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
                
    
        
                    
    
        
    
    Insomnia and Neuroticism in Pakistani Medical Students: A Cross-Sectional Study
                        
    
                
            
                
        Healthcare 2025, 13(21), 2778; https://doi.org/10.3390/healthcare13212778 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background: Sleep disorders, particularly insomnia, represent a significant health concern in medical education. Neuroticism, characterized by emotional instability and stress reactivity, shows cross-sectional associations with sleep disturbances in healthcare trainees. Limited research examines these relationships among South Asian medical students. This cross-sectional
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            Background: Sleep disorders, particularly insomnia, represent a significant health concern in medical education. Neuroticism, characterized by emotional instability and stress reactivity, shows cross-sectional associations with sleep disturbances in healthcare trainees. Limited research examines these relationships among South Asian medical students. This cross-sectional study investigated insomnia symptom prevalence, personality correlates, and environmental factors among Pakistani medical students. Methods: We conducted a cross-sectional study among 364 undergraduate medical and dental students in Peshawar, Pakistan (June–November 2024). Data collection occurred during examination months. Data collection employed validated instruments: the Insomnia Severity Index (ISI) and the NEO Five-Factor Inventory neuroticism subscale (NEO-FFI-12). Statistical analyses included Pearson correlations, chi-square tests, and multivariate regression with interaction terms. Results: Among 364 participants (mean age 21.3 ± 2.3 years, 52.2% female), 47.0% reported severe insomnia symptoms (ISI 22–28), with 89.0% experiencing at least subthreshold symptoms (ISI ≥ 8) during the 2-week assessment period. These prevalence rates reflect symptom severity over a 2-week period during examination months and do not represent clinical diagnoses of chronic insomnia disorder, which requires ≥3 months of symptoms with clinical confirmation. High neuroticism (NEO-FFI ≥ 37) characterized 59.8% of students. Multivariate regression revealed a robust cross-sectional association between neuroticism and insomnia symptom severity (β = 0.239, 95% CI [0.173, 0.305], standardized β = 0.342, p < 0.001) and may reflect measurement during peak examination stress rather than stable trait-outcome relationships. Hostel residents showed non-significantly higher clinical insomnia prevalence than day scholars (75.9% vs. 67.5%, p = 0.081). Clinical-year students demonstrated significantly lower insomnia severity than pre-clinical students (β = −1.271, p < 0.001), a finding that contradicts assumptions about increasing stress through training progression. The neuroticism × living arrangement interaction was non-significant (p = 0.118); however, post hoc power analysis indicated the study was underpowered to detect small moderation effects, making this finding inconclusive. Conclusions: This study documents high insomnia symptom severity during a 2-week assessment period in Pakistani medical students, with a robust cross-sectional association with neuroticism. However, these findings must be interpreted within the constraints of the cross-sectional design, which cannot establish temporal precedence or causality between neuroticism and insomnia symptoms. These symptom prevalence rates likely reflect a combination of chronic sleep disorders and transient examination-related stress. Living arrangements showed small, non-significant associations with insomnia. The observed association between neuroticism and insomnia may be partially mediated or confounded by unmeasured variables, including academic stress, psychiatric comorbidities, substance use, and other sleep disorders. Findings suggest potential benefits from interventions addressing cognitive-emotional factors, though comprehensive diagnostic assessment is needed to distinguish chronic insomnia disorder from transient, stress-related sleep difficulties. Longitudinal research with objective sleep measures, structured psychiatric assessment, and systematic confounder evaluation is essential to establish causal relationships and intervention efficacy in this population.
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                    (This article belongs to the  Section Mental Health and Psychosocial Well-being)
            
        
        
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         Open AccessReview
    
    Open Notes in Mental Health: A Scoping Review of Stakeholder Experiences and Implications for Clinical Practice
                        
            by
                    Michela Monaci, Setareh Javaher and Serena Barello        
    
                
        
        Healthcare 2025, 13(21), 2777; https://doi.org/10.3390/healthcare13212777 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background/Objectives: Open Notes—defined as patients’ electronic, portal-based access to clinicians’ narrative documentation within electronic health records (EHRs)—has become routine through policy and portal initiatives. In mental health (MH), transparency intersects with sensitive formulation and risk language, making outcomes contingent on documentation practices, release
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            Background/Objectives: Open Notes—defined as patients’ electronic, portal-based access to clinicians’ narrative documentation within electronic health records (EHRs)—has become routine through policy and portal initiatives. In mental health (MH), transparency intersects with sensitive formulation and risk language, making outcomes contingent on documentation practices, release timing, and reader support. This scoping review mapped empirical evidence on experiences, perceived impacts, and implementation of Open Notes in MH across stakeholders and settings, deriving implications for practice, training, and policy. Methods: A PRISMA-ScR-guided review was conducted with a preregistered protocol on OSF. Eligible studies examined Open Notes in MH settings and reported stakeholder perspectives. Two reviewers independently screened and extracted data, analyzed through inductive narrative thematic synthesis. Results: Twenty-two studies (2012–2025) from the USA, Sweden, Germany, Canada, and international settings included surveys, qualitative interviews, mixed-methods designs, pilot and quasi-experimental implementations, and a Delphi consensus. Patients consistently reported improved comprehension, recall, empowerment, and—in some cases—greater trust. Large surveys identified error detection and patient-initiated corrections as safety mechanisms, while a minority reported worry or feeling judged by wording. Clinicians adapted documentation—modifying tone, wording, or candor—to minimize misinterpretation. Workload effects were generally modest, limited to occasional clarifications. Implementation and expert studies emphasize organizational readiness, training, patient preparation, and privacy-aware portal design as key enablers of safe transparency. Conclusions: In MH, Open Notes function as a communication and engagement tool that strengthens partnership, comprehension, and safety when implemented with attention to risk-sensitive documentation and privacy safeguards.
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    Open AccessReview
    
