor disorders after childbirth and depends on hormonal changes, anatomical damage that occurs after childbirth, muscle and connective tissue weakness, fascia and nerves. UI is distinguished into three subtypes, including stress urinary incontinence (SUI), urgent urinary incontinence (UUI) and mixed urinary incontinence (MUI). Aim: The purpose of this review is to collect and summarize the results of studies related to the risk factors of urinary incontinence, to disseminate this information to scientists so that this major issue can be prevented, identified and managed. Methodology: This review followed the methodology of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PECO eligibility criteria were used. We included studies published up to 2025 and not before 2019. The review was limited to studies published within the last six years in order to reflect contemporary diagnostic criteria, assessment tools and current postpartum care practices related to urinary incontinence. We searched PubMed, Google Scholar and Scopus for studies concerning the relationship between risk factors and postpartum UI. Results: A total of 1321 citations were identified. Following our exclusion criteria, 36 papers were selected to identify the risk factors for UI. All the research focused on the associated factors of any type of urinary incontinence. Vaginal and instrumental delivery, obesity, maternal age and the neonate’s birth weight were the main risk factors. The multiparity and incontinence symptoms before and during pregnancy were also strong risk factors. Heterogeneity across studies in assessment tools, in outcome measures and timing of postpartum assessment are some of the limitations of the study. Restriction to English-language publications and the absence of protocol registration were some of the additional limitations of the study. Conclusions: This problem affects the inclusion of women in society, the family, limits social activities and even their ability to work. Detection of the type of urinary incontinence by healthcare professionals, lifestyle modifications, monitoring women’s body weight and encouraging them to follow a program of pelvic floor muscle exercises should be a priority for professionals. The strategy of developing prognostic models in the coming years will be the only way to ensure the early identification and follow-up of women at high risk for urinary disorders. Full article

(This article belongs to the Special Issue Contemporary Perspectives in Women's and Maternal Health: Systems, Prevention, Nutrition and Midwifery-Led Innovation)

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17 pages, 441 KB

Open AccessReview

Nurses’ Experience in Providing End-of-Life Care in Intensive Care Unit: A Scoping Review

by Y. Dodi Setyawan, Indah Ayu Susanti, Cecep Eli Kosasih and Hartiah Haroen

Healthcare 2026, 14(3), 417; https://doi.org/10.3390/healthcare14030417 - 6 Feb 2026

Abstract

Background: Most ICU patients are in the terminal phase and require complex palliative care support and End-of-Life Care (EoLC). Nurses play a central role in symptom management, emotional support, and shared decision-making. However, evidence on nurses’ experiences in providing EoLC remains fragmented and [...] Read more.

Background: Most ICU patients are in the terminal phase and require complex palliative care support and End-of-Life Care (EoLC). Nurses play a central role in symptom management, emotional support, and shared decision-making. However, evidence on nurses’ experiences in providing EoLC remains fragmented and lacks a comprehensive synthesis. Objective: This review aimed to identify, map, and synthesize global evidence on ICU nurses’ experiences in delivering EoLC, including challenges, coping strategies, and implications for critical care nursing practice. Methods: A scoping review was conducted following Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Systematic searches were performed in the PubMed, Scopus, and EBSCOhost databases for studies published between 2015 and 2025. Thematic analysis was applied to the qualitative studies to identify patterns and key issues. Results: Twelve qualitative studies conducted in diverse countries met the inclusion criteria. Five major themes emerged: (1) emotional and moral challenges; (2) cultural and spiritual influences; (3) communication and interprofessional collaboration; (4) professional development and organizational support; and (5) resource constraints. These findings indicate that ICU nurses’ experiences with EoLC are multidimensional and shaped by the cultural context and institutional policies. Conclusions: ICU nurses’ experiences with EoLC reflect complex ethical, emotional, and organizational dimensions. Improving care quality requires structured training, organizational support, and culturally sensitive policies to strengthen critical care nursing practice. Full article

(This article belongs to the Special Issue Holistic Assessment in Palliative Care)

25 pages, 524 KB

Open AccessArticle

Where Is the Client in Client-Centered Care? Centering the Experiences of Integrated Care Among Black Women in Public Health Settings

by Annalise J. Tolley, Victoria C. Scott, Jennifer Langhinrichsen-Rohling, Alicia A. Dahl, Ebony Rao and Jae Hoon Lim

Healthcare 2026, 14(3), 416; https://doi.org/10.3390/healthcare14030416 - 6 Feb 2026

Abstract

Background/Objectives: Integrated behavioral healthcare (IC) in public health settings may be optimal for advancing mental health equity among low-income and economically marginalized (LIEM) Black women. This study explores the provision of mental health services in public health clinics and assesses client experiences [...] Read more.

