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 Policy and Services) / CiteScore - Q1 (Leadership and Management)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 21.5 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the first half of 2025).
- 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.
- Journal Cluster of Healthcare Sciences and Services: Geriatrics, Journal of Ageing and Longevity, Healthcare, Hospitals, Hygiene, International Journal of Environmental Research and Public Health and Nursing Reports.
Impact Factor:
2.7 (2024);
5-Year Impact Factor:
2.8 (2024)
Latest Articles
Impact of the Paramedic Role on Athlete Care, Emergency Response, and Injury Prevention in Sports Medicine: A Scoping Review
Healthcare 2025, 13(18), 2301; https://doi.org/10.3390/healthcare13182301 (registering DOI) - 14 Sep 2025
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Introduction: Paramedics are increasingly being recognized as essential contributors to sports medicine, where their role extends beyond emergency response to prevention, planning, and collaboration with other medical professionals. Yet their scope of practice and effectiveness across sporting levels and regions remain insufficiently synthesized.
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Introduction: Paramedics are increasingly being recognized as essential contributors to sports medicine, where their role extends beyond emergency response to prevention, planning, and collaboration with other medical professionals. Yet their scope of practice and effectiveness across sporting levels and regions remain insufficiently synthesized. Methods: This scoping review mapped international evidence on paramedics in sports medicine. Literature published in English between 2013 and 2023 was systematically searched in PubMed, Scopus, and ScienceDirect, and eligible studies were analyzed thematically. Thirty studies were included, spanning professional and amateur sports in North America, Europe, Asia, Oceania, and Africa. Results: The findings demonstrate that paramedics provide critical value across six domains. First, rapid emergency response, supported by innovations such as motorcycle-based ambulances, significantly reduced access times and improved survival rates. Second, preparedness and ongoing training, including physical fitness and interprofessional education, were shown to enhance effectiveness in demanding sporting environments. Third, collaboration with athletic trainers and other professionals improved on-field care and reduced unnecessary hospital transfers. Fourth, paramedics contributed to injury prevention programmes that lowered injury incidence and healthcare costs. Fifth, their involvement at mass gatherings ensured safety, streamlined triage, and reduced pressure on hospitals. Finally, evidence indicates that paramedic-led initiatives are cost-effective, generating both clinical and economic benefits. Conclusions: Paramedics play a multifaceted role in athlete care, emergency response, and injury prevention. Strengthening their integration through targeted training, protocol standardization, and equitable resource allocation can improve both athlete safety and system efficiency. Future research should focus on grassroots contexts and the use of paramedic-generated data to inform prevention and policy.
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Open AccessArticle
Home Difficulties Experienced by Male Firefighters in South Korea: A Qualitative Study on Work–Family Conflict
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Nayoon Lee and Hyun-Ju Lee
Healthcare 2025, 13(18), 2300; https://doi.org/10.3390/healthcare13182300 (registering DOI) - 14 Sep 2025
Abstract
Background/Objective: Family is a key protective factor for firefighters’ mental health, yet the home-related challenges of firefighting’s occupational demands remain underexplored in South Korea. This study aimed to establish an initial understanding of these challenges by conducting in-depth interviews with male firefighters and
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Background/Objective: Family is a key protective factor for firefighters’ mental health, yet the home-related challenges of firefighting’s occupational demands remain underexplored in South Korea. This study aimed to establish an initial understanding of these challenges by conducting in-depth interviews with male firefighters and analyzing their lived experiences using a phenomenological approach. Methods: Twenty-nine married male firefighters (mean age = 43.4 years, range = 31–55) affiliated with the Busan Fire Department participated in individual telephone interviews between April and July 2022 during the COVID-19 pandemic. Data were analyzed using Giorgi’s descriptive phenomenological method, with NVivo Pro 12.0 employed for coding and organization. Results: Six themes were identified: (1) acting as an emergency commander at home, (2) reinterpreting traumatic experiences after marriage, (3) physical and emotional exhaustion from irregular schedules, (4) being national heroes misunderstood by families, (5) guilt-ridden and indebted Superman, and (6) striving to be Superman at home as well. These themes reflected the overarching meaning of a “lonely breadwinner struggling to be Superman both at work and home.” Participants described hyperarousal, emotional withdrawal, strained relationships, guilt over missed family events, and compensatory overextension. Distress was often concealed to protect families, but this limited emotional support. Conclusions: Korean male firefighters face significant work–family conflict shaped by cultural and occupational factors. These findings highlight the need for family-centered counseling, psychoeducation, and organizational interventions. Policy measures such as guaranteed rest after shifts, couple-based communication programs, and resilience-building initiatives are recommended to strengthen families as vital sources of psychological resilience.
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Open AccessArticle
Job Satisfaction Among Healthcare Professionals in Community-Based Care for Older People: Evidence from Greece
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Eirini Michaela Foukaki, Argyroula Kalaitzaki, George Markakis, Athanasios Alegakis and Sofia Koukouli
Healthcare 2025, 13(18), 2299; https://doi.org/10.3390/healthcare13182299 (registering DOI) - 13 Sep 2025
Abstract
Objectives: This study aimed to investigate the level of job satisfaction and the associated factors among health and social care employees of the public sector providing services in open care community settings and home-based care for the older people in Greece. Method: The
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Objectives: This study aimed to investigate the level of job satisfaction and the associated factors among health and social care employees of the public sector providing services in open care community settings and home-based care for the older people in Greece. Method: The self-administered questionnaire, Job Satisfaction Survey (JSS), was distributed to personnel across all four prefectures in the Region of Crete (Greece). In total, 228 valid responses were received. Results: Overall job satisfaction was moderate (mean = 134, SD = 24). Employees reported greater satisfaction with the supervision (mean = 19.3), nature of work (mean = 19.2), and coworkers (mean = 19.0). Lower satisfaction was observed in relation to promotion (mean = 9.7). Women scored significantly higher satisfaction than men in pay (mean = 10.9) and fringe benefits (mean = 12.3), while age was associated with differences in pay and promotion satisfaction. Variations were also found according to service unit and contract type, with permanent staff reporting higher satisfaction (mean = 11.3) in the Promotion scale than temporary staff (mean = 9.2) (p < 0.001). Conclusions: Findings emphasize the need to institute targeted short- and long-term measures to improve job satisfaction in community-based care for older people. Short-term actions should include the introduction of fair and competitive pay structures, improvements in fringe benefits, and the implementation of supportive leadership practices. Meanwhile, long-term strategies should focus on transparent promotion systems, structured professional development and continuing education opportunities, and the provision of stable contracts to retain skilled personnel.