    Small Intestine Tumors: Diagnostic Role of Multiparametric Ultrasound
                        
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                    Kathleen Möller, Christian Jenssen, Klaus Dirks, Alois Hollerweger, Heike Gottschall, Siegbert Faiss and Christoph F. Dietrich        
    
                
        
        Healthcare 2025, 13(21), 2776; https://doi.org/10.3390/healthcare13212776 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Small intestine tumors are rare. The four main groups include adenocarcinomas, neuroendocrine neoplasms (NEN), lymphomas, and mesenchymal tumors. The jejunum and ileum can only be examined endoscopically with device-assisted enteroscopy techniques (DAET), which are indicated only when specific clinical or imaging findings are
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            Small intestine tumors are rare. The four main groups include adenocarcinomas, neuroendocrine neoplasms (NEN), lymphomas, and mesenchymal tumors. The jejunum and ileum can only be examined endoscopically with device-assisted enteroscopy techniques (DAET), which are indicated only when specific clinical or imaging findings are present. The initial diagnosis of tumors of the small intestine is mostly made using computed tomography (CT). Video capsule endoscopy (VCE), computed tomography (CT) enterography, and magnetic resonance (MR) enterography are also time-consuming and costly modalities. Modern transabdominal gastrointestinal ultrasound (US) with high-resolution transducers is a dynamic examination method that is underrepresented in the diagnosis of small intestine tumors. US can visualize wall thickening, loss of wall stratification, luminal stenosis, and dilatation of proximal small-intestinal segments, as well as associated lymphadenopathy. This review aims to highlight the role and imaging features of ultrasound in the diagnosis of small-intestinal tumors.
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    Open AccessSystematic Review
    
    A Systematic Review of Smartphone Applications That Address Patient Care in the Peri-Operative Period
                        
            by
                    Hadal El-Hadi, Brandon Lok-Hang Chan, Brian Wai-Hei Siu, Ivan Ching-Ho Ko, David Ka-Wai Leung, Jeremy Yuen-Chun Teoh, Peter Ka-Fung Chiu, Chi-Fai Ng and Alex Qinyang Liu        
    
                
        
        Healthcare 2025, 13(21), 2775; https://doi.org/10.3390/healthcare13212775 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background: The use of smartphone applications by patients can be utilized to transform peri-operative care. With the ever-evolving landscape, an updated systematic review is needed in this field. Objective: This study aims to summarize the smartphone-based applications used by patients as
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            Background: The use of smartphone applications by patients can be utilized to transform peri-operative care. With the ever-evolving landscape, an updated systematic review is needed in this field. Objective: This study aims to summarize the smartphone-based applications used by patients as discussed in the academic literature in the setting of peri-operative patient care. Methods: Seven databases were searched to identify articles discussing the use of smartphone applications by patients peri-operatively. Articles were included if they examined the use of smartphone-based applications in the setting of the peri-operative period and examined the application’s usability and effectiveness. Each paper was appraised using CASP checklists and analyzed using the thematic synthesis method. Results: Overall, 18 articles were selected for this study from 8204 articles initially obtained. The themes that emerged from the analysis include the following benefits of smartphone applications in peri-operative patient care: (1) patient education and instruction, (2) clear communication, (3) decreasing complications and the use of healthcare resources, (4) post-operative monitoring and pain control, (5) improved patient support, satisfaction, and safety. Other themes also emerged such as requirements of a practical smartphone application, what to include in smartphone application assessments, limitations of smartphone application studies, and future directions of smartphone applications regarding patient peri-operative care. Conclusions: The landscape of mobile applications is exponentially growing and their use in the peri-operative period is imminent for the future. Their use can improve communication between surgical care professionals, enhance patient care in the peri-operative period, and strengthen medical education. Further studies, validation tools, and improvements will be required to implement their use and demonstrate outcomes that can guide recommendations surrounding their use.
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                    (This article belongs to the  Special Issue Advances in eHealth for Healthcare)
            
        
        
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Open AccessArticle
    
    Patients’ Awareness and Attitudes About the Importance of Sharing Medical History with Dentists in Riyadh, Saudi Arabia
                        
            by
                    Khalid A. Abalkhail, Sanjeev B. Khanagar, Alanoud Alfawaz, Rand Alharbi, Deem Alsaykhan and Layan Alqahtani        
    
                
        
        Healthcare 2025, 13(21), 2774; https://doi.org/10.3390/healthcare13212774 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background: A comprehensive medical history is fundamental to dental care, supporting accurate diagnosis, personalized treatment, and the prevention of adverse outcomes. Despite its importance, patients may underestimate its relevance or hesitate to disclose information to dental professionals. This study aimed to assess
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            Background: A comprehensive medical history is fundamental to dental care, supporting accurate diagnosis, personalized treatment, and the prevention of adverse outcomes. Despite its importance, patients may underestimate its relevance or hesitate to disclose information to dental professionals. This study aimed to assess patients’ awareness and willingness to disclose medical histories to dental professionals, as well as the effect of an educational intervention on their knowledge. Methods: A descriptive cross-sectional study was conducted from 1 December 2023 to 30 September 2024 in Riyadh, Saudi Arabia. Data were collected through a structured bilingual questionnaire assessing demographics, awareness of the importance of medical history, willingness to disclose information, and post-intervention knowledge. The questionnaire’s validity and reliability were established through expert evaluation and test–retest reliability, yielding Aiken’s V values greater than 0.90. Internal consistency was confirmed with a Cronbach’s alpha coefficient of 0.8. A convenience sampling technique was used to recruit the study participants. Results: A total of 515 participants completed the survey, with 43.9% withholding medical information from their dentists. Chi-square analysis revealed that disclosure practices were significantly associated with demographic factors, particularly age (p ≤ 0.05). Although 90.7% acknowledged the importance of sharing their medical history, only 67.8% reported disclosing it to dental professionals. The regression analysis revealed that participants under 18 years of age (Odds Ratio (OR) 7.08, Confidence Interval (CI) 3.53–50.90) and those aged 18–29 years (OR 14.36, CI 3.45–25.26), as well as participants with elementary (OR 4.55, CI 2.72–20.57) and middle school education levels (OR 4.55, CI 2.72–20.57), were less likely to disclose any underlying medical condition to their dentist. The younger age group (under 18) respondents were significantly more likely to indicate that it was not essential to inform the dentist about their medical condition (OR 6.60, CI 1.05–41.42). Additionally, a significant number of these respondents (OR 5.77, CI 1.87–17.84) reported being unaware of the reasons why dentists request this information, compared to the older age groups. Conclusions: The findings reveal a significant knowledge gap concerning patient disclosure of medical history in dental care and highlight the importance of patient education. Implementing targeted educational initiatives is recommended to promote patient disclosure, foster interdisciplinary collaboration, and improve overall patient safety and treatment outcomes.
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                    (This article belongs to the  Special Issue Oral and Maxillofacial Health Care: Third Edition)
            
