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Volume 13
Issue 10
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Healthcare, Volume 13, Issue 10 (May-2 2025) – 123 articles

Cover Story (view full-size image): Many people with multiple sclerosis (MS) experience grief related to lost independence and changes in self-identity, factors that raise risk for depression, anxiety, and reduced quality of life. Research has shown that expressive writing reduces emotional distress in other populations, but its effects in MS are unknown. This qualitative study examined a 10-week coach-guided expressive writing program delivered via videoconferencing to 25 adults with MS across 10 US states. Post-program interviews revealed therapeutic themes that indicated that the intervention helped participants process grief and fostered emotional resilience and psychological growth. Further study may lead to widely accessible coach-guided expressive writing programs to support emotional well-being and quality of life in people living with chronic illness. View this paper
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19 pages, 1381 KiB  
Systematic Review
Respiratory Muscle Strength Training in Parkinson’s Disease—A Systematic Review and Meta-Analysis
by Irene Navas-Garrido, Javier Martín-Núñez, Julia Raya-Benítez, María Granados-Santiago, Alba Navas-Otero, Laura López-López and Marie Carmen Valenza
Healthcare 2025, 13(10), 1214; https://doi.org/10.3390/healthcare13101214 - 21 May 2025
Viewed by 491
Abstract
Background/Objectives: The aim of this review was to evaluate the effectiveness of respiratory muscle strength training in patients with Parkinson’s disease (PD). Methods: A systematic review and meta-analysis of randomised controlled trials (RCTs) was performed on PubMed, Web of Science, and Scopus [...] Read more.
Background/Objectives: The aim of this review was to evaluate the effectiveness of respiratory muscle strength training in patients with Parkinson’s disease (PD). Methods: A systematic review and meta-analysis of randomised controlled trials (RCTs) was performed on PubMed, Web of Science, and Scopus databases. We included RCTs that evaluated the effectiveness of respiratory muscle training in patients with PD versus no intervention, sham treatment, or a different type of intervention. Quality assessment and risk of bias were assessed using the Downs and Black scale and the ROB2 tool. Results: Finally, 10 studies were included. The methodological quality of the studies was “good” in most of the studies, with results ranging from 21 to 25. In terms of risk of bias, six of them indicated low risk and four of them showed unclear risk of bias. Data were pooled and a meta-analysis of maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), and voluntary peak expiratory flow rate (PEFR) was performed. Meta-analysis indicated a significant overall effect of respiratory muscle strength training on MEP (MD = 17.08; 95% CI = 2.32, 31.84; p = 0.02) and on voluntary PEFR (MD = 1.50; 95% CI = 0.51, 2.48; p = 0.003). However, results in the meta-analysis showed a non-significant overall effect of respiratory muscle strength training on MIP (MD = 1.69; 95% CI = −11.91, 16.29; p = 0.82). Conclusions: The synthesis of evidence presented in this systematic review and meta-analysis underscores the potential of respiratory muscle strength training as an effective means of increasing MEP and PEFR in patients with PD. Full article
(This article belongs to the Special Issue Innovations in Chronic Patient Management: Monitoring, Evaluation and Rehabilitation)
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33 pages, 825 KiB  
Article
Effects of Short Video App Guided Mindfulness Meditation on Policemen’s Communication Anxiety, PTSD, Anger Management, and Mood Disorders
by Chao Liu, Li-Jen Lin, Kang-Jie Zhang, Thu-Hua Liu and Wen-Ko Chiou
Healthcare 2025, 13(10), 1213; https://doi.org/10.3390/healthcare13101213 - 21 May 2025
Viewed by 418
Abstract
Background: Law enforcement is a high-stress profession, with officers frequently exposed to traumatic events, leading to mental health challenges such as communication anxiety, post-traumatic stress disorder (PTSD), anger management difficulties, and mood disorders. Mindfulness meditation (MM), particularly when guided through short video applications, [...] Read more.
Background: Law enforcement is a high-stress profession, with officers frequently exposed to traumatic events, leading to mental health challenges such as communication anxiety, post-traumatic stress disorder (PTSD), anger management difficulties, and mood disorders. Mindfulness meditation (MM), particularly when guided through short video applications, has shown promise in addressing these issues by enhancing emotional regulation and resilience. Objective: This study explores the effects of an 8-week MM intervention, delivered via short video apps, on communication anxiety, PTSD, anger management, and mood disorders in police officers. Methods: A randomized controlled trial (RCT) was conducted with 110 full-time police officers aged 25–55 in China. The final 92 eligible participants were divided into two groups: the MM group (n = 46) and the control group (n = 46). The intervention consisted of daily 10–15 min video-guided MM sessions. Pre- and post-intervention measures included validated questionnaires assessing communication anxiety (PRCA-24), PTSD (PCL-5), anger management (STAXI-2), and mood disorders (DASS-21). Data analysis was performed using MANOVA. Results: The intervention group showed significant improvements in communication anxiety (F = 8.505, p = 0.004), PTSD (F = 25.831, p < 0.001), anger management (F = 4.968, p = 0.027), and mood disorders (F = 13.058, p < 0.001) compared to the control group. These improvements were supported by significant interaction effects between group and time, indicating that the MM intervention had a positive impact on these mental health variables. Conclusions: Video-guided MM delivered via short video apps significantly reduced communication anxiety, PTSD symptoms, and mood disorders, and improved anger management among police officers. These findings highlight the potential of digital MM interventions as a scalable and accessible tool for enhancing mental well-being and resilience in law enforcement personnel. Full article
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19 pages, 805 KiB  
Article
Metabolic, Hematological, and Functional Health in Adults with Down Syndrome and Significance of Parental Health Literacy: A Cross-Sectional Study
by Petra Rajkovic Vuletic, Marijana Geets-Kesic, Anamarija Jurcev-Savicevic, Nurjanah Nurjanah and Barbara Gilic
Healthcare 2025, 13(10), 1212; https://doi.org/10.3390/healthcare13101212 - 21 May 2025
Viewed by 330
Abstract
Background/Objectives: The evaluation of metabolic and physiological health indicators in people with Down syndrome (DS) is crucial, since these people are more prone to metabolic problems. However, there is limited scientific evidence regarding the health status and health literacy (HL) of adults [...] Read more.
Background/Objectives: The evaluation of metabolic and physiological health indicators in people with Down syndrome (DS) is crucial, since these people are more prone to metabolic problems. However, there is limited scientific evidence regarding the health status and health literacy (HL) of adults with DS and their legal guardians. This study aimed to assess the health status of adults with DS and determine the HL levels of their legal guardians. Methods: Eighteen adults (11 females, 7 males) with DS aged 28.64 ± 9.01 years were tested for health status, and their legal guardians completed the HL survey. Gender differences in all study variables were checked by t-tests for independent samples and Cohen’s D effect sizes (ESs). Differences in all study variables between parents with low and adequate HL were calculated via receiver operating characteristic curves. Results: Males were overweight, whereas females were obese (mean BMI = 26.51 and 30.10 for males and females, respectively). Females had higher high-density lipoprotein concentrations (large ES), whereas males had higher hematocrit and hemoglobin concentrations (large ES). Hematological parameters were the most significant variables that differed between parents with limited and adequate HL status (AUC = 0.79–0.87). Conclusions: These findings suggest that in the absence of severe comorbidities, adults with DS may achieve stable health profiles, particularly when supported by structured physical activity and informed caregiving. The influence of parental HL on health parameters points to the potential for parent-targeted health education to improve health outcomes and promote autonomy in individuals with DS through supported decision-making. Thus, our findings highlight the need for greater investment in caregiver and parental health education and systemic support to optimize health outcomes in adults with DS. Future research should explore interventions aimed at improving parental HL and examine the extent to which these efforts translate into improved health outcomes for people with DS. Full article
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15 pages, 490 KiB  
Article
The Mediation Role of Emotion Regulation in the Relationship Between Anxiety and Depression in University Students with Specific Learning Disorder
by Michela Camia, Angela Ciaramidaro, Erika Benassi, Sara Giovagnoli, Damiano Angelini, Sandro Rubichi and Maristella Scorza
Healthcare 2025, 13(10), 1211; https://doi.org/10.3390/healthcare13101211 - 21 May 2025
Viewed by 389
Abstract
Background: Difficulties in emotion regulation are associated with a range of emotional disorders, such as anxiety disorders and depression. However, the mechanisms that underpin this relationship are still unclear. Moreover, little is known about emotion regulation in university students with specific learning disorder [...] Read more.