Full article
(This article belongs to the Special Issue Healthcare Management: Improving Patient Outcomes and Service Quality)
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Open AccessArticle
Effect of a Multi-Faceted Training Program on Falls in Senior Pickleball Players
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Betsy Myers and June Hanks
Healthcare 2025, 13(18), 2298; https://doi.org/10.3390/healthcare13182298 (registering DOI) - 13 Sep 2025
Abstract
Background/Objectives: Over half of older adults who play pickleball report falling during play, yet little is known regarding the ability of training programs to reduce the incidence of falls or fear of falling (FOF). The purpose of this study was to determine the
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Background/Objectives: Over half of older adults who play pickleball report falling during play, yet little is known regarding the ability of training programs to reduce the incidence of falls or fear of falling (FOF). The purpose of this study was to determine the effect of a multi-faceted training program for senior pickleball players who reported falling while playing pickleball or self-limiting play due to FOF. Methods: This cohort study included 12 participants in the training group (TG) and 17 in the control group (CG) who were at least 55 years of age, regularly played pickleball, and reported falling while playing or limiting play due to FOF. Hip abduction strength, change in direction (COD), and agility were assessed. Participants completed a survey regarding fall history and FOF. The TG participated in a 10-week program focused on strength, balance, COD, and agility. Results: At baseline, there were no between-group differences except that the CG participated in walking for exercise more often than the TG. The strength analysis showed no significant main effects of time or group, but there was a significant Group × Time interaction, F(1, 25) = 14.86, p < 0.001, η2 = 0.240. Simple effects analysis showed that the TG demonstrated a strong trend toward improvement (9.9 Nm increase, +5%, p = 0.091) while the CG significantly declined (18.4 Nm decrease, −12%, p < 0.001). The COD analysis revealed no significant main effects of time or group, but there was a significant Group × Time interaction, F(1, 26) = 8.21, p < 0.001, η2 = 0.373. Simple effects analysis showed that the TG significantly improved their COD time (0.7 s faster, p = 0.045) while the CG showed no significant change (0.25 s slower, p = 0.168). The TG had a significant decrease in FOF, z = −2.427, p = 0.015, r = 0.701. The agility analysis revealed no significant effects for time, group, or Group × Time interaction, F(1, 26) = 0.89, p = 0.354, with both groups showing minimal non-significant changes. At the end of training, the TG was playing 50% more pickleball than the CG, z = −2.192, p = 0.028. At the 5-month follow-up, 25% of the TG reported falling during play compared to 44% of the CG. Conclusions: A multi-faceted training program can effectively reduce FOF and improve physical performance in senior pickleball players.
Full article
(This article belongs to the Special Issue Sports Trauma: From Prevention to Surgery and Return to Sport)
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Open AccessArticle
Motor Innervation of the Trapezius by Cervical Sensitive Nerves: An Intraoperative Neuromonitoring Study and Postoperative Functional Outcomes
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Enver Can Öncül, Ersoy Doğan, Aslı Çakir Çetin, Aybüke Cansu Kalkan, Seher Özyürek, Arzu Genç and Ahmet Ömer İkiz
Healthcare 2025, 13(18), 2297; https://doi.org/10.3390/healthcare13182297 (registering DOI) - 13 Sep 2025
Abstract
Background/Objectives: We investigated whether cervical sensitive nerves (CSN) provide motor input to the trapezius muscle and how this relates to short-term functional outcomes after neck dissection. Methods: A total of 22 neck dissections were performed in 17 patients; the SAN was preserved. CSN
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Background/Objectives: We investigated whether cervical sensitive nerves (CSN) provide motor input to the trapezius muscle and how this relates to short-term functional outcomes after neck dissection. Methods: A total of 22 neck dissections were performed in 17 patients; the SAN was preserved. CSN roots (C2–C4) were stimulated intraoperatively using IONM. Shoulder and neck function were evaluated preoperatively and at 3 months in 15 operated necks using goniometry, an IMU-based motion analysis system (iSen), trapezius isometric strength, the Modified Constant–Murley Score (MCMS), and the Shoulder Pain and Disability Index (SPADI). Results: CSN-evoked trapezius responses were detected in 10/22 (45.5%) dissections (C2: 6/22, 27.2%; C3: 4/22, 18.2%; C4: 0/22). Postoperatively, neck extension/rotation and shoulder abduction/external rotation decreased significantly within groups; upper and middle trapezius strength and MCMS also declined. Shoulder flexion loss was smaller when CSN motor participation was present. Median shoulder flexion (goniometry) changed from 162°→140° in CSN(+) vs. 170°→131° in CSN(−) (between-group p = 0.024). With iSen, shoulder flexion changed 120°→116° in CSN(+) vs. 122°→97° in CSN(−) (p = 0.033). Conclusions: Approximately half of the neck dissections exhibited CSN-related motor responses. Short-term shoulder flexion was better preserved when CSN motor participation was present, suggesting that documenting CSN motor input intraoperatively may inform early rehabilitation planning.