        
        
    Open AccessReview
    
    Cultural and Social Determinants of Physical Therapy Rehabilitation in Saudi Arabia: A Narrative Review
                        
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                    Asma Alonazi        
    
                
        
        Healthcare 2025, 13(21), 2773; https://doi.org/10.3390/healthcare13212773 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background: Modern rehabilitation approaches, encompassing physical, emotional, and social aspects, are gaining momentum in healthcare systems worldwide; however, their acceptance and effectiveness vary across different cultural contexts. Objective: This narrative review aims to produce a culturally informed overview of barriers and enablers, highlighting
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            Background: Modern rehabilitation approaches, encompassing physical, emotional, and social aspects, are gaining momentum in healthcare systems worldwide; however, their acceptance and effectiveness vary across different cultural contexts. Objective: This narrative review aims to produce a culturally informed overview of barriers and enablers, highlighting possible strategies to better align evidence-based rehabilitation with Saudi sociocultural realities. Methods: Drawing on literature from 2010 to 2024, this narrative review was conducted by searching the peer-reviewed literature from PubMed, Scopus, and the Saudi Digital Library using focused keywords. PICO framework was used to define inclusion and exclusion criteria. Relevant studies addressing cultural influences on rehabilitation adoption were included. Results: 1565 articles were initially identified from PubMed, Scopus, and the Saudi Digital Library. After careful screening, eight articles were included in the narrative review. We witnessed key factors relevant to the context of Saudi Arabia deriving health-seeking behaviors to be modesty, fatalism, family support, and religion. Factors possibly associated with the influence of physical therapy rehabilitation were gender, communication barriers, traditional healing practices, and culture and parental involvement. Conclusions: In Saudi Arabia, rehabilitation service utilization and practices may be prone to cultural factors. It is of utmost importance that healthcare providers step in and make sure that they sensitize themselves with cultural-specific awareness, knowledge, and competency to deliver optimal rehabilitation healthcare services that meet the standards and needs of the Saudi community.
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                    (This article belongs to the  Special Issue Holistic Approaches to Health and Nutrition: The Impact of Lifestyle, Nutrition and Stress Management on Physical and Mental Well-Being)
            
        
        
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Open AccessSystematic Review
    
    Smart Speakers for Health and Well-Being of Older Adults: A Mixed-Methods Review
                        
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                    Michael Joseph Dino, Carla Leinbach, Gerald Dino, Ladda Thiamwong, Chloe Margalaux Villafuerte, Mona Shattell, Justin Pimentel, Maybelle Anne Zamora, Anbel Bautista, John Paul Vitug, Joyline Chepkorir and Nerceilyn Marave        
    
                
        
        Healthcare 2025, 13(21), 2772; https://doi.org/10.3390/healthcare13212772 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background: Rapid population aging poses significant challenges to health and wellness systems, necessitating innovative technological interventions. Smart home technologies, particularly voice-activated intelligent assistants (smart speakers), represent a promising avenue for supporting aging populations. Objectives: This study critically examines the empirical literature on smart
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            Background: Rapid population aging poses significant challenges to health and wellness systems, necessitating innovative technological interventions. Smart home technologies, particularly voice-activated intelligent assistants (smart speakers), represent a promising avenue for supporting aging populations. Objectives: This study critically examines the empirical literature on smart speakers’ influence on older adults’ health and well-being, mapping the characteristics of existing studies, assessing the current state of this domain, and providing a comprehensive overview. Methods: A mixed-methods systematic review was conducted in accordance with published guidelines. Bibliometric data, article purposes and outcomes, keyword network analysis, and mixed-methods findings from articles retrieved from five major databases were managed through the Covidence and VosViewer applications. Results: The majority of studies were conducted in the American region. Bibliometric analysis revealed five predominant thematic clusters: health management, psychological support, social connectedness, technology adoption, and usability. Findings demonstrated multifaceted benefits across several domains. Older adults reported improvements in daily living activities, enhanced emotional well-being, strengthened social connections, and overall health benefits. Qualitative evidence particularly emphasized the advantages of medication adherence, routine maintenance, and facilitated social support. However, mixed-method synthesis revealed significant barriers to adoption and sustained use, including privacy concerns, technical difficulties, cost constraints, and limited digital literacy among older users. Conclusions: The integration of smart speakers into the homes of older adults offers considerable potential to enhance technological wellness and promote successful aging in place, underscoring the need for structured integration of smart speaker technology and human-centered designs within geriatric care systems.
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                    (This article belongs to the  Section Digital Health Technologies)
            
        
        
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Open AccessSystematic Review
    