Background: Difficulties in emotion regulation are associated with a range of emotional disorders, such as anxiety disorders and depression. However, the mechanisms that underpin this relationship are still unclear. Moreover, little is known about emotion regulation in university students with specific learning disorder (SLD). This study examined emotion regulation and its role as mediator in the relationship between anxiety and depressive symptoms in a group of university students with and without SLD. Methods: One hundred and twenty-nine Italian university students between 18 and 31 years of age were enrolled. Fifty students had a diagnosis of SLD and seventy-nine were typically developing students (TD). The data were obtained from a cross-sectional study conducted as part of a broader research project investigating the well-being of university students. Participants completed questionnaires for emotion regulation (DERS), anxiety (BAI), and depression (BDI). Results: In comparison to the group without SLD, the participants with SLD self-reported more frequent emotional regulation problems and more symptoms of anxiety and depression. SLD students also reported more difficulties in three domains of emotion regulation (nonacceptance, strategies, and clarity). Moreover, in both SLD and TD students, emotion regulation was found to mediate the association between anxiety and depression. Conclusions: The study suggests the importance of promoting adaptive emotion regulation strategies in university students with SLD and incorporating emotion regulation as a clinical target into existing interventions. Full article
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20 pages, 260 KiB  
Article
The Cross-Cultural Competencies and Attitudes Toward Ultraorthodox Clients Among Secular Therapists in Israel: An Explanatory Study
by Einat Doron, Dariusz Walkowiak, Rivka Tuval-Mashiach, Sławomir Tobis and Jan Domaradzki
Healthcare 2025, 13(10), 1210; https://doi.org/10.3390/healthcare13101210 - 21 May 2025
Viewed by 394
Abstract
Background: To provide effective mental health care across cultural differences, therapists must develop cultural competencies, including an awareness of and sensitivity to diverse backgrounds. In Israel, secular therapists (STs) working with ultra-orthodox (UO), also referred to as Haredi, clients face challenges due to [...] Read more.
Background: To provide effective mental health care across cultural differences, therapists must develop cultural competencies, including an awareness of and sensitivity to diverse backgrounds. In Israel, secular therapists (STs) working with ultra-orthodox (UO), also referred to as Haredi, clients face challenges due to mutual distrust and sociopolitical tensions between the communities. This study aims to assess Israeli STs’ cross-cultural competencies and attitudes toward Haredi clients, examining the association between perceptions and competencies. Methods: The data were collected from an anonymous, self-administered online survey conducted between April and November 2024 among 70 STs in Israel. The study utilized the Cross-Cultural Competence of Healthcare Professionals (CCCHP-27) scale and a self-developed questionnaire assessing STs’ attitudes toward UO clients. The statistical analysis was performed using JASP 0.18.3. Results: While STs exhibited high general cross-cultural competence, their competence in working with Haredi clients was lower and more complex. Therapists with more experience treating UO clients had more positive attitudes toward them, whereas those working in public settings demonstrated lower cultural awareness. Although STs faced cultural and ideological challenges, many expressed openness and professional growth. Notably, while 57.2% felt that working with UO clients improved their skills, only 37.2% recommended it to others. Similarly, while 52.8% enjoyed working with diverse clients, only 27.2% reported enjoying working with UO clients. A negative correlation was found between the emotions about minorities scale and two UO-related subscales, views (ρ = −0.307, p = 0.01) and awareness (ρ = −0.534, p < 0.001), suggesting that local sociopolitical factors influence attitudes toward the Haredi community. Conclusions: This study highlights a gap between STs’ general cross-cultural competencies and their attitudes toward the Haredi population. The findings underscore the need for continued professional training in culturally competent therapy, as personal interactions play a crucial role in bridging societal divides and improving therapeutic relationships. Full article
14 pages, 1115 KiB  
Article
Regional Alliance for Cervical Cancer Prevention in Eastern Europe and Central Asia: Progressing Towards the Target 1 of the Global Strategy for Cervical Cancer Elimination
by Silvia Ussai, Teymur Seyidov, Tamar Khomasuridze and on behalf of the Regional Alliance Group of Experts on HPV Vaccination
Healthcare 2025, 13(10), 1209; https://doi.org/10.3390/healthcare13101209 - 21 May 2025
Viewed by 854
Abstract
Background and Objectives: Cervical cancer remains a critical public health challenge in Eastern Europe and Central Asia (EECA), where systemic barriers have hindered prevention efforts. This descriptive regional study evaluates progress toward achieving Target 1 of the WHO Global Strategy for Cervical Cancer [...] Read more.
Background and Objectives: Cervical cancer remains a critical public health challenge in Eastern Europe and Central Asia (EECA), where systemic barriers have hindered prevention efforts. This descriptive regional study evaluates progress toward achieving Target 1 of the WHO Global Strategy for Cervical Cancer Elimination—vaccinating 90% of girls by age 15—in 17 countries and territories. The research is situated within the context of the Regional Alliance for Cervical Cancer Prevention in EECA, a multi-stakeholder platform launched by UNFPA in 2021 to accelerate regional progress toward WHO targets. The Alliance supports countries through technical collaboration, shared learning, and political engagement. Therefore, as a secondary endpoint, the study explores possible correlations between national achievements and the post-2021 scale-up efforts supported by the Alliance. Methods: A standardized questionnaire, consolidated by United Nation Population Fund (UNFPA) technical experts, was disseminated in November 2024 to 17 national focal points, yielding 19 responses due to disaggregated submissions from Bosnia and Herzegovina. The survey collected data on HPV vaccination policies, delivery models, vaccine type, target populations, and coverage. Results: By late 2024, six countries had implemented HPV vaccination before 2021, while six more launched programs after the Regional Alliance’s formation in 2021. Coverage varied widely, from 0.2% in Brčko District to 99.3% in Uzbekistan. Most countries targeted girls aged 9–14, with increasing male inclusion and catch-up cohorts. Gardasil 4 was the most used vaccine, though Gardasil 9 is gaining ground. School-based and hybrid delivery strategies were associated with significantly higher coverage (p = 0.0121). Inferential analysis also showed significant variation by vaccine type (p = 0.0067) and a positive correlation with program maturity (ρ = 0.52, p = 0.067). However, findings should be interpreted considering limitations including reliance on self-reported country data and absence of independent validation. Conclusions: The results offer actionable insights into delivery models, gender inclusion, and regional disparities—supporting efforts to close the gap toward 2030 elimination targets in EECA Countries. Full article
(This article belongs to the Special Issue UN Sustainable Development Goals (SDGs) Beyond 2030 Agenda: The Role of International Partnerships and Alliances Towards Equitable Access to Care)
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12 pages, 794 KiB  
Article
Knowledge, Adherence, and Barriers to Gluten-Free Diet Among Adults with Celiac Disease in Saudi Arabia: A Pilot Study at a Tertiary Hospital in Madinah, Saudi Arabia
by May A. Alsayb, Suliman A. Alharbi, Renad H. Alloqmani, Ghaida A. Madkli, Rahaf A. Basharahil, Marah I. Alhejaili and Walaa A. Mumena
Healthcare 2025, 13(10), 1208; https://doi.org/10.3390/healthcare13101208 - 21 May 2025
Viewed by 539
Abstract
Background: Celiac disease (CD) is an autoimmune condition triggered by gluten ingestion in genetically predisposed individuals. Management typically involves a strict gluten-free diet (GFD). However, there are limited data concerning adherence to GFD among adult CD patients in Saudi Arabia. Therefore, this [...] Read more.