Background/Objectives: Integrated behavioral healthcare (IC) in public health settings may be optimal for advancing mental health equity among low-income and economically marginalized (LIEM) Black women. This study explores the provision of mental health services in public health clinics and assesses client experiences and recommendations for healthcare system improvement. Methods: Black women receiving mental health services in public health clinics completed surveys (n = 81) and in-depth interviews (n = 8, follow-up: n = 7). Analysis included descriptive statistics, interpretive phenomenological analysis, and member checking (n = 4). Results: Survey respondents reported high perceptions of providers’ cultural responsiveness (M = 13.35/14) and high satisfaction with IC services (M = 4.48/5.0). However, qualitative interviews revealed that these scores may be relative to low baseline expectations for care. Across interviewees, personalized care emerged as critical for high-quality IC service delivery, and pregnant interviewees reflected on the importance of IC during pregnancy, which can compound prior mental health concerns. Notably, positive IC reflections waned over time, and 75% of interviewees “fell through the cracks” between receiving referral for and accessing community resources, resulting in persistent unmet mental health needs. This experience, paired with a lack of systemic follow-up from the public health department, was perceived as a form of institutional betrayal. Conclusions: While IC in public health settings holds promise for health equity, results underscore the need for person-centered care that prioritizes authentic screening, warm handoffs, and closed-loop referrals—particularly for LIEM Black women, who frequently have prior experiences with fragmented healthcare systems. To ensure IC meets client needs without causing unintentional harm, healthcare systems should co-design solutions with clients. Full article

(This article belongs to the Special Issue Health Equity and People-Centered Systems: Meeting Needs and Creating Opportunities for Diverse Communities)

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11 pages, 1863 KB

Open AccessArticle

Inequity in Schoolchildren’s Access to Oral Health Services in Romania: Implications for Public Oral Health Policies

by Anca-Cristina Perpelea, Ruxandra Sfeatcu, Silviu-Mirel Pițuru and Florentina Ligia Furtunescu

Healthcare 2026, 14(3), 415; https://doi.org/10.3390/healthcare14030415 - 6 Feb 2026

Abstract

Background/Objectives: In Romania, the oral health status of schoolchildren is insufficiently documented at the national level. This is due to the lack of systematic oral health reporting and fragmented access to dental care services. Methods: In this context, the main factors [...] Read more.

Background/Objectives: In Romania, the oral health status of schoolchildren is insufficiently documented at the national level. This is due to the lack of systematic oral health reporting and fragmented access to dental care services. Methods: In this context, the main factors influencing schoolchildren’s access to dental services were identified through a triangulation approach that integrated documentary research, routine data on health service coverage, and oral health indicators collected through a survey conducted on 3843 schoolchildren. Results: The results highlight a multitude of interdependent factors that shape children’s access to dental care, namely policy-level constraints, dental workforce distribution and individual-level determinants—and provide insight into how public health policies can be adapted to more effectively meet the needs of this group. Conclusions: Despite legislative provisions on children’s oral health care in Romania, territorial disparities persist, and the use of preventive services remains low. These findings underscore the need for national- and county-level public health policies to improve access, promote preventive dental check-ups, strengthen health literacy, and develop targeted programs specifically dedicated to school-age children. Full article

(This article belongs to the Section Public Health and Preventive Medicine)

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12 pages, 512 KB

Open AccessArticle

Compensation Stability and Workforce Retention During COVID-19: A Paired Comparative Study of Home Care Nurses

by Naudrey Parker-Jenkins and John Kwame Duah

Healthcare 2026, 14(3), 414; https://doi.org/10.3390/healthcare14030414 - 6 Feb 2026

Abstract

Background/Objectives: Home care nurses play a vital role in maintaining continuity of care for vulnerable populations. However, the COVID-19 pandemic exposed long-standing vulnerabilities in the workforce within home and community-based services. While compensation is often emphasized as a primary driver of workforce retention, [...] Read more.