    Advancing Evidence-Based Nursing: The Updated German Expert Standard on Continence Promotion
                        
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                    Julien Pöhner, Julia Kaiser, Moritz Krebs, Andreas Büscher and Daniela Hayder-Beichel        
    
                
        
        Healthcare 2025, 13(21), 2771; https://doi.org/10.3390/healthcare13212771 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background: Incontinence is a widespread and socially taboo phenomenon worldwide. Incontinence, with its various manifestations, is one of the most common illnesses in outpatient medical care and represents a serious health problem for those affected of all ages. As part of the second
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            Background: Incontinence is a widespread and socially taboo phenomenon worldwide. Incontinence, with its various manifestations, is one of the most common illnesses in outpatient medical care and represents a serious health problem for those affected of all ages. As part of the second update of the German expert standard published in 2024 on continence promotion, a systematic literature review was conducted to identify, appraise, and synthesize current evidence on nursing interventions to promote urinary and fecal continence. The expert standard does not provide a gradation of recommendations, but rather that the criteria depicted in the standard have the highest possible recommendation character in the sense of the best available knowledge. The aim of this article is to present the examination of available evidence within the context of the second update of the expert standard. Methodology: A systematic literature review was conducted between September and December 2022 with additional guideline research in December 2023 in Medline (via PubMed), CINAHL (via EBSCO), and the Cochrane Library, using predefined inclusion and exclusion criteria. Additional guideline databases and organizational websites were searched manually. The review process and reporting were guided by PRISMA 2020 reporting standards. Eligible studies included qualitative, quantitative, and guideline publications in English or German published since 2012. Study selection, data extraction, and critical appraisal were conducted independently by two reviewers. Results: Of 2850 initial records, 60 studies met the inclusion criteria and were included in the review. The majority were systematic reviews and evidence-based guidelines. The central literature-based results of the expert standard are presented based on the steps of the nursing process. The findings were thematically synthesized along the steps of the nursing process and informed key nursing interventions for continence promotion and compensation, including assessment, patient education, pelvic floor training, and selection of continence aids. Discussion: There are a variety of evidence-based interventions that can be used to deal with urinary and/or fecal incontinence and the tasks that professional nurses take on in promoting continence are complex. Patients and their relatives want information and advice on treatment options, reliable contacts and individual support offers to make informed decisions.
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    Knowledge, Attitudes, and Practices Toward Weight Management Among Patients with Type 2 Diabetes Mellitus in Saudi Arabia: A Cross-Sectional Study
                        
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                    Miyad Khazna, Abdullah Zaki Al-Fahd, Jomanah Atyah Alatawi, Badriah Almotiri, Remas Abdulrahman Alduwaish, Rahaf Alanazi, Khalid Albedaiwi and Sharfuddin Chowdhury        
    
                
        
        Healthcare 2025, 13(21), 2770; https://doi.org/10.3390/healthcare13212770 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background/Objectives: Weight management is crucial for preventing and managing diabetes. This study aimed to evaluate the knowledge, attitude, and practice (KAP) of people with Type 2 Diabetes Mellitus (T2DM) regarding weight management in Saudi Arabia. Methods: This cross-sectional survey of patients
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            Background/Objectives: Weight management is crucial for preventing and managing diabetes. This study aimed to evaluate the knowledge, attitude, and practice (KAP) of people with Type 2 Diabetes Mellitus (T2DM) regarding weight management in Saudi Arabia. Methods: This cross-sectional survey of patients with T2DM in Saudi Arabia was conducted from October 2024 to February 2025. Participants completed a self-administered online questionnaire, which was validated and adapted from a previous study. Results: Among 385 individuals, 60.0% were females, and 34.0% were between 18 and 25 years old. The average scores for knowledge, attitude, and practice were 8.7 ± 3.6 (possible range: 0–13), 28.5 ± 4.4 (possible range: 10–50), and 28.3 ± 4.0 (possible range: 9–45), respectively. Pearson’s correlation analysis shows no significant correlation between knowledge and attitude (r = −0.016, p = 0.750). However, a weak yet statistically significant positive correlation was found between knowledge and practice (r = 0.155, p = 0.002). Additionally, a moderate negative correlation was observed between attitude and practice (r = −0.353, p = 0.001). Conclusions: The participants exhibited moderate knowledge, negative attitudes, and moderate practices regarding weight management. These findings provide crucial guidance for developing healthcare strategies to improve the KAP of diabetic patients in weight management.
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                    (This article belongs to the  Section Public Health and Preventive Medicine)
            
        
        
    Open AccessArticle
    
    Mental Health Factors Related to Quality of Life in Older Adults Using Long-Term Care Services in Mexico
                        
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                    Christian Díaz de León-Castañeda, Ana Celia Anguiano-Morán, Elva Rosa Valtierra-Oba, Barbara Monica Lemus-Loeza, Gabriela Galván-Villalobos, Ericka Ivonne Cervantes-Pacheco, Christian Cortés-Rojo, Rocío Montoya-Pérez and Alaín Raimundo Rodríguez-Orozco        
    
                
        