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Open AccessBrief Report
Effects of Neighborhood Deprivation Index on Survival in Gastroesophageal Adenocarcinoma
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Sawyer Bawek, Mrinalini Ramesh, Malak Alharbi, Nour Nassour, Kayla Catalfamo, Han Yu, Beas Siromoni, Deepak Vadehra and Sarbajit Mukherjee
Healthcare 2025, 13(18), 2296; https://doi.org/10.3390/healthcare13182296 (registering DOI) - 13 Sep 2025
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Previous studies linked disadvantaged neighborhoods to poor cancer outcomes. The Neighborhood Deprivation Index (NDI) quantifies socioeconomic disadvantage, but its impact on gastroesophageal adenocarcinoma outcomes remains understudied. We conducted a retrospective analysis of 40,589 patients with esophageal or gastric adenocarcinoma from the SEER database
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Previous studies linked disadvantaged neighborhoods to poor cancer outcomes. The Neighborhood Deprivation Index (NDI) quantifies socioeconomic disadvantage, but its impact on gastroesophageal adenocarcinoma outcomes remains understudied. We conducted a retrospective analysis of 40,589 patients with esophageal or gastric adenocarcinoma from the SEER database (1996–2015), stratifying them by NDI: less disadvantaged (NDI < 60) and highly disadvantaged (NDI ≥ 60). Multivariate regression showed NDI ≥ 60 was independently associated with worse overall survival (OS) (HR 1.027, p = 0.017) and disease-specific survival (DSS) (HR 1.025, p = 0.04). Other predictors of poor OS and DSS included older age (≥60 years old), male sex, single marital status, lack of insurance, advanced stage/grade, and gastric tumor site. In contrast, Hispanic and non-Hispanic Black ethnicity, urban residence, and undergoing surgery were associated with better outcomes. Disadvantaged neighborhoods are linked to poorer survival in upper GI cancers, likely due to socioeconomic barriers. Addressing social determinants of health is crucial to reducing these disparities.
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Open AccessArticle
Inequities in Forgone Medical Care and Health Insurance in a Key Geopolitical Area Along the US–Mexico Border
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Samuel D. C. Towne, Jr., Wei Li, Chanam Lee, Minjie Xu, Jiahe Bian, Leah D. Whigham and Marcia G. Ory
Healthcare 2025, 13(18), 2295; https://doi.org/10.3390/healthcare13182295 (registering DOI) - 13 Sep 2025
Abstract
Background: Residents of the US–Mexico border face cost-related barriers in accessing necessary medical care. Given the potential for individualized or broader tailoring of solutions to reflect community needs, we sought to identify risk factors for being uninsured and forgoing necessary medical care due
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Background: Residents of the US–Mexico border face cost-related barriers in accessing necessary medical care. Given the potential for individualized or broader tailoring of solutions to reflect community needs, we sought to identify risk factors for being uninsured and forgoing necessary medical care due to cost among a largely Hispanic adult population residing along the US–Mexico border. Methods: Surveys among adults in a major US–Mexico border area were used to investigate cost-related forgone medical care and lack of insurance. Binary Logit models were employed to model multiple binary outcomes informed by our theoretical frameworks. Results: Lower education, Hispanic ethnicity, being younger, lacking underlying illness and/or having obesity, forgoing medical care due to cost, and having lower income were associated with a higher likelihood of being uninsured; while being female, being younger, having underlying illness and/or having obesity (potential increased risk of severe illness due to COVID-19), lacking insurance, and having a lower income were risk factors for forgone medical care due to cost. Conclusions: This study adds novel insight into existing health inequities facing those residing along the US–Mexico border region, thereby holding timely public health implications.
Full article
Open AccessArticle
Revitalizing Dementia Care: Empowering Lives Through Personalized Exercise and Advanced Technologies
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Anamarija Kejžar, Vlado Dimovski, Francesco Miele, Vojko Strojnik, Katri Maria Turunen and Simon Colnar
Healthcare 2025, 13(18), 2294; https://doi.org/10.3390/healthcare13182294 (registering DOI) - 13 Sep 2025
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Background/Objectives: The known benefits of sport and exercise for people with dementia (PwD) and their caregivers mean that physical activity could be prioritized over pharmacological treatment. Research suggests that physical activity not only enhances the overall wellbeing of PwD, but also improves
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Background/Objectives: The known benefits of sport and exercise for people with dementia (PwD) and their caregivers mean that physical activity could be prioritized over pharmacological treatment. Research suggests that physical activity not only enhances the overall wellbeing of PwD, but also improves the relationships and wellbeing of their caregivers. The text examines the importance of physical activity for PwD and explores whether certain types of exercise, as well as modern tools like information and communication technology (ICT) and artificial intelligence (AI), are particularly suitable for this population given their different living environments, such as at home or in institutions. Methods: The study employed a qualitative design, conducting three focus groups (N = 17) in Slovenia with three distinct participant groups: informal caregivers (N = 6), physiotherapists in care homes (N = 7), and people diagnosed with dementia (N = 4). Data collection involved structured focus group discussions guided by key questions on types of exercise, challenges faced, and potential ICT and AI applications. Descriptive statistics including frequencies, means and standard deviations were used to summarize demographic data of respondents. Given the qualitative nature of the focus groups the emphasis was on thematic content analysis to identify common themes and insights supported by descriptive summaries to contextualize the findings. Results: The results suggest that regular physical activity tailored to an individual’s existing lifestyle and abilities can be essential for improving the quality of life of PwD. Although ICT and AI play an important role in promoting and monitoring regular physical activity and a sense of safety, the use of ICT and AI tools are still the exception, not the rule. Key barriers include inadequate awareness of existing solutions, cognitive decline, physical limitations, safety concerns, and limited access to appropriate programs. The study highlights the unused potential of ICT and AI for overcoming these barriers and offers solutions like personalized exercise—which refers to a physical activity program that is tailored to an individual’s specific needs, abilities, preferences, and goals—tracking, adaptive programs, and AI-driven virtual assistants that promote safety and encourage regular physical activity.