Background/Objectives: Home care nurses play a vital role in maintaining continuity of care for vulnerable populations. However, the COVID-19 pandemic exposed long-standing vulnerabilities in the workforce within home and community-based services. While compensation is often emphasized as a primary driver of workforce retention, less is known about how compensation satisfaction and retention intentions changed over time during a public health emergency. Methods: This study employed a cross-sectional survey with retrospective paired comparisons among home care nurses at five home care agencies in Maryland. To assess temporal changes, respondents retrospectively evaluated compensation satisfaction, job satisfaction, and retention intentions before and during the COVID-19 pandemic. Paired samples t-tests were used to examine within-respondent differences across time periods. Herzberg’s Motivator-Hygiene Theory guided the interpretation of these changes in extrinsic and intrinsic workplace factors. Results: Compensation satisfaction did not differ significantly between the pre-pandemic and pandemic periods. In contrast, selected retention-related perceptions, particularly financial stability and feeling well paid, changed significantly and were associated with organizational and preparedness-related factors such as leadership, communication, and professional growth opportunities. Several intrinsic job satisfaction dimensions improved during the pandemic, while resource-related challenges remained. Conclusions: The findings suggest that compensation stability functioned as a hygiene factor that was insufficient to secure workforce retention during the COVID-19 pandemic. Retention intentions were shaped by the interaction of financial security and organizational preparedness. Workforce policies to strengthen home care systems should combine compensation strategies with leadership development, professional growth opportunities, and emergency preparedness planning to build resilience during future crises. Full article

(This article belongs to the Section Healthcare Organizations, Systems, and Providers)

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20 pages, 947 KB

Open AccessSystematic Review

A Systematic Review of Multimodal Frameworks for Assessing Health Vulnerability in Academicians Across Ergonomic, Lifestyle, and Dietary Domains

by Pooja Oza, Shraddha Phansalkar, Aayush Shrivastava, Abhishek Sharma, Jun-Jiat Tiang and Wei Hong Lim

Healthcare 2026, 14(3), 413; https://doi.org/10.3390/healthcare14030413 - 6 Feb 2026

Abstract

Background: Lifestyle challenges such as prolonged sitting, irregular dietary habits, high stress levels, and lack of physical activity have become increasingly common among working professionals. All these factors contribute to the risk of chronic diseases such as diabetes, heart disease, obesity, and high [...] Read more.

Background: Lifestyle challenges such as prolonged sitting, irregular dietary habits, high stress levels, and lack of physical activity have become increasingly common among working professionals. All these factors contribute to the risk of chronic diseases such as diabetes, heart disease, obesity, and high blood pressure, which in turn result in reduced work performance and quality of life and may further affect health services access through increase healthcare needs. The teaching environment, like many other work environments, is mentally, emotionally, and practically demanding, and it puts extra pressure on those who work in it. Academicians, who devote themselves to guiding young minds, often make unhealthy daily choices and face significant work-related stress, which can lead to serious long-term health problems. This review highlights that health and well-being are shaped not by a single factor such as diet, work patterns, or habits, but by their combined effect. Methods: A study of around 113 studies has highlighted that academicians usually feel drained and physically exhausted. Result: The factors like prolonged fasts, insufficient water intake, long-standing hours, long and continuous talking, and extended periods in the sitting position have added to their stress levels at the workplace. The most critical finding is that these factors do not affect in isolation but impact as a combined interaction. These issues influence each other, thus increasing the vulnerability to lifestyle disorders. Conclusions: This critical problem can be addressed with a Multimodal Assessment Framework that integrates teachers’ data on dietary habits, workplace ergonomics, sleep quality, and levels of physical activity. The presented work also proposes a statistical technique with an Artificial Intelligence (AI) model, and generates Vulnerability Quotient (VQ) that show lifestyle disease-related exposure of the teachers, which may be further used to provide remedial interventions. These insights can further guide institutions and policymakers to design healthier, supportive, and sustainable teaching environments. Full article

(This article belongs to the Special Issue Occupational Health and Workers’ Well-Being: From Research to Practice)

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15 pages, 950 KB

Open AccessArticle

Usability and Feasibility of a School-Based Digital Framework for Bullying Prevention

by Christopher Murray, Claudia G. Vincent, Dorothy L. Espelage, Luis Anunciacao, Hill Walker, Rita Svanks, Alberto Valido and Brion Marquez

Healthcare 2026, 14(3), 412; https://doi.org/10.3390/healthcare14030412 - 6 Feb 2026

Abstract

Bullying and school violence contribute directly to mental health difficulties among youth in the United States. Background/Objectives: This study describes the development and initial evaluation of a technology-enabled, multi-component school safety framework designed to support bullying prevention in middle and high schools. [...] Read more.