        Healthcare 2025, 13(21), 2769; https://doi.org/10.3390/healthcare13212769 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background: Older adults are a vulnerable population wherein their advancing age leads to limitations in physical and mental functionality that can compromise quality of life. Objective: The objective of this study was to analyze the relationship between mental health factors and quality of
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            Background: Older adults are a vulnerable population wherein their advancing age leads to limitations in physical and mental functionality that can compromise quality of life. Objective: The objective of this study was to analyze the relationship between mental health factors and quality of life in older adult users of long-term care services in Mexico. Methods: The present cross-sectional study was conducted with a convenience sample of 131 older adult users of long-term care services (three residential care homes and a day center) in Morelia, Michoacán, Mexico. A questionnaire including the World Health Organization Quality of Life Older Adults Scale (WHO-QoL-Old), Geriatric Depression Scale (GDS), Hamilton Anxiety Rating Scale (HARS), Cognitive Reserve Questionnaire (CRQ), and sociodemographic variables was administered. The analysis of the relationship between variables was performed using bivariate analysis (comparisons between groups and Pearson correlations). Due to the type of sampling, the representativeness of the sample obtained was not evaluated. Results: Depression and anxiety were found to inversely influence overall quality of life and its dimensions, while cognitive reserve is a factor that favors quality of life. Also, as related to cognitive reserve, level of education was found to be a factor that favors quality of life. Conclusions: Older adult users of long-term care services are a vulnerable group, given the negative impact on their quality of life that some mental health conditions could have, such as depression, anxiety, and low cognitive reserve.
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                    (This article belongs to the  Special Issue Aging and Quality of Life: Second Edition)
            
        
        
    Open AccessArticle
    
    Clinical and Psychosocial Predictors of Physical Activity in Systemic Lupus Erythematosus: A Multicentre Cross-Sectional Study
                        
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                    Alba Castañón-Fernández, Rubén Cuesta-Barriuso and José María Torres-Quiles        
    
                
        
        Healthcare 2025, 13(21), 2768; https://doi.org/10.3390/healthcare13212768 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background/Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterised by musculoskeletal manifestations such as myopathies, arthritis, and arthralgia. Physical activity may improve patients’ quality of life and overall wellbeing. This study aimed to evaluate physical activity levels in patients with
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            Background/Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterised by musculoskeletal manifestations such as myopathies, arthritis, and arthralgia. Physical activity may improve patients’ quality of life and overall wellbeing. This study aimed to evaluate physical activity levels in patients with SLE and identify how clinical, psychosocial, and sociodemographic factors influence these levels. Methods: A multicentre cross-sectional study was conducted including 64 patients with SLE. Clinical variables were obtained from medical records, and patient-reported outcomes were collected at the time of the survey. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ-SF). Independent variables included fatigue (FAS), quality of life (SF-36), sleep (PSQI), depression (BDI-II), anxiety (HARS), age, disease factors (activity, duration, damage), sex, smoking, and comorbidities. Results: Significant associations were found between physical activity levels and smoking status (χ2 = 11.88; p = 0.003), sleep quality (χ2 = 6.81; p = 0.03), and anxiety (χ2 = 18.39; p = 0.001). In multivariable analyses, poor sleep (PSQI > 5) (OR = 14.40; 95% CI: 2.50–82.99), higher anxiety (HARS; per point OR = 1.12; 95% CI: 1.05–1.20), and higher SF-36 Physical Component Summary (PCS) scores (per point OR = 1.29; 95% CI: 1.15–1.45) were associated with being in a higher physical activity category. Given the counterintuitive direction for sleep and the limited model fit, these results should be interpreted cautiously. Conclusions: In patients with SLE, physical activity was associated with sleep disturbances, anxiety, and perceived physical health. These findings underscore the need to integrate psychosocial and behavioural factors into multidisciplinary strategies promoting physical activity in lupus care and provide a rationale for future longitudinal and interventional studies to validate and extend these associations.
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                    (This article belongs to the  Special Issue Physical Exercise in Chronic Diseases: Assessment, Implementation and Effectiveness)
            
        
        
    Open AccessArticle
    
    Visceral Adiposity and Lower-Body Strength and Endurance in Women: Correlations Using BIA and the Chair Stand Test
                        
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                    Nouf Abdulaziz Aljawini        
    
                
        
        Healthcare 2025, 13(21), 2767; https://doi.org/10.3390/healthcare13212767 (registering DOI) - 31 Oct 2025
    
                            
    
                    
        
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            Background: Visceral adipose tissue (VAT) around internal organs is strongly related to metabolic disorders. While its metabolic effects are well-established, its influence on musculoskeletal function, particularly lower-body strength and endurance in women, remains underexplored. Lower-body strength is essential for mobility, independence, and fall
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            Background: Visceral adipose tissue (VAT) around internal organs is strongly related to metabolic disorders. While its metabolic effects are well-established, its influence on musculoskeletal function, particularly lower-body strength and endurance in women, remains underexplored. Lower-body strength is essential for mobility, independence, and fall prevention. The 30 s chair stand test (30CST) is a reliable measure of lower-body function, and bioelectrical impedance analysis (BIA) offers a non-invasive method for evaluating VAT. Despite its potential, BIA remains underutilized in clinical practice. Integrating these tools could provide critical insights into how VAT affects functional health and guide evidence-based interventions. Objective: To examine the relationship between visceral adiposity, quantified by visceral fat rating (VFR) via BIA, and lower-body strength and endurance assessed by the 30CST in women. Methods: A cross-sectional study of 131 Saudi women examined VAT using BIA with VFR as a VAT marker. Lower-body strength and endurance were evaluated using the 30CST. Spearman’s rank correlation was employed to explore relationships between VFR and 30CST. Results: The median age was 56 (IQR 45–61). The median VFR was 10 (IQR 7–12), and the median 30CST score was 8 (IQR 7–10). In the entire sample, a significant negative correlation was observed between VFR and 30CST performance (r = −0.4106, p < 0.0001). Women with obesity (n = 73) had significantly higher VFR (12, IQR 10–13) compared to women without obesity (n = 58), who had a median VFR of 7 (IQR 6–9) (p < 0.0001). In contrast, women with obesity had significantly lower 30CST (8, IQR 6–9) compared to those without obesity (9, IQR 8–11) (p = 0.0004). Additionally, the entire sample had significant negative correlations between 30CST and age, weight, BMI, %BF, FM, and FFM (p < 0.05). Conclusions: Elevated visceral fat is associated with lower lower-body strength and endurance in women, highlighting the value of routine visceral fat assessment for guiding musculoskeletal health evaluation and management.
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                    (This article belongs to the  Special Issue Integrative Approaches to Musculoskeletal Disorders, Health-Related Issues and Physical Fitness: From Diagnosis to Management)
            