Background: Celiac disease (CD) is an autoimmune condition triggered by gluten ingestion in genetically predisposed individuals. Management typically involves a strict gluten-free diet (GFD). However, there are limited data concerning adherence to GFD among adult CD patients in Saudi Arabia. Therefore, this study aimed to pilot test the assessment of knowledge, adherence to GFD, and barriers to adherence to GFD among adult celiac patients in Madinah, Saudi Arabia. Methods: Cross-sectional data were collected from 36 adults with celiac disease at King Fahad Hospital, Madinah (2021–2022). After obtaining consent, participants completed an online questionnaire covering sociodemographic data, GFD knowledge, adherence, and related barriers. Results: Only 33% of participants were aware of the Ministry of Health’s GFD support program, with 30.6% utilizing gluten-free products and 27.8% receiving financial assistance. Higher adherence scores were significantly associated with awareness of the program, reading nutrition labels, understanding GFD requirements, receiving financial support, and using separate utensils for gluten-free food preparation. The majority (58.3%) had not consulted a dietitian, and no significant association was found between dietitian consultation and GFD adherence. Poor knowledge and difficulty interpreting nutrition labels were reported as primary barriers. Conclusions: Improving public and patient awareness of the GFD and available support programs is essential in enhancing adherence among CD patients in Saudi Arabia. Healthcare providers should play a more active role in patient education and ongoing support. Full article
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18 pages, 892 KiB  
Article
Trends of Korean Medicine Treatment for Parkinson’s Disease in South Korea: A Cross-Sectional Analysis Using the Health Insurance Review and Assessment Service–National Patient Sample Database
by BackJun Kim, Huijun Kim, Ye-Seul Lee, Yoon Jae Lee, In Chul Jung, Ju Yeon Kim and In-Hyuk Ha
Healthcare 2025, 13(10), 1207; https://doi.org/10.3390/healthcare13101207 - 21 May 2025
Viewed by 433
Abstract
Background/Objectives: Parkinson’s disease (PD) is a major neurodegenerative condition, mainly treated using dopamine-based therapies. However, the side effects and limitations of these therapies hinder their use. This study aimed to analyze the utilization of Korean medicine (KM) by patients with PD in Korea. [...] Read more.
Background/Objectives: Parkinson’s disease (PD) is a major neurodegenerative condition, mainly treated using dopamine-based therapies. However, the side effects and limitations of these therapies hinder their use. This study aimed to analyze the utilization of Korean medicine (KM) by patients with PD in Korea. Methods: Data of the Health Insurance Review and Assessment Service–National Patient Sample were used to investigate the status and trend of KM utilization by patients with PD in Korea from January 2010 to December 2019. Data of 18,562 patients were included, and analyses were performed on the status of KM and Western medicine (WM) utilization, cost of care, prescribed medications, comorbidities, and characteristics of patients with PD. Results: The number of patients who utilized KM services for PD gradually increased over the 10-year period, with 10.6% of all patients with PD using KM services in 2019. In addition, the number of KM users with PD, number of claims, and expenses all showed an increase. The rate of increase in KM service utilization was greater than that of WM. Among KM services, acupuncture had the highest expense (50.6%). Regarding comorbidities in patients with PD, musculoskeletal diseases were the most common (58.6%). Among WM medications prescribed for the KM users, dopa and dopa derivatives (15.5%) and anti-dementia drugs (11.7%) were the most common. Conclusions: This study provides useful information on KM utilization status and trends among patients with PD and the characteristics of these patients. Follow-up research is warranted on the utilization status of more diverse KM services. Full article
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18 pages, 1348 KiB  
Article
Reconciliation of Work and Personal Roles Among Critical Care Nurses: Constructivist Grounded Theory Research
by Miguel Valencia-Contrera, Lissette Avilés and Naldy Febré
Healthcare 2025, 13(10), 1206; https://doi.org/10.3390/healthcare13101206 - 21 May 2025
Viewed by 371
Abstract
Objectives: There are numerous and varied theoretical gaps in the study of work–family interaction, which limits the understanding and approach to this phenomenon, especially among vulnerable groups such as critical care nursing professionals. In this regard, the objective of this study was to [...] Read more.
Objectives: There are numerous and varied theoretical gaps in the study of work–family interaction, which limits the understanding and approach to this phenomenon, especially among vulnerable groups such as critical care nursing professionals. In this regard, the objective of this study was to theorize the work–family interaction process among nurses working in Critical Care Units in Chile. Methods: Constructivist grounded theory was employed to conceptualize the phenomenon of interest from the perspectives of nurses, their families, and administrative staff. Data were collected through observations in two high-complexity hospitals in Chile, one public and one private; document analysis; and 51 in-depth interviews. Data analysis was conducted using constant comparisons and multi-level coding. To ensure rigor, the study followed the 13 criteria proposed by Charmaz and Thornberg for constructivist grounded theory studies and was approved by a Scientific Ethics Committee. Results: The reconciliation of work and personal roles emerged as the core process explaining the interaction between work and personal life among nurses in Critical Care Units. This complex and multidimensional process comprised three stages: resisting the war of roles, hitting rock bottom, and reconciling, through which nurses attempt to achieve balance between work and personal roles. Conclusions: We developed a theory that explains the work–family interaction process. The theory developed highlights the importance of an integrated approach that considers both sources of conflict and reconciliation strategies. Addressing this phenomenon effectively requires interventions at the individual, organizational, and public policy levels. Full article
(This article belongs to the Section Nursing)
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23 pages, 1106 KiB  
Review
A Scoping Review of AI-Driven Digital Interventions in Mental Health Care: Mapping Applications Across Screening, Support, Monitoring, Prevention, and Clinical Education
by Yang Ni and Fanli Jia
Healthcare 2025, 13(10), 1205; https://doi.org/10.3390/healthcare13101205 - 21 May 2025
Cited by 1 | Viewed by 1779
Abstract
Background/Objectives: Artificial intelligence (AI)-enabled digital interventions are increasingly used to expand access to mental health care. This PRISMA-ScR scoping review maps how AI technologies support mental health care across five phases: pre-treatment (screening), treatment (therapeutic support), post-treatment (monitoring), clinical education, and population-level prevention. [...] Read more.
Background/Objectives: Artificial intelligence (AI)-enabled digital interventions are increasingly used to expand access to mental health care. This PRISMA-ScR scoping review maps how AI technologies support mental health care across five phases: pre-treatment (screening), treatment (therapeutic support), post-treatment (monitoring), clinical education, and population-level prevention. Methods: We synthesized findings from 36 empirical studies published through January 2024 that implemented AI-driven digital tools, including large language models (LLMs), machine learning (ML) models, and conversational agents. Use cases include referral triage, remote patient monitoring, empathic communication enhancement, and AI-assisted psychotherapy delivered via chatbots and voice agents. Results: Across the 36 included studies, the most common AI modalities included chatbots, natural language processing tools, machine learning and deep learning models, and large language model-based agents. These technologies were predominantly used for support, monitoring, and self-management purposes rather than as standalone treatments. Reported benefits included reduced wait times, increased engagement, and improved symptom tracking. However, recurring challenges such as algorithmic bias, data privacy risks, and workflow integration barriers highlight the need for ethical design and human oversight. Conclusion: By introducing a four-pillar framework, this review offers a comprehensive overview of current applications and future directions in AI-augmented mental health care. It aims to guide researchers, clinicians, and policymakers in developing safe, effective, and equitable digital mental health interventions. Full article
(This article belongs to the Special Issue Adversarial Learning and Its Applications in Healthcare)
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17 pages, 620 KiB  
Review
Surface Electromyography Combined with Artificial Intelligence in Predicting Neuromuscular Falls in the Elderly: A Narrative Review of Present Applications and Future Perspectives
by Yuandan Liao, Gang Tan and Hui Zhang
Healthcare 2025, 13(10), 1204; https://doi.org/10.3390/healthcare13101204 - 21 May 2025
Viewed by 425
Abstract
Background: Falls among the elderly are a major public health concern, leading to increased disability and mortality. Traditional protective measures are important, but early detection and prevention are equally critical. Surface electromyography (sEMG) signals, which assess muscle electrical activity, can indicate a [...] Read more.