Bullying and school violence contribute directly to mental health difficulties among youth in the United States. Background/Objectives: This study describes the development and initial evaluation of a technology-enabled, multi-component school safety framework designed to support bullying prevention in middle and high schools. Methods: Students (n = 46), school personnel (n = 79), and parents/caregivers (n = 28) participated in three waves of usability and feasibility testing focused on a mobile application (Speak Out with Advocatr), companion classroom instructional materials, and guidelines for a school-wide safety campaign. Quantitative data were summarized using descriptive statistics and benchmark comparisons, and group differences across respondent roles were examined using analysis of variance with post hoc pairwise tests. Given small and unequal sample sizes, bootstrap resampling with 1000 resamples was used to obtain robust estimates of group means and confidence intervals. Qualitative responses were analyzed using content analysis. Results: Across waves, mean ratings generally met or exceeded predefined usability benchmarks, indicating favorable perceptions of the system. Findings indicated strong student acceptance and engagement with the framework. Adult participants expressed particular interest in restorative approaches to addressing student conflict, as well as concerns about preventing the recurrence of bullying behaviors. Conclusions: Findings provide initial support for the usability and feasibility of a multi-component, technology-enabled approach to school-based bullying prevention. Results also highlight the value of role-specific feedback for refining integrated mental health and safety interventions within school settings. Full article

(This article belongs to the Special Issue The Relationship of Social Media and Cyberbullying with Mental Health)

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13 pages, 3666 KB

Open AccessArticle

Strain Analysis from Transverse CMR Cine Imaging in Congenital Heart Disease: Feasibility, Reproducibility, and Comparison to Global Longitudinal Strain

by Victoria Zieschang, Peter Kramer, Collin Götze, Sebastian Kelle, Regina Stegherr, Alireza Khasheei, Felix Berger, Johannes Nordmeyer, Titus Kühne, Sarah Nordmeyer and Marie Schafstedde

Healthcare 2026, 14(3), 411; https://doi.org/10.3390/healthcare14030411 - 6 Feb 2026

Abstract

Background: Global longitudinal strain (GLS), derived from long-axis cine images (LAX), is a sensitive marker for myocardial dysfunction and a strong predictor for clinical events and future ventricular deterioration. In patients with complex congenital heart disease (CHD) transverse-oriented cine imaging is part [...] Read more.

Background: Global longitudinal strain (GLS), derived from long-axis cine images (LAX), is a sensitive marker for myocardial dysfunction and a strong predictor for clinical events and future ventricular deterioration. In patients with complex congenital heart disease (CHD) transverse-oriented cine imaging is part of the standard cardiac magnetic resonance (CMR) protocol. We aimed to study the feasibility and reproducibility of strain measurements derived from transverse-oriented cine images (Transverse Strain (TrS)) and compare them with standard GLS. Methods: We retrospectively analyzed CMR cine images from 40 patients (n = 20 Fontan, n = 20 Tetralogy of Fallot (ToF)) and 10 healthy controls. Strain analysis was performed in every subject using both the conventional GLS and the TrS approach. Results: TrS showed high intra- and interobserver reproducibility in patients with CHD (intraclass correlation coefficient (ICC) > 0.75, p < 0.05). Intermethod agreement between TrS and GLS was strong in Fontan patients and in the right ventricle (RV) of ToF patients (ICC > 0.75) but showed a positive bias for TrS in the left ventricle (LV) of ToF patients (mean difference = 5.03) and in both ventricles of healthy controls (mean difference LV = 5.36, RV = 4.01). Conclusions: TrS is feasible and reproducible and may offer a new methodological approach for strain assessment, especially in CHD patients with univentricular physiology and ToF patients. Further studies are needed to validate this new approach and perform correlations to clinical outcomes. Full article

(This article belongs to the Special Issue Advances in Cardiac Imaging: Innovations, AI Integration, and Clinical Applications)

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21 pages, 393 KB

Open AccessArticle

Adolescents’ Responses to High-Intensity Versus Standard Physical Education on Body Fat, Blood Pressure, and VO₂max: A Secondary Analysis Using TE-Based Responder Classification

by Jarosław Domaradzki, Eugenia Murawska-Ciałowicz, Katarzyna Kochan-Jacheć, Paweł Szkudlarek, Dawid Koźlenia and Marek Popowczak

Healthcare 2026, 14(3), 410; https://doi.org/10.3390/healthcare14030410 - 5 Feb 2026

Abstract

Background/Objectives: A persistent challenge in adolescent health promotion is insufficient exercise intensity during physical education (PE) lessons, limiting their potential to reduce cardiometabolic risk. National curricula further restrict teacher flexibility in implementing effective preventive strategies. Brief, high-intensity exercise protocols may provide a [...] Read more.