        
        
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Open AccessSystematic Review
    
    Identifying Key Factors in Adherence and Dropouts in Active Physiotherapy in Children with Acute Leukemia: A Systematic Review with Meta-Analysis and Meta-Regression
                        
            by
                    Laura Ramírez-Pérez and Noelia Moreno-Morales        
    
                
        
        Healthcare 2025, 13(21), 2766; https://doi.org/10.3390/healthcare13212766 - 30 Oct 2025
    
                            
    
                    
        
                    Abstract 
            
            
                        
    
            Background/Objectives: Adherence to active physiotherapy programs in children suffering from cancer is essential to enhance the improvement generated by the treatment. Therefore, the main aim of this review was to identify the factors influencing adherence and dropout rates in exercise programs applied
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            Background/Objectives: Adherence to active physiotherapy programs in children suffering from cancer is essential to enhance the improvement generated by the treatment. Therefore, the main aim of this review was to identify the factors influencing adherence and dropout rates in exercise programs applied to children with acute lymphoblastic leukemia. Methods: A systematic review with meta-analysis and meta-regression was conducted. The search was performed using PubMed, Scopus, Embase, SPORTDiscus, and PEDro databases. Eligible studies included randomized controlled trials focusing on determining adherence in active physiotherapy programs compared to standard care. A meta-synthesis was performed together with a random-effects meta-analysis. Furthermore, a proportion meta-analysis was developed, dividing by exercise modality, and a multivariate regression was performed to determine what factors were able to moderate the dropout rates. Results: Thirteen studies were selected, including 654 patients. Of them, 8 studies opt for multicomponent exercise, 3 used strength, and 2 selected virtual reality-based treatment. Overall, dropout rates were similar between groups. However, dropout proportions varied by intervention type, with minor attritions in strength (8.6%) and exergaming interventions (8.7%) compared to multicomponent exercise programs (18.4%). Meta-regression did not identify statistically significant moderators of dropouts. Conclusions: The heterogeneity of the studies in this target population meant that no factor could be identified as a moderator of dropouts, but exercise modality stands out as a potential moderator of adherence. Therefore, future studies should develop and test adherence-enhancing strategies to facilitate clinical implementation.
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                    (This article belongs to the  Special Issue Healthcare Resilience and Patient Adherence in Rehabilitation)
            
        
        
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Open AccessArticle
    
    The Impact of Internet and Mobile Phone Usage and Unemployment on Adult Obesity: Empirical Evidence from the BRICS States
                        
            by
                    Gamze Sart, Yilmaz Bayar, Marina Danilina and Marius Dan Gavriletea        
    
                
        
        Healthcare 2025, 13(21), 2765; https://doi.org/10.3390/healthcare13212765 - 30 Oct 2025
    
                            
    
                    
        
                    Abstract 
            
            
                        
    
            Background/Objectives: The number of overweight and obese people has significantly increased in the world, and this phenomenon is referred to as globesity. Globally increasing obesity has become one of the major problems to be dealt with for countries, given obesity-related health problems,
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            Background/Objectives: The number of overweight and obese people has significantly increased in the world, and this phenomenon is referred to as globesity. Globally increasing obesity has become one of the major problems to be dealt with for countries, given obesity-related health problems, including nutrition-related noncommunicable diseases and some types of cancer, and the economic and social costs of obesity. Therefore, countries try to combat obesity through diverse strategies related to nutrition, physical activity, and education. In this regard, identifying the factors behind obesity is critical to making progress in the fight against obesity. Methods: This study explores the interplay amongst ICT (information and communication technologies) indicators, including Internet and mobile phone usage, unemployment, and adult obesity in the BRICS states from 1995 to 2022, using recently developed cointegration techniques and causality tests. Results: The outcomes of causality tests uncover an interaction between Internet and mobile phone usage, unemployment, and adult obesity. In addition, the cointegration coefficients reveal that Internet and mobile phone usage positively impact adult obesity, while unemployment has a negative effect on adult obesity. Conclusions: Our outcomes uncover that improper use of the Internet and mobile phones foster adult obesity, but proper utilization of the Internet and mobile phones can be effective instruments in combatting adult obesity through increasing the awareness of healthy lifestyles and online weight loss programs.
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                    (This article belongs to the  Special Issue Obesity and Overweight: Prevention, Causes and Treatment)
            
        
        
    Open AccessArticle
    
    Overall Health Status of Patients with Mild-to-Moderate Cubital Tunnel Syndrome: A Case–Control Study
                        
            by
                    Michał Wieczorek and Tomasz Wolny        
    
                
        
        Healthcare 2025, 13(21), 2764; https://doi.org/10.3390/healthcare13212764 (registering DOI) - 30 Oct 2025
    
                            
    
                    
        
                    Abstract 
            
            
                        