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Open AccessArticle
Mapping the Scientific Landscape Between Respiratory Conditions and Costs: A Bibliometric Analysis
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Ioannis Ch. Lampropoulos, Foteini Malli, Eleftherios Aggelopoulos, Angeliki Tsameti, Erasmia Rouka, Zoe Daniil and Konstantinos I. Gourgoulianis
Healthcare 2025, 13(18), 2293; https://doi.org/10.3390/healthcare13182293 (registering DOI) - 13 Sep 2025
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Introduction: The objective of the present study was to systematically explore the scientific literature to examine the relationship between respiratory diseases and economic cost. The research question focused on identifying the thematic, methodological, and temporal trends that link these two scientific fields. Methods:
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Introduction: The objective of the present study was to systematically explore the scientific literature to examine the relationship between respiratory diseases and economic cost. The research question focused on identifying the thematic, methodological, and temporal trends that link these two scientific fields. Methods: A comprehensive search was conducted in the PubMed database using the terms “Pulmonology OR respiratory” AND “Cost”, which returned 30,274 publications from 1921 up to April 2025. For the bibliometric review, VOSviewer software was used to create bibliometric maps through the tools of network, overlay, and density visualization. Results: The analysis revealed six clusters, which include clinical prognosis, pandemics, pharmacoeconomics, epidemiology, chronic conditions, and health services research. After 2010, there was a particularly important increase in academic research related to pulmonology and cost, with this rise being especially evident during and after the COVID-19 pandemic. Recent studies have increasingly focused on cost-effectiveness, quality of life, hospitalization, and multimorbidity. Discussion: The scientific field of respiratory conditions is undergoing a substantial transformation, shifting from traditional clinical descriptions to an interdisciplinary framework that incorporates economic evaluation. This evolution highlights the need for strategies based on economically informed decisions and effective public health policy making. The term “economic cost” in this study refers to both direct costs (e.g., hospitalization and treatment) and indirect economic impacts, such as resource allocation and healthcare burden. Conclusions: The findings demonstrate that research linking respiratory diseases and economic cost is expanding rapidly, particularly after the COVID-19 pandemic, and is characterized by interdisciplinary approaches that combine clinical, epidemiological, and economic perspectives. This trend underlines the importance of integrating cost-effectiveness considerations into respiratory healthcare policies and highlights the need for collaborative strategies to ensure sustainable and efficient health systems.
Full article
(This article belongs to the Special Issue Quality of Healthcare and Patient Safety Across Disciplines: Innovations, Evidence, and Practice)
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Open AccessArticle
Assessing the Impact of Computable Type 2 Diabetes Phenotypes on Predicting Healthcare Utilization Using Electronic Health Records and Administrative Claims
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Priyanka D. Sood, Star Liu, Chintan Pandya and Hadi Kharrazi
Healthcare 2025, 13(18), 2292; https://doi.org/10.3390/healthcare13182292 (registering DOI) - 12 Sep 2025
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Background/Objectives: Type 2 Diabetes (T2D) computable phenotypes, which leverage electronic health records (EHRs) and administrative claims data, provide the basis for T2D population health research. Our study investigates how T2D phenotypes affect downstream healthcare utilization prediction, specifically inpatient (IP) and emergency room
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Background/Objectives: Type 2 Diabetes (T2D) computable phenotypes, which leverage electronic health records (EHRs) and administrative claims data, provide the basis for T2D population health research. Our study investigates how T2D phenotypes affect downstream healthcare utilization prediction, specifically inpatient (IP) and emergency room (ER) admissions. Methods: This study included 15,338 adult patients from a large academic medical center with both EHR and claims data from 2017 to 2019. We compared widely adopted and locally developed T2D phenotypes. EHR predictors and claims-based outcomes were used for utilization prediction. Models were developed using a 70/30 training-and-test split over 100 iterations. Mean area under the curve (AUC), odds ratios (ORs), positive predictive values, and negative predictive values were reported. Results: Models had comparable performance in concurrent predictions. Impact of phenotypic variation impact was more apparent in prospective predictions. The CMS Chronic Conditions Data Warehouse (CCW) phenotype was more discriminatory in predicting concurrent IP and ER admissions (AUCs of 0.80 and 0.74) than prospective IP and ER visits (0.70 and 0.73) in 2019. Conclusions: Our study demonstrated how phenotypic variations and data sources impact healthcare utilization prediction in T2D patients. Furthermore, we highlight the significance of phenotype selection for targeted T2D population health initiatives and management strategies.