Background/Objectives: A persistent challenge in adolescent health promotion is insufficient exercise intensity during physical education (PE) lessons, limiting their potential to reduce cardiometabolic risk. National curricula further restrict teacher flexibility in implementing effective preventive strategies. Brief, high-intensity exercise protocols may provide a scalable solution within school systems. Although their general effectiveness is established, less is known about the variability of individual health responses, particularly across multiple outcomes and in relation to sex and intervention type. This study aimed to (1) assess the prevalence of responders (Rs) and non-responders (NRs) by sex and intervention type, (2) examine sex-by-intervention interactions, and (3) evaluate the likelihood of combined positive health responses across body fat percentage (BFP), systolic and diastolic blood pressure (SBP and DBP), and cardiorespiratory fitness (maximal oxygen consumption [VO₂max]). Methods: A total of 145 adolescents (aged 16 years; 48% males) from experimental school-based PE programs were analyzed. Two intervention modalities were implemented: high-intensity interval training (HIIT) and high-intensity plyometric training (HIPT). Rs were identified using typical error (TE) methodology. Statistical analyses included chi-squared tests (χ²), log-linear modeling, and odds ratios (ORs). Results: Chi-squared analyses indicated sex-by-intervention associations in the distribution of responder classifications for body fat percentage (BFP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and VO₂max (χ² range = 8.26–10.10, p < 0.01). A simple association between intervention type and DBP was also observed (χ² = 6.49, p = 0.011). However, logistic regression analyses yielded odds ratios with wide 95% confidence intervals crossing the null value for all outcomes, indicating limited precision and the absence of statistically robust interaction effects. Multinomial logistic regression examining combined responses (two or three concurrent improvements) revealed no statistically significant main or interaction effects (all p > 0.05).Conclusions: Brief high-intensity exercise protocols delivered within school-based physical education were associated with favorable changes in adiposity, blood pressure, and cardiorespiratory fitness in a substantial proportion of adolescents. However, sex- and intervention-specific differences in responder classification were not statistically significant and should be interpreted as exploratory. Further adequately powered studies are required to determine whether individual characteristics meaningfully moderate responsiveness to specific high-intensity exercise modalities. Full article

12 pages, 613 KB

Open AccessArticle

How Risky Is Mixed Martial Arts? Injury Rates and Patterns in Competitive Versus Recreational Athletes

by Lukas Groessing, Vasco Starke, Armin Runer, Friedemann Schneider, Markus Merkl, Wolfgang Zemann and Michael Schwaiger

Healthcare 2026, 14(3), 409; https://doi.org/10.3390/healthcare14030409 - 5 Feb 2026

Abstract

Background/Objectives: Mixed martial arts (MMA) is a popular full-contact combat sport. The aim of this study was to determine injury mechanisms, rates, severity, patterns, circumstances, and the resulting economic healthcare consequences by conducting a detailed survey of competitive and recreational athletes. Methods [...] Read more.

Background/Objectives: Mixed martial arts (MMA) is a popular full-contact combat sport. The aim of this study was to determine injury mechanisms, rates, severity, patterns, circumstances, and the resulting economic healthcare consequences by conducting a detailed survey of competitive and recreational athletes. Methods: In 2023, MMA athletes were retrospectively questioned regarding their injuries in the last 24 months and the resulting healthcare impact (medical attention, hospitalization, incapacity to work). An injury was defined as any physical complaint resulting from MMA exposure. The severity of the injury was categorized according to the resulting restriction of sport participation (i.e., ‘severe’: more than four weeks of restriction). Results: A total of 112 participants (93% male; 41% non-competitive and 59% competitive) were included. All in all, 93,857 h of MMA activities were performed, and 127 injuries were recorded, resulting in an overall injury rate of 1.4 injuries per 1000 h of exposure. Non-competitive athletes reported significantly fewer total injuries in the past 24 months (95% CI 0.87–2.04; p = 0.003) and had significantly fewer severe or even critical injuries compared to competitive athletes (OR 0.55; 95% CI 0.21–1.43; p = 0.042). Head- and neck lesions (20%) were the most common injuries. The most common types of injury were joint sprains (21%) and ligament strains (17%). The healthcare burden of these sports-related injuries was minimal: By median, injuries led to zero days of hospitalization and incapacity to work, with no statistically significant differences between recreational and competitive athletes. Conclusions: Competitive athletes suffer more severe injuries compared to recreational athletes. Overall, injuries in MMA are rare, and the economic impact and burden on the healthcare system are negligible compared to other sport disciplines. Full article

(This article belongs to the Special Issue Healthcare Advances in Trauma and Orthopaedic Surgery)

16 pages, 551 KB

Open AccessArticle

A Moderated Mediation Analysis of Timely EMS Activation and Bystander CPR in the Association Between Regional Deprivation and Outcomes Following Out-of-Hospital Cardiac Arrest

by So Yeon Kong and Seungmin Jeong

Healthcare 2026, 14(3), 408; https://doi.org/10.3390/healthcare14030408 - 5 Feb 2026

Abstract

Background/Objectives: Out-of-hospital cardiac arrest (OHCA) outcomes remain poor and vary widely across communities with socioeconomic deprivation. This study examines whether delays in emergency medical services (EMS) activation, the earliest link in the Chain of Survival, mediate the association between regional deprivation and [...] Read more.