Background: Falls among the elderly are a major public health concern, leading to increased disability and mortality. Traditional protective measures are important, but early detection and prevention are equally critical. Surface electromyography (sEMG) signals, which assess muscle electrical activity, can indicate a fall risk by detecting muscle weakness or instability. Objective: This narrative review synthesizes the research progress of sEMG in predicting neuromuscular falls among the elderly. Our goal is to explore the innovative application and development potential of the integration of sEMG and artificial intelligence (AI) in fall prevention among the elderly. Methods: A systematic search of PubMed, IEEE Xplore, and Web of Science (2013–2023) was conducted using the following keywords: artificial intelligence, wearable, sEMG, neuromuscular, and fall prediction. The inclusion criteria prioritized studies integrating sEMG with AI for elderly fall risk assessments, while non-empirical or non-English studies were excluded. Results: AI algorithms hold significant potential in medical applications, and studies on predicting neuromuscular falls in the elderly using sEMG signals have made notable progress. However, limitations include a reliance on simulated data, a lack of standardized models, sensor inaccuracies, and a focus on prediction rather than prevention. To address these challenges, this study proposes collecting authentic sEMG signals from elderly individuals with fall histories and healthy controls. By leveraging AI to develop predictive models and designing a portable sEMG acquisition and analysis system tailored for elderly communities, real-time fall risk predictions and early warnings can be achieved, thereby reducing fall incidences among the elderly. Conclusions: The combination of sEMG and AI presents a substantial promise for predicting neuromuscular falls in the elderly. Future research should prioritize validating models in real-world settings, refining sensor technology and signal processing techniques, and shifting focus toward comprehensive preventive strategies rather than mere prediction. These advancements could significantly enhance the quality of life and health outcomes of the elderly, while alleviating burdens on families and healthcare systems. Full article
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14 pages, 2068 KiB  
Project Report
How to Promote the Idea of Transplantation—Second Life Social Campaign as an Example of Successful Action in Poland—What Youth Is Used to, Adults Remember
by Jacek Zawierucha, Julia Piasecka, Agnieszka Patelka, Sławomir Jerzy Małyszko, Jacek Stanisław Małyszko and Jolanta Małyszko
Healthcare 2025, 13(10), 1203; https://doi.org/10.3390/healthcare13101203 - 21 May 2025
Viewed by 292
Abstract
Background: Solid organ transplantation, which began as an experimental procedure over 100 years ago, has now become a viable therapeutic option for the vast majority of patients with end-stage organ failure. However, a major limiting factor remains the shortage of organs available [...] Read more.
Background: Solid organ transplantation, which began as an experimental procedure over 100 years ago, has now become a viable therapeutic option for the vast majority of patients with end-stage organ failure. However, a major limiting factor remains the shortage of organs available for transplantation. To expand the donor pool, it is essential to increase awareness of transplantation, including its legal, cultural, and ethical aspects. Every year, numerous organizations, primarily non-governmental, organize hundreds of campaigns promoting transplantation worldwide. The majority of these initiatives are one-time events tied to observances such as World Transplant Day, World Kidney Day, and others. The growing role of social media in spreading information is also becoming a key factor in promoting organ donation and transplantation, as social factors play an important role in expanding the donor pool. Many organizations that support transplantation, along with healthcare providers, widely use platforms like Facebook and other social media to promote and increase organ donation. Objectives: The “Second Life” is a social campaign presentation to raise awarenes about transplantation. Project Description: The campaign has been running continuously for 17 years in Poland, promoting the concepts of organ donation and transplantation in collaboration with high school students. During this time, 950 high schools across the country participated in the project, with approximately 450,000 high school students actively engaging in the campaign. Outcomes: They organized a series of activities to promote organ donation and transplantation within their social circles, distributing nearly 1.5 million declarations of will. Additionally, they helped raise awareness about presumed consent and educated others on the concepts of organ donation and transplantation. Conclusions/Implications: This long-term initiative is crucial for raising awareness, educating the public, and promoting the idea of organ donation. It fosters a more positive attitude toward organ donation and transplantation, ultimately contributing to the expansion of the donor pool and an increase in transplantations in the near future. Full article
(This article belongs to the Special Issue Health Promotion, Disease Prevention, and Chronic Illness Experience: A Health Psychology Perspective)
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11 pages, 1014 KiB  
Viewpoint
Multimorbidity: Addressing the Elephant in the Clinic Room
by David Cosio
Healthcare 2025, 13(10), 1202; https://doi.org/10.3390/healthcare13101202 - 21 May 2025
Viewed by 421
Abstract
Multimorbidity is the conjoint presence of multiple conditions in patients, which is a public health problem. Multimorbidity is like the elephant in the clinic room because it remains the unaddressed challenge we face in healthcare. Clinical health psychology has a role to play [...] Read more.
Multimorbidity is the conjoint presence of multiple conditions in patients, which is a public health problem. Multimorbidity is like the elephant in the clinic room because it remains the unaddressed challenge we face in healthcare. Clinical health psychology has a role to play in this undertaking because it recognizes the intersection and interface of concurrent mental and/or behavioral problems and physical diseases. The current article will define multimorbidity, describe current statistics, how it differs from comorbidity, how to use the biopsychosocial model, and ways in which clinical health psychologists can manage and prevent it in their clinics. A model of how to address multimorbidity will be shared using the role of a clinical health psychologist working in a multidisciplinary pain clinic in a hospital setting serving patients who are socioeconomically disadvantaged. Full article
(This article belongs to the Special Issue Innovations in Interprofessional Care and Training)
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25 pages, 592 KiB  
Article
Beyond the Unitary: Direct, Moderated, and Mediated Associations of Mindfulness Facets with Mental Health Literacy and Treatment-Seeking Attitudes
by Matea Gerbeza, Kelsy Dąbek, Katelyn Lockinger, Isabelle M. Wilkens, Mia Loarca-Rodriguez, Katimah Grogan and Shadi Beshai
Healthcare 2025, 13(10), 1201; https://doi.org/10.3390/healthcare13101201 - 20 May 2025
Viewed by 508
Abstract
Background and Objectives: Psychological disorders are prevalent and distressing. Early treatment initiation can prevent adverse outcomes and reduce healthcare system impacts. Improving mental health literacy (MHL)—one’s knowledge regarding psychological disorders—and treatment-seeking attitudes (TSAs) is key in early treatment initiation. Examining the facets of [...] Read more.
Background and Objectives: Psychological disorders are prevalent and distressing. Early treatment initiation can prevent adverse outcomes and reduce healthcare system impacts. Improving mental health literacy (MHL)—one’s knowledge regarding psychological disorders—and treatment-seeking attitudes (TSAs) is key in early treatment initiation. Examining the facets of dispositional mindfulness—the capacity to pay attention to present-moment experiences with acceptance—may offer more granular insights into understanding MHL and TSAs. This study examined (a) associations between mindfulness facets and MHL and TSAs, (b) facets’ prediction of MHL and TSAs beyond demographics, (c) moderation of the MHL–TSA relationship by mindfulness facets, and (d) mediation of mindfulness–TSA relationships via general self-efficacy (GSE). Methods: A community sample of 299 adults was recruited online (TurkPrime) and completed demographic questions and self-report measures: Five-Facet Mindfulness Questionnaire-15, Mental Health Literacy Scale, Mental Help-Seeking Attitudes Scale, and General Self-Efficacy Scale. Results: Describe, Non-Judgment, and Act with Awareness were modestly associated with MHL; all five facets correlated with TSAs. Hierarchical regressions controlling for demographics showed that Describe and Non-Reactivity predicted MHL, while Act with Awareness uniquely predicted TSAs. Non-Reactivity moderated the MHL–TSA relationship, with higher Non-Reactivity amplifying the relationship. GSE fully mediated relationships between Observe and Non-Judgment with TSAs, suggesting self-efficacy is a key mechanism of these facets. Conclusions: Interventions cultivating Non-Reactivity, Describe, and Act with Awareness may improve the translation of mental health knowledge into treatment-seeking behaviors. Future research should explore how mindfulness facets independently and interactively foster early intervention and treatment engagement. Full article
(This article belongs to the Special Issue Health Promotion, Disease Prevention, and Chronic Illness Experience: A Health Psychology Perspective)
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15 pages, 435 KiB  
Article
Pretransplant Physical Activity and Cardiovascular Risk Factors in Kidney Transplant Candidates: A Cross-Sectional Study
by Emilia Ferrer-López, Víctor Cantín-Lahoz, Francisco Javier Rubio-Castañeda, Juan José Aguilón-Leiva, María García-Magán, Carlos Navas-Ferrer, Eva Benito-Ruiz, María Isabel Serrano-Vicente, Isabel Blázquez-Ornat, Isabel Antón-Solanas and Fernando Urcola-Pardo
Healthcare 2025, 13(10), 1200; https://doi.org/10.3390/healthcare13101200 - 20 May 2025
Viewed by 349
Abstract
Background/Objectives: Individuals with chronic kidney disease often face significant physical and clinical challenges, such as muscle weakness, fatigue, and reduced cardiorespiratory capacity, that impact their quality of life. Physical activity has emerged as an effective intervention to counteract these effects, with clinical guidelines [...] Read more.