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Open AccessArticle
New Generation Automatic Massage Chairs for Enhancing Daytime Naps: A Crossover Placebo-Controlled Trial
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Ilias Ntoumas, Nikolas Antoniou, Christoforos D. Giannaki, Fotini Papanikolaou, Aggelos Pappas, Efthimios Dardiotis, Christina Karatzaferi and Giorgos K. Sakkas
Healthcare 2025, 13(18), 2291; https://doi.org/10.3390/healthcare13182291 - 12 Sep 2025
Abstract
Background/Objectives: Modern technology is transforming the field of massage, enhancing relaxation and wellness through innovative devices. The aim of the present study was to examine the effect of various massage protocols available using an automatic electric massage chair (AEMC) prior to daytime
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Background/Objectives: Modern technology is transforming the field of massage, enhancing relaxation and wellness through innovative devices. The aim of the present study was to examine the effect of various massage protocols available using an automatic electric massage chair (AEMC) prior to daytime napping on relaxation and indices of sleep quality. Methods: This study is a randomized, single-blind, placebo-controlled, four arm, interventional clinical trial. A total of 12 healthy individuals (21.8 ± 2.2 years, 6 F/6 M) were randomly assigned to four different groups: (1) the control (CON) session involving a 30 min rest on an automatic switch-off massage chair, (2) the easy-sleep (ES) massage session designed to promote sleep, (3) the fatigue-recovery (FR) massage session designed to reduce muscle fatigue, and (4) the worker-mode (WM) massage session designed to promote muscle relaxation. During the four sessions, participants sat in the massage chair for 30 min, followed immediately by an additional 30 min period of lying down on a standard double bed. Brain activity was monitored using a polysomnography EEG system, while validated tests and questionnaires assessed vitals and the state of relaxation. Results: The ES massage significantly reduced muscle tone by 12% and heart rate by 22% (p = 0.008 and p = 0.007, respectively). Additionally, it increased subjective sleepiness by 4.5% and sleep efficiency by 5.7% compared to the results for the control condition (p ≤ 0.005). Conclusions: It is evident that the use of an AEMC can reduce tension and improve feelings of relaxation. The easy-sleep program seems to be a promising non-pharmacological approach for enhancing relaxation and promoting daytime sleep, acting as a non-pharmacological tool to reduce stress, improve sleep quality, and promote workplace well-being. The trial was registered as NCT06784700.
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Open AccessArticle
Supporting Meaningful Choices: A Decision Aid for Individuals Facing Existential Distress and Considering Psilocybin-Assisted Therapy
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Ariane Bélanger, Sue-Ling Chang, Jean-François Stephan, Florence Moureaux, Diane Tapp, Robert Foxman, Pierre Gagnon, Johanne Hébert, Houman Farzin and Michel Dorval
Healthcare 2025, 13(18), 2290; https://doi.org/10.3390/healthcare13182290 - 12 Sep 2025
Abstract
Background/Objectives: Given the limitations of traditional approaches to treating existential distress in seriously ill patients, psilocybin-assisted therapy (PAT) has emerged as a promising treatment option. However, weighing up the potential risks and benefits of this approach can be challenging for both healthcare
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Background/Objectives: Given the limitations of traditional approaches to treating existential distress in seriously ill patients, psilocybin-assisted therapy (PAT) has emerged as a promising treatment option. However, weighing up the potential risks and benefits of this approach can be challenging for both healthcare professionals and patients. Decision aids can play a key role in supporting shared decision making by clarifying options, improving knowledge, and enhancing decision quality. To date, there is no decision aid specific to PAT. This descriptive study aimed to develop a decision aid for individuals considering this therapy. Methods: A paper-based/electronic decision aid was developed with a multidisciplinary steering committee following the International Patient Decision Aids Standards Collaboration (IPDAS). Development included conducting a literature review and prototype design, evaluating acceptability and usability by potential users (i.e., patients and healthcare professionals), and producing a final version. Questionnaires, direct feedback, and semi-structured interviews with potential users allowed for evaluation and refinement of design and content. Results: The final version of the decision aid is presented as a booklet, covering areas such as PAT education, comparison of treatment options, and personal reflection. Feedback from patients (n = 5) and healthcare professionals (n = 5) guided improvements, helping clarify content, ensuring balanced information, optimizing its length for usability, and providing decision-making support. Conclusions: The decision aid developed in this study demonstrated satisfactory acceptability and usability, meeting IPDAS criteria. By providing balanced and accessible information, it may facilitate shared decision-making for individuals considering PAT, representing a significant step forward in this emerging area of palliative care.
Full article
(This article belongs to the Special Issue Psychedelic Therapy in Palliative Care)
Open AccessReview
Wearables in Healthcare Organizations: Implications for Occupational Health, Organizational Performance, and Economic Outcomes
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Daniele Virgillito, Pierluigi Catalfo and Caterina Ledda
Healthcare 2025, 13(18), 2289; https://doi.org/10.3390/healthcare13182289 - 12 Sep 2025
Abstract
Background: Healthcare organizations face major challenges in protecting staff health and ensuring business continuity, particularly in high-risk settings. Wearable technologies are emerging tools to monitor occupational health indicators, improve staff safety, and strengthen organizational resilience. Objectives: This scoping review aimed to
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Background: Healthcare organizations face major challenges in protecting staff health and ensuring business continuity, particularly in high-risk settings. Wearable technologies are emerging tools to monitor occupational health indicators, improve staff safety, and strengthen organizational resilience. Objectives: This scoping review aimed to map the current evidence on wearable technologies in healthcare, focusing on their impact on occupational health, staff safety, and economic outcomes, as well as barriers and facilitators to their adoption. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Embase, CINAHL, sources from inception to July 2025. Studies were included if they evaluated wearable technologies used by healthcare workers and assessed outcomes related to occupational health, organizational resilience, absenteeism, presenteeism, or cost-effectiveness. The review followed the Arksey and O’Malley framework and PRISMA-ScR guidelines. Results: 31 studies met the inclusion criteria. Most were pilot or feasibility studies; only two randomized controlled trials were identified. The wearable technologies evaluated included continuous physiological monitoring devices, real-time location systems, hands-free communication tools, and consumer-grade devices. Evidence suggests potential benefits in improving staff safety, reducing stress and burnout, and enhancing workflow efficiency. However, economic evidence was limited and outcomes varied considerably. Barriers included alert fatigue, privacy concerns, interoperability challenges, and limited staff engagement. Facilitators included leadership support, user-centered design, and adequate infrastructure. Conclusions: Wearable technologies show promise for supporting occupational health and organizational resilience in healthcare, but evidence remains fragmented.