Background/Objectives: Out-of-hospital cardiac arrest (OHCA) outcomes remain poor and vary widely across communities with socioeconomic deprivation. This study examines whether delays in emergency medical services (EMS) activation, the earliest link in the Chain of Survival, mediate the association between regional deprivation and OHCA outcomes, and whether this effect is modified by bystander cardiopulmonary resuscitation (CPR) status. Methods: We analyzed adult patients (aged 18–80 years) with witnessed, EMS-treated OHCA of presumed cardiac etiology from the Korean nationwide OHCA registry (2015–2022). Regional deprivation was defined by the Regional Deprivation Index and dichotomized into deprived (top 20%) vs. non-deprived areas. Timely EMS activation, defined as collapse to EMS activation, was measured as an awareness time interval (ATI) < 5 min. Outcomes were good neurological recovery (CPC 1–2) and survival to discharge. Causal mediation analysis within the counterfactual framework quantified the proportion of the association mediated by timely EMS activation, with stratification by bystander CPR status. Results: Among 43,032 patients, 6.1% resided in deprived areas. Deprived areas had lower bystander CPR (22.6% vs. 36.3%) and timely EMS activation (67.8% vs. 75.6%) (p < 0.05 for all). Regional deprivation was associated with poorer outcomes (good neurological prognosis: aOR 0.46, 95% CI 0.39–0.55; survival: aOR 0.65, 95% CI 0.57–0.73). Mediation analysis showed that ATI < 5 min accounted for 3.7% of the total deprivation effect on good neurological outcome and 7.9% on survival, with stronger mediation among patients receiving bystander CPR (7.9% and 14.7%, respectively). Conclusions: Regional deprivation is significantly associated with poorer OHCA outcomes, partly mediated by delays in EMS activation, particularly among patients who received bystander CPR. Interventions to enhance early recognition, rapid EMS activation, and bystander CPR in deprived communities are critical to improving survival equity after OHCA. Full article

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15 pages, 803 KB

Open AccessArticle

Well-Being and Sexual Diversity in Higher Education: The Role of Mental Health, Optimism, Academic Performance, and Motivation in Portuguese Students

by José Alberto Ribeiro-Gonçalves, Diana Fernandes, Ester Câmara and Margarida Pocinho

Healthcare 2026, 14(3), 407; https://doi.org/10.3390/healthcare14030407 - 5 Feb 2026

Abstract

Introduction. Entering higher education represents a significant and challenging stage, marked by substantial changes that impact students’ well-being, mental health, and academic performance. These challenges can be particularly intensified for lesbian, gay, or bisexual (LGB) students, who are frequently subject to minority stress. [...] Read more.

Introduction. Entering higher education represents a significant and challenging stage, marked by substantial changes that impact students’ well-being, mental health, and academic performance. These challenges can be particularly intensified for lesbian, gay, or bisexual (LGB) students, who are frequently subject to minority stress. In this context, few studies have focused on aspects associated with the well-being of these students. This study aimed to assess well-being, mental health, optimism, motivation, and academic performance according to students’ sexual orientation, as well as the main predictors of well-being in both groups. Method. The sample comprised 285 higher education Portuguese students, of whom 129 were heterosexual and 156 were LGB, aged between 18 and 69 years. Results. The results revealed that the LGB students showed significantly lower levels of optimism, but higher levels of academic performance and mental health, compared to heterosexual students. Among LGB students, optimism stood out as one of the main predictors of well-being, while mental health stood out among heterosexual students. Conclusions. The results highlight the need for more inclusive university environments and psychological interventions focused on promoting optimism to reduce the impact of minority stress and promote the well-being and academic retention of LGB students. More studies are needed that consider the diverse sexual orientations of university students. Full article

(This article belongs to the Special Issue Gender, Sexuality and Mental Health)

26 pages, 1262 KB

Open AccessViewpoint

The Anabranch Framework for the Ruralization of Health Professional Education

by Debra Jones, Annemarie Hennessy, Mariah Goldsworthy, Xiang-Yu Hou, Sandra Thompson, Hannah Dean, Kazuma Honda, Danielle Minnis, Charlene Noye, Tracy Robinson, Wendy Gleeson, Reakeeta Smallwood, Aliza Lord, Brendan McCormack and Danielle White

Healthcare 2026, 14(3), 406; https://doi.org/10.3390/healthcare14030406 - 5 Feb 2026

Abstract

Background/Objective: The quality of care afforded to rural, remote, and First Nations Peoples is dependent on access to a health workforce with the capacity to contextualize healthcare and practice to the needs and expectations of these populations. In Australia, the lack of representation [...] Read more.