    
            Objectives: This cross-sectional case–control study, conducted at the Department of Physiotherapy, Academy of Physical Education, in Katowice, between July 2022 and April 2023, aimed to assess the overall health status (OHS) of patients with mild-to-moderate cubital tunnel syndrome (CuTS) compared with a
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            Objectives: This cross-sectional case–control study, conducted at the Department of Physiotherapy, Academy of Physical Education, in Katowice, between July 2022 and April 2023, aimed to assess the overall health status (OHS) of patients with mild-to-moderate cubital tunnel syndrome (CuTS) compared with a healthy control population. Methods: The SF-36 questionnaire was used to evaluate the following domains: physical functioning (PF), role limitations due to physical health problems (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH). Results: A total of 152 participants were enrolled in the study. The CuTS and control groups consisted of 82 and 70 individuals, respectively. The CuTS group had significantly lower scores in most domains when compared with the control group; however, no significant difference was observed in the BP domain. Notably, the VT domain showed a statistically significant difference in favor of the CuTS group, indicating slightly higher perceived vitality despite functional limitations. Conclusions: Mild and moderate forms of CuTS are associated with significant deterioration in general health, encompassing both physical and psychological components, as assessed by the SF-36 questionnaire; however, no significant difference was observed in the BP domain, suggesting that the burden of CuTS may manifest more strongly in functional, psychosocial, and mental health aspects rather than in generalized pain perception. These findings highlight the importance of a comprehensive evaluation and management strategy that addresses both physical and psychosocial dimensions of patient care.
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                    (This article belongs to the  Special Issue Patient Experience and the Quality of Health Care)
            
        
        
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Open AccessSystematic Review
    
    The Impact of Social Media on Health Behaviors, a Systematic Review
                        
            by
                    Bernadette Paul and Sely-Ann Headley-Johnson        
    
                
        
        Healthcare 2025, 13(21), 2763; https://doi.org/10.3390/healthcare13212763 (registering DOI) - 30 Oct 2025
    
                            
    
                    
        
                    Abstract 
            
            
                        
    
            Background: Social media has transformed and influenced how health information is accessed, how people engage in health-promoting behaviors, and how they develop attitudes toward wellness. Methods: This systematic review examines the impact of social media on various health behaviors from 2010
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            Background: Social media has transformed and influenced how health information is accessed, how people engage in health-promoting behaviors, and how they develop attitudes toward wellness. Methods: This systematic review examines the impact of social media on various health behaviors from 2010 to 2025. Guided by the PRISMA-ScR framework, and after screening 436 articles from databases such as PubMed, PsycINFO, Scopus, and CINAHL, 82 studies were included that were published in English, and examined Social Media’s influence on health-related behaviors. Results: Thematic synthesis revealed five dominant categories: physical activity and fitness, dietary behaviors and nutrition, mental health and wellbeing, substance use and risky behavior, and health misinformation. The platform, content exposure, and user engagement are all factors that can contribute to social media being an enabler and an obstacle to positive health behavior change. Conclusions: This review identifies key knowledge gaps, highlights emerging trends, and provides direction for future interdisciplinary research and public health strategies. This review was not registered and received no funding.
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                    (This article belongs to the  Special Issue The Influence of Social Media on Health Behavior)
            
        
        
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Open AccessArticle
    
    A Pilot Study on a Reliable and Accessible Approach to Remote Mental Health Assessment: Lessons from Italian Pregnant Women During the COVID-19 Pandemic
                        
            by
                    Chiara Colliva, Veronica Rivi, Pierfrancesco Sarti, Alice Ferretti, Giulia Ganassi, Lorenzo Aguzzoli and Johanna Maria Catharina Blom        
    
                
        
        Healthcare 2025, 13(21), 2762; https://doi.org/10.3390/healthcare13212762 - 30 Oct 2025
    
                            
    
                    
        
                    Abstract 
            
            
                        
    
            Objective: This pilot study assessed the psychological and physical impact of the COVID-19 pandemic on postpartum women that gave birth during the pandemic, and evaluated the feasibility of remote monitoring for maternal mental health. The study also proposes a conceptual framework to
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            Objective: This pilot study assessed the psychological and physical impact of the COVID-19 pandemic on postpartum women that gave birth during the pandemic, and evaluated the feasibility of remote monitoring for maternal mental health. The study also proposes a conceptual framework to strengthen remote maternal care in future public health emergencies. Methods: Conducted between 2020 and 2021 in Reggio Emilia, one of Italy’s ten hardest-hit provinces during the early COVID-19 outbreak, this study enrolled 21 pregnant women (10 COVID-19-positive at delivery, 11 COVID-19-negative controls). Psychological and physical health were assessed using validated instruments: the Beck Depression Inventory (BDI) and Edinburgh Postnatal Depression Scale (EPDS) for depression, the State-Trait Anxiety Inventory (STAI) for anxiety, the Impact of Event Scale–Revised (IES-R) for trauma-related stress, and the SF-36 for physical functioning. Additional measures included breastfeeding experience and resilience. Remote assessments were conducted between 6 and 12 months postpartum to evaluate psychological recovery and satisfaction with perinatal care. C test was used to compare the two groups of women. Results: COVID-19-positive women reported significantly higher depressive symptoms (BDI: 13.50 ± 8.14 vs. 6.73 ± 4.73; U = 27, p = 0.048), and elevated state anxiety levels (STAI-S: 41.60 ± 10.23 vs. 33.64 ± 10.15; U = 27, p = 0.048) compared to controls. Post-traumatic stress symptoms were also higher among COVID-positive participants (IES-R total: 41.10 ± 19.33 vs. 30.64 ± 7.99; U = 24.5, p = 0.029). No significant differences emerged in EPDS or trait anxiety scores. Conclusions: Remote data collection proved feasible for postpartum women during the pandemic and highlighted elevated depressive, anxiety, and trauma-related symptoms in COVID-19-positive mothers. These findings support the development of flexible digital care frameworks for maternal well-being in crises. The introduction of the “10 Gold Rules for Remote Maternal Healthcare in Critical Situations” offers a forward-looking, expert-informed conceptual framework to guide the development of scalable, trust-based digital care models that go beyond monitoring to include proactive, patient-centred support.
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                    (This article belongs to the  Section Digital Health Technologies)
            
        
        
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Open AccessArticle
    
    Associations Between Body Image Satisfaction, Body Mass Index, Quality of Life, and Screen Time in Portuguese Students
                        
            by
                    Jéssica Silva, Joana Serpa, Vanessa Santos, Fernando Vieira, Nuno Casanova, Renata Willig, Fábio Flôres and Priscila Marconcin        
    