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(This article belongs to the Section Artificial Intelligence in Healthcare)
Open AccessArticle
Medical Complications Among Children and Adolescents with Sickle Cell Disease in Texas Medicaid
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Gloria N. Odonkor, Hyeun Ah Kang, Jamie C. Barner, Kenneth A. Lawson and Titilope Fasipe
Healthcare 2025, 13(18), 2288; https://doi.org/10.3390/healthcare13182288 - 12 Sep 2025
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Background: Patients with sickle cell disease (SCD) experience severe and life-threatening complications over their lifespans. However, research on SCD age-related complications is limited. Objective: This study examined differences in the number and type of SCD-related complications by age group among Texas
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Background: Patients with sickle cell disease (SCD) experience severe and life-threatening complications over their lifespans. However, research on SCD age-related complications is limited. Objective: This study examined differences in the number and type of SCD-related complications by age group among Texas Medicaid pediatric patients, and the factors associated with salient complications. Methods: This retrospective study used Texas Medicaid prescription and medical claims (2012–2021). Subjects aged 2 to 18 years, with ≥3 SCD hospitalizations or outpatient visits, and continuously enrolled for ≥12 months after the first SCD diagnosis claim were included. Complications were characterized by number and type of organ systems affected. Sociodemographic and clinical factors were used as potential factors associated with the most salient complications. Descriptive and inferential (ANOVA, Chi-square, and multivariable logistic regression) analyses were employed. Results: The included 1555 patients (mean age = 9.5 ± 5.1) were categorized into four age groups: 2–4 (23.4%), 5–9 (26.9%), 10–14 (27.4%), and 15–18 (22.3%) years. Documented number and type of complications differed significantly (all p < 0.0001) by age group, with the 2–14 years group having more documented complications compared to the 15–18 years group. Neurological complications were most common (~65%), followed by infections (~42%), and cardio-pulmonary complications (~30%). Young age group, hydroxyurea use, and having mental health comorbidities were associated with greater likelihood of experiencing vaso-occlusive crises, respiratory infections, and acute chest syndrome. Conclusions: Patterns of SCD-related complications (e.g., VOCs, respiratory infections, and acute chest syndrome) differ significantly by age group, leading to increased morbidity and acute care utilization. Despite its reported association with better outcomes, hydroxyurea utilization was found to be poor, with only 16% of patients receiving it for at least 180 days annually. Access to appropriate healthcare and improved utilization of hydroxyurea are needed to improve health outcomes of this population over their lifespan.
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Open AccessArticle
Efficacy of a Multicomponent Occupational Therapy Intervention on Balance, Functional Mobility, and Proprioception in Institutionalized Older Adults: A Randomized Controlled Pilot Trial
by
Alejandro Caña-Pino and Alba Marín-Rubio
Healthcare 2025, 13(18), 2287; https://doi.org/10.3390/healthcare13182287 - 12 Sep 2025
Abstract
Background: With the progressive aging of the in institutionalized settings population, functional decline—manifested as reduced proprioception, joint stiffness, and muscle loss—poses a growing threat to the autonomy and quality of life of older adults. Occupational therapy plays a central role in addressing
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Background: With the progressive aging of the in institutionalized settings population, functional decline—manifested as reduced proprioception, joint stiffness, and muscle loss—poses a growing threat to the autonomy and quality of life of older adults. Occupational therapy plays a central role in addressing these challenges through targeted, evidence-based interventions. Objectives: This clinical trial evaluates the effectiveness of a multicomponent occupational therapy intervention that integrates balance and postural stability exercises, proprioceptive stimulation, and lower-limb strengthening with conventional gerontogymnastics. The program was designed to improve gait performance, reduce fall risk, and promote independence in institutionalized older adults. Methods: A total of 35 community-dwelling older adults were randomly assigned to three groups: gerontogymnastics intervention (n = 13), multicomponent intervention (n = 13), and control (n = 9). Participants underwent a 6-week intervention comprising two 45 min sessions per week. Pre- and post-intervention assessments focused on postural stability and balance-related functional outcomes. Results: The multicomponent group exhibited trends toward improvement in balance, proprioception, and functional mobility, although these did not reach statistical significance. Clinically meaningful improvements were defined using minimally clinically important differences (MCIDs) for functional measures such as Timed UP and Go (TUG) (>1.3 s) and Performance-Oriented Mobility Assessment (POMA) (≥3 points). The multicomponent group showed a 22.1% improvement in proprioceptive accuracy and a 13.9% improvement in mobility (TUG). Additionally, this trend may indicate a potential protective effect against age-related functional decline. Conclusions: These findings suggest that a multicomponent occupational therapy intervention may help maintain mobility and reduce functional decline in institutionalized older adults. Statistically significant gains were observed in lower-limb strength, while other improvements—such as proprioception and balance—did not reach significance but approached clinical relevance. These preliminary results support further investigation into balance-specific training within occupational therapy to promote independence and reduce fall risk. Interpretation should remain cautious due to the small sample size (n = 35) and short intervention duration, which limit statistical power and generalizability.