Background/Objective: The quality of care afforded to rural, remote, and First Nations Peoples is dependent on access to a health workforce with the capacity to contextualize healthcare and practice to the needs and expectations of these populations. In Australia, the lack of representation of rural health in undergraduate and post graduate health professional education undermines this preparedness and consideration of rural practice uptake and longevity, compounding the inequities confronted by 7 million Australians residing in these locations. Urgent educational reforms are required to address this omission, the deficit discourses used to characterize rural healthcare, and the persistent health workforce shortages experienced. This paper presents the Anabranch Framework for the Ruralization of Health Professional Education, a high-level strategy to transform rural healthcare provision, professional practice, and health workforce outcomes. Methods: The framework was developed through an iterative process involving a series of systematic steps. The process included the following: individual and group critical dialogues with internal academic educators, external health service leaders, metropolitan academic allies, and leaders of other rural health academic departments; an internal review of empirical studies of relevance to the ruralization of health professional education and practice; the visualization of a place-based framework; the academic conceptualization of the framework; and further critical dialogues to test the framework’s face validity. Results: The Anabranch Framework comprises four inter-related rural domains: theories, pedagogies, practices, and connectivity; four constructs: knowledge acquisition and generation, immersion in rural curriculum, knowledge translation and sharing, and relational practice; and two structural elements: spiraled and scaffolded curriculum and duration and the quality of rural placement and practice. Conclusions: The Anabranch Framework is a high-level strategy to ruralize health professional worldviews, advance rural person-centered practice, enable a deeper understanding of rural places and the development of an equity-orientated, sustainable and rural-literate health workforce. Full article

(This article belongs to the Topic Bridging Socio-Economic Inequalities in Health: Addressing Access Gaps in Low-Income and Vulnerable Populations)

21 pages, 1480 KB

Open AccessArticle

Early Detection of Chronic Kidney Disease in Men Using Lifestyle and Demographic Indicators: A Machine Learning Approach for Primary Healthcare Settings

by Mc Neil Valencia, Jun Kim, Zeeshan Abbas and Seung Won Lee

Healthcare 2026, 14(3), 405; https://doi.org/10.3390/healthcare14030405 - 5 Feb 2026

Abstract

Background/Objective: Chronic kidney disease (CKD) is a major global health concern associated with significant morbidity, mortality, and healthcare burden. This study aimed to develop an explainable machine learning framework that integrates lifestyle, sociodemographic, and biochemical factors for early CKD risk prediction among middle-aged [...] Read more.

Background/Objective: Chronic kidney disease (CKD) is a major global health concern associated with significant morbidity, mortality, and healthcare burden. This study aimed to develop an explainable machine learning framework that integrates lifestyle, sociodemographic, and biochemical factors for early CKD risk prediction among middle-aged men using public health survey data. Methods: Data from 968 male participants were preprocessed by removing missing values, deriving eGFR and ACR, and labeling CKD status. Five machine learning algorithms, (i.e., Random Forest, AdaBoost, Naïve Bayes, SVM, and XGBoost) were trained and evaluated using accuracy, precision, recall, and F1-score. Model interpretability was assessed using SHAP, LIME, Boruta, and Pearson’s correlation analyses. Results: AdaBoost yielded the best performance (accuracy = 0.7258, F1 = 0.6457, recall = 0.6923), with robust generalization confirmed by the precision–recall curve (AP = 0.715). SHAP and LIME revealed that serum creatinine, blood urea nitrogen, urinary creatinine, and age were major predictors, whereas lifestyle and metabolic indicators such as BMI, sodium and sugar intake, and sleep duration emerged as secondary factors for CKD. Conclusions: This study demonstrates the effectiveness of an explainable machine learning model that integrates lifestyle, sociodemographic and biochemical data for early CKD prediction among middle-aged men. The AdaBoost-based framework shows strong potential for implementation as a clinical decision-support tool within EHR systems and may contribute to personalized and preventive interventions. It emphasizes the growing importance of modifiable behaviors in kidney disease development and supports future work involving multiple cohorts and temporal model expansion to improve risk stratification for individuals at risk of kidney disease. Full article

(This article belongs to the Special Issue Digital Health and AI for Chronic Disease Control and Management)

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18 pages, 966 KB

Open AccessArticle

Love, Compassion, and Personality as Predictors of Burnout in Nurses: A Path Analysis Study

by Agapi L. Batiridou, Elena Dragioti, Zoe Konstanti, Stefanos Mantzoukas and Mary Gouva

Healthcare 2026, 14(3), 404; https://doi.org/10.3390/healthcare14030404 - 5 Feb 2026

Abstract

Background/Objectives: This study examined how personality traits, compassion, and love are associated with the three dimensions of burnout among nurses, while accounting for demographic factors such as gender, age, and work shift. Methods: A total of 403 nurses participated in this [...] Read more.