Background/Objectives: Individuals with chronic kidney disease often face significant physical and clinical challenges, such as muscle weakness, fatigue, and reduced cardiorespiratory capacity, that impact their quality of life. Physical activity has emerged as an effective intervention to counteract these effects, with clinical guidelines recommending exercise as a standard treatment for kidney transplant recipients. The aim of this study was to assess pretransplant physical activity levels in a cohort of transplant patients and analyze their relationships with cardiovascular risk factors. Methods: A cross-sectional, analytical, and correlational study was conducted from September 2020 to June 2022 with a sample of 122 kidney transplant recipients assessed before kidney transplantation. Sociodemographic data, anthropometric data, comorbidities, renal replacement therapy types, and clinical and analytical data were collected from the patients’ clinical records. Physical activity was assessed via the International Physical Activity Questionnaire. Results: The average time spent waiting for transplantation was 423 ± 405 days, which was longer (387 ± 524) in the group of those under 65 years than in those over 65 years (194 ± 256) (p = 0.010). The median energy expenditure was 1742 (IQR = 1719) METs. In addition, 15.6% of the participants reported inactivity. Men reported higher physical activity levels (median: 2076 METs/week; IQR: 2037) than women did (median: 1386 METs/week; IQR: 1238). A higher level of physical activity was found in non-dialysis patients, overweight patients, and those with a history of stroke. A significant positive correlation was found between physical activity levels and serum urea. Conclusions: Increased physical activity levels were observed in men and in participants under 65 years of age. Patients with cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, overweight and obesity, reported lower activity levels, whereas those with a prior history of cerebrovascular accidents engaged in more physical activity. This study highlights the importance of assessing physical activity and promoting exercise for chronic kidney disease patients awaiting kidney transplantation. Further research is needed to explore the evolution of physical activity in this population and its impact post-transplantation. Full article
(This article belongs to the Special Issue Nursing Competencies: New Advances in Nursing Care)
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18 pages, 467 KiB  
Article
Beliefs and Attitudes of Hesitant Spaniards Towards COVID-19 Vaccines: “A Personal Decision”
by Andrea Langbecker and Daniel Catalan-Matamoros
Healthcare 2025, 13(10), 1199; https://doi.org/10.3390/healthcare13101199 - 20 May 2025
Viewed by 355
Abstract
Background/Objectives: Vaccine hesitancy has increased during the coronavirus pandemic, a period marked by the spread of disinformation and conspiracy theories about COVID-19 vaccines. This qualitative study aimed to explore the beliefs and attitudes of Spaniards towards COVID-19 vaccines and analyze the role of [...] Read more.
Background/Objectives: Vaccine hesitancy has increased during the coronavirus pandemic, a period marked by the spread of disinformation and conspiracy theories about COVID-19 vaccines. This qualitative study aimed to explore the beliefs and attitudes of Spaniards towards COVID-19 vaccines and analyze the role of information sources in this process. Methods: Semi-structured interviews were conducted with 35 residents of Spain who exhibited varying levels of vaccine hesitancy. Through thematic content analysis, the narratives supporting vaccination-related decisions, as well as the influence and trust in information sources, were examined. Results: Reasons for getting vaccinated included perceptions of it being “almost an obligation” and “fear of illness and death”. Conversely, reasons for not getting vaccinated included “uncertainty about vaccines”, the belief that “the risk is not real”, and the perception that “vaccination is a personal decision”. Regarding vaccine-related information sources, interviewees expressed distrust of the media, particularly television, as they considered news about vaccine effectiveness and characteristics to be contradictory and constantly changing, which created uncertainty about its reliability. Most interviewees were unsure if social media influenced their decision not to get vaccinated. However, those who acknowledged its impact mentioned trusting sources such as people with a university education. Additionally, close contacts—particularly healthcare professionals—had a significant influence on the decision not to get vaccinated. Conclusions: This study shows that the decision not to vaccinate is shaped by personal beliefs and sources of information—particularly social media and close acquaintances, including healthcare professionals. Full article
(This article belongs to the Section Coronaviruses (CoV) and COVID-19 Pandemic)
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18 pages, 226 KiB  
Article
Knowledge, Attitude, and Practice Regarding Antibiotic Prescription Among Dentists in Saudi Arabia—A Cross-Sectional Survey
by Kiran Iyer, Jawaher Alhababi, Alanoud Aldhafayan, Amal Albarrak, Faey Alburidy, Fatimah Alanazi, Fatimah Albawardi and Abdulmohsen Alfadley
Healthcare 2025, 13(10), 1198; https://doi.org/10.3390/healthcare13101198 - 20 May 2025
Viewed by 326
Abstract
Background/Objectives: Prescription challenges in antibiotics contribute to the global prevalence of antimicrobial resistance (AMR). We are rapidly moving into an age of ‘resistome’, which has grave consequences. Dentists frequently prescribe antibiotics for intraoral infections and as prophylaxis, particularly for immunocompromised patients, although the [...] Read more.
Background/Objectives: Prescription challenges in antibiotics contribute to the global prevalence of antimicrobial resistance (AMR). We are rapidly moving into an age of ‘resistome’, which has grave consequences. Dentists frequently prescribe antibiotics for intraoral infections and as prophylaxis, particularly for immunocompromised patients, although the clinical justification for these prescriptions remains a point of concern. This study aimed to evaluate the knowledge, attitudes, and practices of dental practitioners in Saudi Arabia regarding antibiotic prescription. Methods: A cross-sectional survey was conducted from October to November 2024, involving 252 dentists from various regions of Saudi Arabia. Data were gathered through social media. Results: The dentists were likely to agree to prescribe antibiotics post-procedurally to be safe [OR 0.18, p = 0.42, CI −0.94]. Contrastingly, the knowledge of less experienced dentists [OR 9.60, p = 0.03, CI 1.21–76.15] was updated regarding prescribing penicillin for women in the third trimester of pregnancy than that of experienced dentists (>10 years). Conclusions: Although the knowledge level of practitioners in the public sector is reasonably good, there are concerns about antibiotic prescription practice among private dental practitioners. Full article
(This article belongs to the Special Issue Implications for Healthcare Policy and Management)
20 pages, 666 KiB  
Article
Influence of Lifestyle Habits on Psychological Well-Being of University Students: A Quantitative Cross-Sectional Study
by Laura García-Pérez, Rosario Padial-Ruz, Mar Cepero-González and José Luis Ubago-Jiménez
Healthcare 2025, 13(10), 1197; https://doi.org/10.3390/healthcare13101197 - 20 May 2025
Viewed by 559
Abstract
Background: This study explored the influence of three key lifestyle habits—physical activity (PA), adherence to the Mediterranean diet (MD), and sleep duration—on psychological well-being indicators (resilience, psychological distress, and self-esteem) in university students. Methods: A total of 928 students (67.3% females; [...] Read more.
Background: This study explored the influence of three key lifestyle habits—physical activity (PA), adherence to the Mediterranean diet (MD), and sleep duration—on psychological well-being indicators (resilience, psychological distress, and self-esteem) in university students. Methods: A total of 928 students (67.3% females; total sample mean age = 21.01 ± 1.95) from the Faculty of Education at the University of Granada participated. Validated self-report instruments were used to assess all variables: the International Physical Activity Questionnaire (IPAQ-SF), the KIDMED index, the Connor–Davidson Resilience Scale (CD-RISC), the Depression Anxiety Stress Scales (DASS-21), and the Rosenberg Self-Esteem Scale. Results: Results showed that male students reported higher levels of PA, better MD adherence, longer sleep duration, and more favorable psychological outcomes. Stepwise regression analyses indicated that MD adherence was the strongest and most consistent predictor of resilience, self-esteem, and psychological distress. Sleep duration emerged as a key factor, particularly in predicting resilience among men. Although no direct association was found between PA and psychological distress, mediation analysis revealed a significant indirect effect through sleep duration. Conclusions: These findings underscore the relevance of promoting healthy lifestyle habits in an integrated and sex-sensitive manner to enhance mental health (MH) in university students. In particular, targeting future teachers may be essential, given their potential role as promoters of well-being in school settings. Full article
(This article belongs to the Special Issue Future Trends of Physical Activity in Health Promotion)
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13 pages, 624 KiB  
Systematic Review
Effects of Physical Exercise on the Physical and Mental Health of Family Caregivers: A Systematic Review
by Ana Bravo-Vazquez, Ernesto Anarte-Lazo, Juan Jose Gonzalez-Gerez, Cleofas Rodriguez-Blanco and Carlos Bernal-Utrera
Healthcare 2025, 13(10), 1196; https://doi.org/10.3390/healthcare13101196 - 20 May 2025
Viewed by 429
Abstract
The number of family caregivers of dependent older adults is increasing. The adverse effects of the work provided by these caregivers can have a negative impact on their own physical and mental health, so it is necessary to develop strategies that support and [...] Read more.