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(This article belongs to the Special Issue Future Trends of Physical Activity in Health Promotion)
Open AccessPerspective
Delivering Musculoskeletal Rehabilitation in the Digital Era: A Perspective on Clinical Strategies for Remote Practice
by
Muhammad Alrwaily
Healthcare 2025, 13(18), 2286; https://doi.org/10.3390/healthcare13182286 - 12 Sep 2025
Abstract
The purpose of this perspective is to present a structured framework for delivering musculoskeletal (MSK) care via telerehabilitation, advocating for a fundamental shift in the mindset of physical therapists. Rather than viewing virtual care as a limited substitute, it is redefined as a
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The purpose of this perspective is to present a structured framework for delivering musculoskeletal (MSK) care via telerehabilitation, advocating for a fundamental shift in the mindset of physical therapists. Rather than viewing virtual care as a limited substitute, it is redefined as a clinically valid model that requires deliberate reengineering of traditional assessment and treatment practices. The article addresses three key questions: (1) How can MSK assessment and treatment be effectively delivered in the digital environment? (2) What clinical reasoning pathways can guide patient triage in virtual care? and (3) What value does telerehabilitation offer to both patients and therapists? The article outlines how MSK sessions can be conducted remotely through a systematic approach to preparation, subjective examination, and physical assessment, each adapted to both the constraints and opportunities of the digital environment. Core elements of in-person care are translated into telehealth-compatible formats, including visual observation, patient-guided special tests, and digitally administered patient-reported outcome measures. It further proposes clinical decision pathways that enable therapists to triage patients into three categories: those fully suitable for telehealth, those requiring hybrid care, and those needing referral. The value proposition of MSK telerehabilitation is discussed from both the patient and therapist perspectives, highlighting enhanced accessibility, efficiency, and patient empowerment. The article contrasts the in-person and telerehabilitation models, underscoring the elevated importance of communication, creativity, resourcefulness, and clinical reasoning in virtual contexts. Beyond current challenges such as regulatory ambiguity, reimbursement variability, and digital inequity, the article explores future directions for MSK care. These include integration of wearable technologies, AI-assisted assessments, and an evolving therapist role as a director of care within a digitally enabled system. Ultimately, this article offers not just a model for virtual MSK sessions, but a vision for sustainable, evidence-informed transformation in rehabilitation delivery.
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(This article belongs to the Section Digital Health Technologies)
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Open AccessSystematic Review
Integrating Multimorbidity Assessment into Rheumatology Care: Prognostic Role of the Charlson Comorbidity Index in Systemic Lupus Erythematosus
by
Ryuichi Ohta, Yoshinori Ryu, Chiaki Sano and Kunihiro Ichinose
Healthcare 2025, 13(18), 2285; https://doi.org/10.3390/healthcare13182285 - 12 Sep 2025
Abstract
Background/Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with significant morbidity and premature mortality. As patients with SLE often suffer from multiple comorbid conditions, evaluating the overall health burden is critical for improving risk stratification and long-term outcomes. The Charlson Comorbidity
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Background/Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with significant morbidity and premature mortality. As patients with SLE often suffer from multiple comorbid conditions, evaluating the overall health burden is critical for improving risk stratification and long-term outcomes. The Charlson Comorbidity Index (CCI) is a widely used tool for quantifying the burden of comorbidity. This systematic review and meta-analysis aimed to assess the prognostic value of the CCI for all-cause mortality in adult patients with SLE. Methods: We conducted a systematic review and meta-analysis in accordance with the PRISMA 2020 guidelines. Three databases (PubMed, Embase, and Web of Science) were searched up to May 2025. Three studies (n = 1175 participants) met the inclusion criteria. Eligible studies included adult SLE populations that evaluated the comorbidity burden using the CCI and reported all-cause mortality. Study characteristics and effect sizes were extracted, and a fixed-effects model (after considering both random- and fixed-effects approaches) was applied to calculate pooled odds ratios (ORs). Risk of bias was assessed using the Newcastle–Ottawa Scale. Results: Three observational studies (n = 1175 participants) met the inclusion criteria. All demonstrated a significant association between higher CCI scores and increased all-cause mortality. The pooled OR for mortality in patients with a high comorbidity burden was 3.92 (95% CI: 2.74–5.60), with no observed heterogeneity (I2 = 0%). The risk of bias was moderate to high across all studies. Conclusions: Multimorbidity, as measured by the CCI, is a strong independent predictor of mortality in SLE. Integrating comorbidity assessment into rheumatology care may enhance prognostic evaluation, guide personalized treatment, and support interdisciplinary management strategies for patients with complex disease profiles.
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(This article belongs to the Special Issue Innovative Strategies in Rheumatology Care)
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Open AccessArticle
Which Infectious Diseases Drive the Highest Absenteeism Costs—An Analysis Based on National Data Covering the Entire Polish Population in the Period of 2018–2023
by
Michał Seweryn, Grzegorz Juszczyk and Marcin Czech
Healthcare 2025, 13(18), 2284; https://doi.org/10.3390/healthcare13182284 - 12 Sep 2025
Abstract
Background: Infectious diseases pose a serious epidemiological and economic challenge for all healthcare systems. However, there is a lack of comprehensive analyses assessing the cost of absenteeism attributable to all infectious diseases. Our objective was to evaluate the burden of absenteeism-related costs due
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Background: Infectious diseases pose a serious epidemiological and economic challenge for all healthcare systems. However, there is a lack of comprehensive analyses assessing the cost of absenteeism attributable to all infectious diseases. Our objective was to evaluate the burden of absenteeism-related costs due to infectious diseases in comparison with other major public health challenges. Methods: We applied the human capital approach to estimate the indirect costs of absenteeism caused by infectious diseases in Poland between 2018 and 2023. In particular, we assessed the relative contribution of different groups of infectious diseases to the overall economic burden. Data were obtained from the Social Insurance Institution (ZUS). Results: The total cost of absenteeism due to infectious diseases in Poland during the six-year period was EUR 5.3 billion. Over 78% of these costs were attributed to pneumonia and other acute lower respiratory tract infections (ICD-10: J12–J22): EUR 1.89 billion, COVID-19 (ICD-10: U07–U09): EUR 1.82 billion, and influenza (ICD-10: J09–J11): EUR 444.5 million. Infectious diseases imposed a greater economic burden in terms of absenteeism than each of the three conditions used as comparators: malignant neoplasms, depression, and ischemic heart disease. Conclusions: Our six-year analysis of sickness absence in Poland indicates that infectious diseases—particularly during the COVID-19 pandemic—are major drivers of productivity loss. When compared with other leading public health challenges, their economic burden is substantial. These findings underscore the importance of investing in preventive measures, particularly vaccination programs.