                
        
        Healthcare 2025, 13(21), 2761; https://doi.org/10.3390/healthcare13212761 - 30 Oct 2025
    
                            
    
                    
        
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            Background: This study examined the relationship between screen time, body image satisfaction, body mass index (BMI), and quality of life among children and adolescents from two school clusters in Sesimbra, Portugal. Methods: The sample included 80 students aged 10 to 18 years, assessed
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            Background: This study examined the relationship between screen time, body image satisfaction, body mass index (BMI), and quality of life among children and adolescents from two school clusters in Sesimbra, Portugal. Methods: The sample included 80 students aged 10 to 18 years, assessed using validated questionnaires (Collins’ Figure Rating Scale and KIDSCREEN-27). Results: Results indicated sex differences in electronic game use, with boys reporting higher usage. A negative association was found between time spent on social networks and perceived autonomy and parent–child relationship quality. A high prevalence of body image dissatisfaction was found, particularly among boys, which was significantly associated with BMI. Regarding quality of life, participants scored lower than the European average in the domains of physical and psychological well-being. Conclusions: Findings suggest that screen time, body image, and BMI interdependently affect quality of life, underscoring the need to promote digital literacy, self-esteem, body acceptance, and healthy lifestyles in both school and family settings.
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Open AccessSystematic Review
    
    Federated Learning in Public Health: A Systematic Review of Decentralized, Equitable, and Secure Disease Prevention Approaches
                        
            by
                    Sayed Tariq Shah, Zulfiqar Ali, Muhammad Waqar and Ajung Kim        
    
                
        
        Healthcare 2025, 13(21), 2760; https://doi.org/10.3390/healthcare13212760 - 30 Oct 2025
    
                            
    
                    
        
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            Background and Objectives: Public health needs collaborative, privacy-preserving analytics, but centralized AI is constrained by data sharing and governance. Federated learning (FL) enables training without moving sensitive data. This review assessed how FL is used for disease prevention in population and public health,
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            Background and Objectives: Public health needs collaborative, privacy-preserving analytics, but centralized AI is constrained by data sharing and governance. Federated learning (FL) enables training without moving sensitive data. This review assessed how FL is used for disease prevention in population and public health, and mapped benefits, challenges, and policy implications. Methods: Following PRISMA 2020, we searched PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar for peer reviewed English-language studies from January 2020–30 June 2025, applying FL to surveillance, outbreak detection, risk prediction, or policy support. Two reviewers screened and extracted data with third-reviewer arbitration. Quality was appraised with a tool adapted from MMAT and AI reporting frameworks. No meta-analysis was performed. Results: Of 5230 records identified (4720 after deduplication), 200 full texts were assessed and 19 were included. Most used horizontal FL across multiple institutions for communicable diseases, COVID-19, tuberculosis and some chronic conditions. Reported gains included privacy preservation across sites, better generalizability from diverse data, near real-time intelligence, localized risk stratification, and support for resource planning. Common barriers were non-IID data, interoperability gaps, compute and network limits in low-resource settings, unclear legal pathways, and concerns about fairness and transparency. Few studies linked directly to formal public-health policy or low-resource deployments. Conclusions: FL is promising for equitable, secure, and scalable disease-prevention analytics that respect data sovereignty. Priorities include robust methods for heterogeneity, interoperable standards, secure aggregation, routine fairness auditing, clearer legal and regulatory guidance, and capacity building in underrepresented regions.
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                    (This article belongs to the  Section Artificial Intelligence in Healthcare)
            
        
        
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Open AccessArticle
    
    When Employee Mental Health Deteriorates: Examining the Relationship Between Health-Oriented Leadership, Disclosure, and Sickness Absence
                        
            by
                    Sarah Pischel, Jörg Felfe and Lene S. Fröhlich        
    
                
        
        Healthcare 2025, 13(21), 2759; https://doi.org/10.3390/healthcare13212759 - 30 Oct 2025
    
                            
    
                    
        
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            Background/Objectives: Given the high prevalence of mental health problems in the workplace, fostering disclosure and reducing sickness absence are critical for ensuring timely support and sustaining employees’ work ability. Drawing on the health-oriented riented leadership (HoL) model, this paper examines the associations between
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            Background/Objectives: Given the high prevalence of mental health problems in the workplace, fostering disclosure and reducing sickness absence are critical for ensuring timely support and sustaining employees’ work ability. Drawing on the health-oriented riented leadership (HoL) model, this paper examines the associations between staff care, disclosure, and sickness absence, and addresses the underexplored question of whether staff care continues to show beneficial relationships when employees experience acute health deterioration. To account for differing perspectives, we included samples with employees and with leaders. Methods: We conducted three distinct cross-sectional studies with (1) predominantly healthy employees (N1 = 148), (2) employees with severe mental health issues or a diagnosis (N2 = 338), and (3) leaders (N3 = 91). Results: Staff care is positively related to disclosure across all studies. In study 1, this relationship was unexpectedly stronger for low than for high health deterioration, though still significant for high deterioration. In studies 2 and 3, the interaction was non-significant. However, a perceptual gap emerged: simple slopes showed that leaders with low staff care still expected disclosure from employees with high health deterioration (study 3), whereas employees reported higher concealment intentions (study 1). Staff care was negatively related to sickness absence only in study 2, with this relationship strengthened under high health deterioration. Conclusions: Staff care seems particularly relevant for supporting disclosure during early health declines and for mitigating sickness absence during acute deterioration among those already affected. Divergent leader–employee perceptions may hinder timely support. We provide practical recommendations for organizations.
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                    (This article belongs to the  Special Issue Effective Strategies for Promoting Mental Health: Global Perspectives and Innovations)
            
        
        
     
            
            
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