The number of family caregivers of dependent older adults is increasing. The adverse effects of the work provided by these caregivers can have a negative impact on their own physical and mental health, so it is necessary to develop strategies that support and improve the quality of life and functional capacity of this group. Background/Objectives: The aim of this systematic review is to analyze physical exercise interventions for family caregivers and the effects on their physical and mental health, quality of life and functioning. Methods: A comprehensive search was conducted in the scientific databases PubMed, Embase, Scopus and CINAHL. Data extraction was carried out from the selected articles, obtaining information about the characteristics of the study subjects, type and characteristics of the intervention and results. Results: A total of 17 studies were selected for the review. All studies were based on physical exercise interventions and reported significant improvements in caregivers’ physical and mental health, as well as an increase in their quality of life and functioning. Most of the study subjects were older adult women relatives. No adverse effects were found to the interventions. Conclusions: Physical exercise seems to be effective in improving the physical and mental health of family caregivers, increasing their quality of life and functional capacity. More future research is needed to make interventions more accessible to family caregivers. Full article
(This article belongs to the Topic New Trends in Physiotherapy Care: Improvements in Functionality, Pain Management, and Quality of Life)
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15 pages, 649 KiB  
Article
Smoking Knowledge and Behaviors in a Population of Italian Students in Dental Hygiene or Other Health Disciplines
by Fabrizio Guerra, Alessia Pardo, Vanessa Di Nasta, Roberta Grassi and Gianna Maria Nardi
Healthcare 2025, 13(10), 1195; https://doi.org/10.3390/healthcare13101195 - 20 May 2025
Viewed by 364
Abstract
Background/Objectives: Smoking remains a major public health concern, and healthcare professionals (HCPs) play a crucial role in smoking cessation efforts. This study aimed to assess the awareness, knowledge, and smoking behaviors of Italian students and graduates in dental hygiene from different regional [...] Read more.
Background/Objectives: Smoking remains a major public health concern, and healthcare professionals (HCPs) play a crucial role in smoking cessation efforts. This study aimed to assess the awareness, knowledge, and smoking behaviors of Italian students and graduates in dental hygiene from different regional areas (Group A) and students in health disciplines at a single university (Group B). Methods: Two separate surveys were conducted using a specifically designed online questionnaire administered to voluntary participants between February and April 2024. The questionnaire collected data on smoking habits, awareness of smoke-free products, sources of information, and perceptions of health effects. Results: A total of 878 questionnaires were completed. While 49.8% of participants had never smoked, 16.3% were regular smokers and 14% were occasional users of either traditional cigarettes or alternative smoke-free products. Awareness of non-combustion products was high, with social circles (74%) and social media (47.9%) being primary sources of information. Users of smoke-free products reported subjective improvements in halitosis, dental discoloration, cough, exercise capacity, and sense of taste. Despite 78% of participants receiving specific training on smoking-related diseases, gaps in knowledge persisted, particularly regarding the toxicological nature of smoking and the role of nicotine in smoking-related diseases. Conclusions: These findings highlight the need for continued education and training on smoking cessation and tobacco harm reduction among future HCPs. Strengthening evidence-based knowledge could enhance their ability to manage smoking-related diseases and promote effective cessation strategies. Full article
(This article belongs to the Special Issue Oral Health Care and Services for Patients)
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16 pages, 1251 KiB  
Article
Effectiveness of Psychotherapy for Post-Traumatic Stress Disorder in Subjects Suffering from Traumatic Brain Injuries After Motor Vehicle Accidents
by Agnieszka Popiel, Beata Banaszak, Ewa Pragłowska and Bogdan Zawadzki
Healthcare 2025, 13(10), 1194; https://doi.org/10.3390/healthcare13101194 - 20 May 2025
Viewed by 320
Abstract
Background and Objectives: PTSD and traumatic brain injury (TBI) frequently co-occur in survivors of combat exposure, blasts, assaults, or motor vehicle accidents (MVAs), yet the impact of TBI on the psychotherapy outcomes for PTSD, especially in civilians, remains underexplored and frequently underestimated. Methods [...] Read more.
Background and Objectives: PTSD and traumatic brain injury (TBI) frequently co-occur in survivors of combat exposure, blasts, assaults, or motor vehicle accidents (MVAs), yet the impact of TBI on the psychotherapy outcomes for PTSD, especially in civilians, remains underexplored and frequently underestimated. Methods: This study focused on analysis of the effectiveness of psychotherapies (trauma-focused: prolonged exposure (PE); non-trauma-focused: self-efficacy-focused cognitive therapy (SEF-CT)) in individuals with PTSD, comparing those with and without TBIs. The data of 45 PTSD patients with TBIs were drawn from a clinical trial cohort, with a total of 134 completing treatment. PTSD symptoms were assessed pre- and post-treatment using CAPS-5 and PDS-5. Cognitive functioning was measured via tests of fluid and crystallized intelligence. ANCOVA models examined the level of post-treatment PTSD symptoms with the control of pretreatment symptoms and the effects of TBI, treatment type, gender, age, education, time since the MVA, and level of cognitive functioning. Results: Both psychotherapies were equally effective in reducing PTSD symptoms, regardless of TBI status. The early initiation of treatment predicted better outcomes in non-TBI patients but not in those with TBIs. The TBI participants who began treatment earlier exhibited lower fluid intelligence scores, suggesting mild cognitive impairments that may have moderated the therapy benefits. Conclusions: Patients with PTSD and TBIs can benefit from both trauma-focused and non-trauma-focused CBT. While earlier intervention is beneficial for patients with PTSD alone, cognitive impairments may reduce this advantage in those with TBIs. Full article
(This article belongs to the Special Issue Psychological Diagnosis and Treatment of People with Mental Disorders)
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6 pages, 161 KiB  
Editorial
Advancing Comprehensive Stroke Care—From Acute Recovery to Long-Term Wellbeing
by Tharshanah Thayabaranathan and Dominique A. Cadilhac
Healthcare 2025, 13(10), 1193; https://doi.org/10.3390/healthcare13101193 - 20 May 2025
Viewed by 350
Abstract
Stroke is one of the most complex diseases of our time; it impacts individuals across many facets of functioning, depending on the areas of the brain that have been damaged [...] Full article
(This article belongs to the Special Issue Stroke and Ageing)
11 pages, 608 KiB  
Perspective
Are We Going to Give Up Imaging in Cryptorchidism Management?
by Cristina Gavrilovici, Alma-Raluca Laptoiu, Carmen-Iulia Ciongradi, Petronela Pirtica, Elena-Lia Spoiala, Elena Hanganu, Alexandru Pirvan and Monika Glass
Healthcare 2025, 13(10), 1192; https://doi.org/10.3390/healthcare13101192 - 20 May 2025
Viewed by 267
Abstract
Background and Purpose: Undescended testes (UDT) is recognized as the most prevalent anomaly of the male genitalia and presents a significant risk factor for long-term complications, including infertility and testicular cancer. Currently, there is no consensus on the necessity of imaging in the [...] Read more.