Background/Objectives: This study examined how personality traits, compassion, and love are associated with the three dimensions of burnout among nurses, while accounting for demographic factors such as gender, age, and work shift. Methods: A total of 403 nurses participated in this cross-sectional study and completed validated self-report measures of personality, compassionate love, and burnout, as well as an in-house, exploratory Love Instrument. Path analysis was used to examine patterns of direct and indirect associations among the study variables while controlling demographic covariates. Results: Men reported higher psychoticism and depersonalization, whereas women scored higher in compassion. Neuroticism was associated with greater emotional exhaustion and depersonalization and with lower personal accomplishment. Compassion showed indirect association patterns linking extraversion and the Lie scale with personal accomplishment and linking psychoticism with depersonalization. Extraversion was positively associated with accomplishment both directly and indirectly, while psychoticism was associated with higher depersonalization. Love-related variables showed mixed findings. Specifically, love experience was not associated with burnout, whereas love intensity was positively associated with both depersonalization and accomplishment. Older nurses reported more exhaustion but also greater accomplishment; male gender and rotating shifts were associated with higher depersonalization and exhaustion. Conclusions: The findings support neuroticism as a key dispositional vulnerability correlated with burnout and suggest that compassion and extraversion are linked to more favorable burnout-related profiles, particularly higher accomplishment and lower depersonalization. Love-related emotion intensity showed small, mixed associations and should be interpreted cautiously given the exploratory measurement approach. These results highlight the emotional complexity of nursing and may inform future research and workplace initiatives aimed at supporting occupational well-being. Full article

(This article belongs to the Special Issue Employees’ Well-Being: Effective Measures to Cope with Job Stress and Workplace Bullying: Second Edition)

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17 pages, 552 KB

Open AccessArticle

Gestational Weight Gain Counseling Insights from Healthcare Providers and Saudi Women: Riyadh Mother and Baby Follow-Up Study (RAHMA Explore)

by Amel Fayed, Samia Esmaeil, Alya Khalid AlZabin, Wijdan Awad Almutiri, Ebtesam Hoshan Almajed and Hayfaa Wahabi

Healthcare 2026, 14(3), 403; https://doi.org/10.3390/healthcare14030403 - 5 Feb 2026

Abstract

Background: Monitoring and managing gestational weight gain (GWG) during antenatal care (ANC) is linked to better maternal and neonatal outcomes. The Institute of Medicine (IOM) guidelines are based on pre-pregnancy BMI and reduce obstetric risks. Pregnant women’s views and healthcare providers’ (HCPs) [...] Read more.

Background: Monitoring and managing gestational weight gain (GWG) during antenatal care (ANC) is linked to better maternal and neonatal outcomes. The Institute of Medicine (IOM) guidelines are based on pre-pregnancy BMI and reduce obstetric risks. Pregnant women’s views and healthcare providers’ (HCPs) practices are key to effective GWG counseling. This study aims to: (1) investigate the proportion of women who received GWG advice per IOM guidelines, and (2) explore HCP practices and views on GWG counseling. Methods: This is a cross-sectional study of Saudi pregnant women who delivered within one year of the study and HCPs who provided ANC. Women provided data on demographics, pre-pregnancy BMI, recall of GWG advice, and their target GWG. HCPs rated their knowledge and counseling practices. Results: Of 1151 women, 48.8% were pre-pregnancy overweight or obese, 47.6% were normal weight, and 3.6% were underweight. Most women (74.5%) received no GWG advice, and only 8.8% followed IOM guidelines. Women with obesity and overweight were more likely to receive correct advice (15.5% and 11.5%), compared to 5.3% of normal-weight and 2.4% underweight women. Overweight and obese women were more likely to define the correct GWG (AOR = 2.84 and 5.85). Receiving proper advice greatly increased the likelihood of proper GWG definition (AOR = 7.13). Among 28 HCPs, 53.6% reported that women rarely ask about the GWG target. Nearly 93% of them weigh women at each visit, but only 21.4% set personalized GWG targets. Most HCPs (82.2%) viewed discussing GWG as a high priority, and 70% felt confident providing guidance on GWG, diet, and exercise. Conclusions: Many women receive no GWG guidance, and most advice does not align with IOM guidelines. Enhancing Saudi women’s knowledge regarding GWG targets through health education, in conjunction with ongoing medical education for healthcare professionals concerning guidelines for GWG, represents modifiable factors and a critical opportunity to foster healthier pregnancy outcomes. Full article

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