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(This article belongs to the Special Issue Transforming Healthcare: Innovation, Economics, and Clinical Applications)
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Open AccessArticle
Concordance of an Artificial Intelligence Model (ChatGPT 4.0) with Physician Decisions in Smoking Cessation Clinics: A Comparative Evaluation
by
Yagmur Gokseven Arda and Guzin Zeren Ozturk
Healthcare 2025, 13(18), 2283; https://doi.org/10.3390/healthcare13182283 - 12 Sep 2025
Abstract
Background: Smoking is one of the leading causes of preventable mortality worldwide. Smoking cessation treatments require personalized therapeutic approaches. Artificial intelligence (AI) is increasingly utilized in clinical decision support systems; however, its role in smoking cessation treatment remains underexplored. This study aims to
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Background: Smoking is one of the leading causes of preventable mortality worldwide. Smoking cessation treatments require personalized therapeutic approaches. Artificial intelligence (AI) is increasingly utilized in clinical decision support systems; however, its role in smoking cessation treatment remains underexplored. This study aims to evaluate the concordance between ChatGPT-4.0-generated treatment recommendations and physician decisions in smoking cessation therapy. Methods: This retrospective and descriptive study was conducted by reviewing the electronic records of patients who presented to a Smoking Cessation Clinic. The ChatGPT-4.0 model was used to compare AI-generated treatment recommendations with physician-prescribed therapies. Concordance rates and the quality of AI-generated information (inappropriate, useful, or perfect information) were assessed. Statistical analyses were performed using SPSS 25.0. Results: A total of 82 patient records were analyzed. The mean age was 40.71 ± 12.87 years (range: 19–69). The overall concordance rate between physicians and ChatGPT-4.0 was 67.1%. Regarding ChatGPT-4.0-generated information quality, 32.9% of cases received inappropriate recommendations, 36.6% received useful recommendations, and 30.5% received optimal recommendations. ChatGPT-4.0 provided inappropriate recommendations in 81.5% of cases involving chronic diseases and 77.8% of cases involving regular medication use (p = 0.021, p = 0.030, respectively). ChatGPT-4.0 achieved the highest rate of optimal recommendations (52.0%) for cytisine therapy. Conclusions: ChatGPT-4.0 can serve as a supportive tool in smoking cessation treatment. However, it remains insufficient in managing complex clinical cases, emphasizing the necessity of physician oversight in final decision-making. Enhancing AI models with larger and more diverse datasets may improve the accuracy of treatment recommendations.
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(This article belongs to the Special Issue The Impact of Digital Technologies and AI-Powered Personalized Lifestyle Interventions on Health-Related Outcomes)
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Open AccessArticle
Teledentistry Improves Access to Oral Care: A Cluster Randomised Controlled Trial
by
Somayyeh Azimi, Basheer Bennamoun, Maryam Mehdizadeh, Janardhan Vignarajan, Di Xiao, Boyen Huang, Heiko Spallek, Michelle Irving, Estie Kruger, Marc Tennant and Mohamed Estai
Healthcare 2025, 13(18), 2282; https://doi.org/10.3390/healthcare13182282 - 12 Sep 2025
Abstract
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Objectives: There is a paucity of research evaluating the use of telehealth applications for preventive oral care, such as remote dental screening and oral health promotion. This study aimed to assess the efficacy of teledentistry in improving the oral health of school-aged children.
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Objectives: There is a paucity of research evaluating the use of telehealth applications for preventive oral care, such as remote dental screening and oral health promotion. This study aimed to assess the efficacy of teledentistry in improving the oral health of school-aged children. Methods: In this cluster randomised controlled trial, a total of 175 children aged 4–15 years were enrolled from six schools across Western Australia. The schools were randomly assigned to either the teledentistry or the control group. The intervention consisted of dental screening and oral health promotion. Qualified oral health therapists (OHTs) performed in-person dental examinations on participants in the control group. Different OHTs conducted dental photography-based screenings for participants in the teledentistry group. Both groups received screening reports and educational leaflets. Nine months later, in-person examinations were conducted on all participants in both groups to assess their dental condition and adherence to the dental advice provided at baseline. The primary outcomes included decay experience (dft/DFT index) and the proportion of children converting from a ‘caries-free’ state to a ‘caries-active’ state at the follow-up. Results: A total of 164 children completed the follow-up (mean age, 7.7 ± 2.4 years). At baseline, the prevalence of dental caries in the control and teledentistry groups was 47% and 46%, respectively. The incidence of dental caries in the teledentistry (10%) and control (12%) groups at follow-up was not significantly different (p = 0.7). Conclusion: The findings suggest that teledentistry has comparable efficacy to traditional preventive oral care in maintaining oral health. Teledentistry may offer a viable solution for expanding access to preventive oral care, especially for disadvantaged communities.
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