Background and Purpose: Undescended testes (UDT) is recognized as the most prevalent anomaly of the male genitalia and presents a significant risk factor for long-term complications, including infertility and testicular cancer. Currently, there is no consensus on the necessity of imaging in the management of UDT, nor is there agreement on which imaging modality is preferred or to what extent these tests offer real added value in the clinical setting. This review aims to evaluate the various imaging options available in the management of cryptorchidism, discussing their utility, advantages, and disadvantages compared to exploratory laparoscopy. Methods: We conducted a PubMed search using the following search terms: [“undescended testis”] OR [(“cryptorchidism”) OR (“diagnostic imaging”)] OR [(“Ultrasound”), OR (“CT scan”) OR (“MRI”)] AND [“laparoscopy”]. We analyzed 90 full articles, excluding irrelevant ones, and, in total, 18 publications were included in this review. Results: Ultrasound (US) is the most commonly used technique due to its non-invasive nature and absence of ionizing radiation. It is particularly beneficial in cases of non-palpable UDT. However, its main limitation lies in the difficulty in accurately locating UDT, especially when they are situated outside the inguinal region. Computed tomography (CT) scans serve as a crucial diagnostic tool, particularly for testes located below the internal inguinal ring. While CT exhibits comparable accuracy in detecting UDT, the need for sedation or general anesthesia, along with the costs and potential risks of secondary malignancy due to radiation exposure, does not favor its routine use. Magnetic resonance imaging (MRI) offers higher sensitivity than US and does not utilize ionizing radiation or intravascular contrast agents. It allows for the generation of multiplanar images, thereby providing improved tissue characterization. However, limitations include prolonged scan durations, the potential for motion artifacts during imaging, the need for sedation, and higher costs. Laparoscopy has been shown to provide better accuracy, offering both diagnostic and therapeutic benefits, particularly in cases of non-palpable UDT. It is widely regarded as the gold standard in achieving clear diagnostic and definitive therapeutic procedures and has demonstrated its utility in determining the anatomical position of intra-abdominal testes, owing to its magnification capabilities and minimally invasive approach. Conclusions: Achieving a correct and comprehensive diagnosis of cryptorchidism requires the medical team to decide on the appropriate imaging studies, as these will not significantly influence or alter the therapeutic decision-making process. It is unlikely that medical practice will eliminate imaging studies before a surgical decision is made in the near future. Therefore, a multidisciplinary approach that includes clinical examination, imaging, and diagnostic laparoscopy remains essential for the accurate management of UDT. Full article
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20 pages, 796 KiB  
Article
Development and Psychometric Validation of the Patient Experience for Disease Management Scale (PEDMS) in Outpatient Settings in Najran, Saudi Arabia
by Nasser Saeed Alqahtani
Healthcare 2025, 13(10), 1191; https://doi.org/10.3390/healthcare13101191 - 20 May 2025
Viewed by 345
Abstract
Background: Measuring patient experience is essential for enhancing healthcare quality, particularly in disease management contexts. Existing instruments often lack specificity for outpatient settings. Objective: The objective of this study is to create and assess the Patient Experience for Disease Management Scale [...] Read more.
Background: Measuring patient experience is essential for enhancing healthcare quality, particularly in disease management contexts. Existing instruments often lack specificity for outpatient settings. Objective: The objective of this study is to create and assess the Patient Experience for Disease Management Scale (PEDMS) psychometrically in order to precisely record patient experiences. Method: A mixed-methods approach was used, with qualitative insights derived from the literature and expert consultations, followed by quantitative analyses. A sample of 600 outpatients was surveyed in Najran, Saudi Arabia, from September 2023 to May 2024, using exploratory and confirmatory factor analyses (CFA) to test the scale’s psychometric qualities. Results: The PEDMS identified eight distinct factors, explaining 86.32% of the variance. The findings from the CFA significantly affirm the validity of the PEDMS’s structure, demonstrating excellent model fit as indicated by multiple fit indices: CFI (0.965), NFI (0.975), SRMR (0.051), and RMSEA (0.067). Additionally, the PEDMS exhibits strong convergent validity, supported by high CR and AVE values, both exceeding 0.70 and 0.50, respectively. Furthermore, all item loadings are greater than 0.70, reinforcing the PEDMS’s robustness. The reliability of the PEDMS is considered excellent, as demonstrated by a Cronbach’s alpha coefficient of 0.878 for the entire 38-item scale. Each factor exhibits strong internal consistency, with values ranging from 0.827 to 0.879, all surpassing the threshold of 0.7. Conclusions: The PEDMS provides a reliable tool for measuring patient experiences in disease management, offering healthcare providers actionable insights for patient-centered care. This study emphasizes the need to integrate standardized metrics into quality improvement frameworks in order to improve healthcare outcomes. Full article
(This article belongs to the Special Issue Patient Experience and the Quality of Health Care)
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15 pages, 852 KiB  
Article
The Impact of Language Variability on Artificial Intelligence Performance in Regenerative Endodontics
by Hatice Büyüközer Özkan, Tülin Doğan Çankaya and Türkay Kölüş
Healthcare 2025, 13(10), 1190; https://doi.org/10.3390/healthcare13101190 - 20 May 2025
Viewed by 449
Abstract
Background: Regenerative endodontic procedures (REPs) are promising treatments for immature teeth with necrotic pulp. Artificial intelligence (AI) is increasingly used in dentistry; thus, this study evaluates the reliability of AI-generated information on REPs, comparing four AI models against clinical guidelines. Methods: ChatGPT-4o, Claude [...] Read more.
Background: Regenerative endodontic procedures (REPs) are promising treatments for immature teeth with necrotic pulp. Artificial intelligence (AI) is increasingly used in dentistry; thus, this study evaluates the reliability of AI-generated information on REPs, comparing four AI models against clinical guidelines. Methods: ChatGPT-4o, Claude 3.5 Sonnet, Grok 2, and Gemini 2.0 Advanced were tested with 20 REP-related questions from the ESE/AAE guidelines and expert consensus. Questions were posed in Turkish and English, with or without prompts. Two specialists assessed 640 AI-generated answers via a four-point rubric. Inter-rater reliability and response accuracy were statistically analyzed. Results: Inter-rater reliability was high (0.85–0.97). ChatGPT-4o showed higher accuracy with English prompts (p < 0.05). Claude was more accurate than Grok in the Turkish (nonprompted) and English (prompted) conditions (p < 0.05). No model reached ≥80% accuracy. Claude (English, prompted) scored highest; Grok-Turkish (nonprompted) scored lowest. Conclusions: The performance of AI models varies significantly across languages. English queries yield higher accuracy. While AI shows potential for REPs information, current models lack sufficient accuracy for clinical reliance. Cautious interpretation and validation against guidelines are essential. Further research is needed to enhance AI performance in specialized dental fields. Full article
(This article belongs to the Special Issue Application of Artificial Intelligence in the Diagnosis, Treatment and Management of Diseases)
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9 pages, 195 KiB  
Article
Surrogate Trust in the Intensive Care Unit: What Can We Do Better?
by Abdul W. Kazi, Phoebe Chun, David Oxman and Erika J. Yoo
Healthcare 2025, 13(10), 1189; https://doi.org/10.3390/healthcare13101189 - 20 May 2025
Viewed by 201
Abstract
Background/Objectives: Previous investigation into patients’ trust in medical providers is largely limited to the outpatient setting, where increased trust is associated with improved adherence, satisfaction, and self-reported quality of life. Contrastingly, in the intensive care unit (ICU), patients are frequently incapacitated, and it [...] Read more.
Background/Objectives: Previous investigation into patients’ trust in medical providers is largely limited to the outpatient setting, where increased trust is associated with improved adherence, satisfaction, and self-reported quality of life. Contrastingly, in the intensive care unit (ICU), patients are frequently incapacitated, and it is surrogates that engage with clinicians for decision making. This pilot study aims to measure and compare surrogate trust in the healthcare system and ICU physicians. Methods: We measured surrogate trust in both the healthcare system and providers by administering two domain-specific trust-measuring surveys (the Healthcare System Distrust Scale and a modified Trust in Physicians Scale) to surrogates of mechanically ventilated medical ICU patients at an urban academic medical center between November 2021 and April 2024. Results: Responses from twenty-seven surrogates were included in the analysis. The overall mean distrust in healthcare system score was 19.29 (SD 5.8). The overall mean trust in individual physician score was 42.4 (SD 6.26). When subdivided into specific domains, surrogates reported higher mean scores for trust in healthcare system and physician competence than values. Conclusions: In our population, surrogates for medical ICU patients are overall more trusting of their medical providers than the healthcare system. Moreover, surrogates are more trusting of a provider’s professional competence and knowledge than a provider’s values. Our findings may inform trust-building interventions designed specifically for the high-acuity ICU setting to improve quality in communication and family-centered care. Full article
(This article belongs to the Section Critical Care)
16 pages, 406 KiB  
Article
Positive Psychology Insights on the Effects of Spirituality on Shared Decision-Making in Patients with Chronic Heart Failure: The Chain-Mediated Effects of Benefit-Finding and Decision Self-Efficacy
by Zitian Liu, Weiyue Zhou, Yinglan Wu, Yuxin Zhou and Weimin Jiang
Healthcare 2025, 13(10), 1188; https://doi.org/10.3390/healthcare13101188 - 19 May 2025
Viewed by 396
Abstract
Background: As the terminal stage of cardiovascular disease, heart failure (HF) has garnered significant attention due to its recurrent nature, high mortality rates, and substantial medical burden. Shared decision-making (SDM) is an innovative strategy to improve medication adherence. From positive psychology insights, [...] Read more.
Background: As the terminal stage of cardiovascular disease, heart failure (HF) has garnered significant attention due to its recurrent nature, high mortality rates, and substantial medical burden. Shared decision-making (SDM) is an innovative strategy to improve medication adherence. From positive psychology insights, the effects on spirituality, benefit-finding (BF), decision self-efficacy, and patient engagement in SDM remain unexplored. Methods: This quantitative cross-sectional study was conducted from January 2023 to September 2024 at a hospital in Jiangsu. Data on general information, spirituality, BF, decision self-efficacy, and SDM were collected from 387 patients with chronic heart failure. Results: Spirituality was significantly associated with SDM (β = 0.8839, p < 0.001). BF played a mediating role in the relationship between spirituality and SDM (β = 0.2020, 95% CI: 0.0058–0.0261), accounting for 22.9% of the total effect. Decision self-efficacy was identified as a mediator in this relationship (β = 0.2636, 95% CI: 0.0120–0.0284), accounting for 29.8%. In addition, both BF and decision self-efficacy exhibited a chain mediation effect on the association between spirituality and SDM (β = 0.1451, 95% CI: 0.0061–0.0162), and the total indirect effect accounted for 69.1%. Conclusions: This study is the first to demonstrate that spirituality has significant direct and indirect effects on SDM, and it also reveals the underlying psychological mechanisms. Spiritual support services, BF intervention, and enhancing patients’ decision self-efficacy can promote their participation in SDM. These findings highlight the role of positive psychology in promoting SDM, showing potential contribution to promoting medication adherence in HF patients. Full article
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26 pages, 1743 KiB  
Article
Effectiveness of New Reactivation Approaches in Integrated Long-Term Care—Contribution to the Long-Term Care Act
by Suzanna Mežnarec-Novosel, Marija Bogataj, David Bogataj and Eneja Drobež
Healthcare 2025, 13(10), 1187; https://doi.org/10.3390/healthcare13101187 - 19 May 2025
Viewed by 498
Abstract
Objectives: This study evaluates the effectiveness of an innovative, integrated healthcare approach based on the “Long-term Care (LTC) in the Community” pilot project, aimed at testing solutions for the new LTC Act and associated regulations in Slovenia. It is based on a small [...] Read more.
Objectives: This study evaluates the effectiveness of an innovative, integrated healthcare approach based on the “Long-term Care (LTC) in the Community” pilot project, aimed at testing solutions for the new LTC Act and associated regulations in Slovenia. It is based on a small sample, which can be financed from European project funds. This methodology is crucial for the subordinate legislation derived from the LTC Act. Methods: We selected beneficiaries who decided to receive integrated services in their home environment in rural areas. Among 132 beneficiaries who received various care services at home, 75 beneficiaries received integrated services to maintain independence, while a control group of 57 persons did not receive these despite eligibility. The hypothesis that the new reactivation and other services to strengthen and maintain independence facilitate a transition to a lower category of LTC within the system of different states of abilities and that new approaches with integrated home care are much more successful were tested using the Z + 4 test. Results: Seven out of eight users’ abilities were improved by an inventive approach to LTC at home, including reactivation activities, with p < 0.025. The probability that the new methods will outperform the old ones for an arbitrarily selected senior eligible for LTC exceeded 0.89. Thus, we used quantitative methods to confirm the reasonableness of the decisions included in the LTC Act and will help to estimate savings in the health fund. Conclusions: These positive results promote the implementation of integrated care strategies, norms, and standards, which will be further articulated in subordinate legislation. Full article
(This article belongs to the Special Issue Quality Integrated Long-Term Care for Older People)
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15 pages, 410 KiB  
Article
Knowledge, Attitudes, Practices, and Perceived Usability of Respirators Among Thai Healthcare Personnel During the COVID-19 Pandemic
by Kampanat Wangsan, Ratana Sapbamrer, Wachiranun Sirikul, Wuttipat Kiratipaisarl, Krongporn Ongprasert, Pheerasak Assavanopakun, Vithawat Surawattanasakul, Amornphat Kitro, Jinjuta Panumasvivat and Amnart Wongcharoen
Healthcare 2025, 13(10), 1186; https://doi.org/10.3390/healthcare13101186 - 19 May 2025
Viewed by 361
Abstract
Background: Respirators are essential for protecting healthcare personnel (HCPs) from airborne infections, and were particularly valuable during the COVID-19 pandemic. However, knowledge gaps, attitudes, and perceived usability issues may hinder their proper use, especially in settings lacking formal respiratory protection programs. Objective [...] Read more.
Background: Respirators are essential for protecting healthcare personnel (HCPs) from airborne infections, and were particularly valuable during the COVID-19 pandemic. However, knowledge gaps, attitudes, and perceived usability issues may hinder their proper use, especially in settings lacking formal respiratory protection programs. Objective: The aim of this study was to assess the knowledge, attitudes, practices (KAP), and perceived usability of respirators among Thai healthcare personnel at a university hospital in Northern Thailand and identify differences across job roles. Methods: A cross-sectional survey was conducted among HCPs at a university hospital in Northern Thailand. Participants completed a validated questionnaire covering demographic data, KAP, and perceived usability of respirators. Descriptive and inferential statistics were used to analyze group differences. Results: A total of 479 valid responses were analyzed from physicians (31.7%), nurses (37.6%), and other HCPs (30.7%). Only around 12% of all participants correctly identified that surgical masks are not respirators, although over 90% correctly identified the nature of N95/KN95-type filtering facepiece respirators. Nurses demonstrated higher knowledge of respirator standards and proper use. Confidence and willingness to use industrial or reprocessed sterile respirators varied significantly by role (p < 0.05). Only 30.5% had received fit-testing. Perceived usability concerns included discomfort, heat, and breathability, reported across all groups. Conclusions: Knowledge, attitudes, and practices related to respirator use varied by professional role, with notable gaps in fit-testing and perceived usability. Findings highlight the need for targeted training, consistent fit-testing protocols, and improved respirator design for comfort to ensure effective respiratory protection in healthcare settings. Full article
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Article
Premature Hair Graying and Its Associated Factors Among Medical Students and Resident Physicians at Imam Abdulrahman Bin Faisal University
by Inaam B. Aldamanhori, Nada J. Alghamdi, Sadan M. Alharbi, Shadan A. Aljarri, Haya A. AlHemli and Moataza M. Abdel Wahab
Healthcare 2025, 13(10), 1185; https://doi.org/10.3390/healthcare13101185 - 19 May 2025
Viewed by 645
Abstract
Background: Premature hair graying (PHG) is one of the most prevalent conditions affecting individuals worldwide. It has been recognized as an important cause of low self-esteem, with a significant physical and social impact. This study investigated the factors associated with PHG by comparing [...] Read more.
Background: Premature hair graying (PHG) is one of the most prevalent conditions affecting individuals worldwide. It has been recognized as an important cause of low self-esteem, with a significant physical and social impact. This study investigated the factors associated with PHG by comparing medical students and resident physicians to other non-medical majors at Imam Abdulrahman Bin Faisal University (IAU). Methods: This is a comparative cross-sectional study conducted on resident physicians and students from 10 different colleges of IAU, Eastern Province, Saudi Arabia. This study evaluated the characteristics of PHG and its associated risk factors using an online distributed questionnaire. Results: A total of 2644 students and resident physicians were included in this study, with 45.6% coming from medical colleges. The findings show that the premature graying of hair was higher among obese and overweight individuals and those with a combined deficiency of vitamins B12 and vitamin D. Other factors associated with PHG included a family history of PHG, a lack of exercise, smoking, and allergic rhinitis. Gray hair onset before 25 years old was higher among those with high stress levels (95%) than those with moderate (90%) and or mild (86%) stress levels (p = 0.029). Conclusions: In our study, higher stress levels were related to an earlier age of PHG onset, and there was no difference between medical and non-medical students in PHG. Recommendations for future research include randomized clinical trials and larger cohort studies regarding the characteristics of PHG in the Middle East and those with Arabic ethnicity and assessing the medications that induce possible hair repigmentation. Full article
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