Healthcare

19 pages, 617 KiB

Open AccessArticle

Unpacking Young Adults’ Fact-Checking Intent on Oral Health Misinformation: Parallel Mediating Roles of Need for Cognition and Perceived Seriousness—A Cross-Sectional Study

by Donghwa Chung, Yongjun Zhang, Jiaqi Wang and Yanfang Meng

Healthcare 2025, 13(11), 1354; https://doi.org/10.3390/healthcare13111354 - 5 Jun 2025

Viewed by 224

Abstract

Background: Oral health misinformation has increasingly proliferated across social media platforms in China, prompting rising concerns about the accuracy of health-related content. Fact-checking intent has been identified as a key strategy for mitigating the spread of such misinformation. However, empirical research on the [...] Read more.

Background: Oral health misinformation has increasingly proliferated across social media platforms in China, prompting rising concerns about the accuracy of health-related content. Fact-checking intent has been identified as a key strategy for mitigating the spread of such misinformation. However, empirical research on the psychological factors shaping engagement in fact-checking behaviors remains limited. Objectives: This study aims to examine the association between misinformation recognition and fact-checking intent among Chinese young adults (aged 18–36). Methods: Guided by status quo bias theory, this study integrates psychological constructs into its theoretical framework. A stimulus-based online survey was conducted, yielding 452 valid responses. Direct, mediated, and serial mediation hypotheses were tested using SPSS 26.0 and Jamovi 2.6.24. Results: The findings indicate a significant positive relationship between misinformation recognition and fact-checking intent. A parallel mediation model involving need for cognition and perceived seriousness was supported, clarifying the psychological mechanisms underlying this relationship. Conclusions: This study contributes valuable empirical evidence to the understanding of fact-checking intent among Chinese young adults in the context of oral health misinformation. The findings offer practical implications for developing targeted interventions to increase misinformation awareness and promote active engagement in fact-checking behaviors. Full article

(This article belongs to the Special Issue Oral Health Care and Services for Patients)

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19 pages, 3237 KiB

Open AccessArticle

Therapeutic Potentials of Virtual Blue Spaces: A Study on the Physiological and Psychological Health Benefits of Virtual Waterscapes

by Su-Hsin Lee, Yi-Chien Chu, Li-Wen Wang and Shu-Chen Tsai

Healthcare 2025, 13(11), 1353; https://doi.org/10.3390/healthcare13111353 - 5 Jun 2025

Viewed by 305

Abstract

Background: Physical and mental health issues are increasingly becoming a global focus of attention, and telemedicine is widely attracting academic interest. Objectives: This exploratory study aimed to investigate the therapeutic potential of immersive virtual blue spaces for individuals with distinct lifestyle backgrounds—specifically, office [...] Read more.

Background: Physical and mental health issues are increasingly becoming a global focus of attention, and telemedicine is widely attracting academic interest. Objectives: This exploratory study aimed to investigate the therapeutic potential of immersive virtual blue spaces for individuals with distinct lifestyle backgrounds—specifically, office workers and retirees. The research explores how different virtual waterscapes influence emotional and physiological states in populations with varying stress profiles and life rhythms. Methods: A mixed-methods design was employed, combining quantitative measurements with qualitative interviews. In September 2023, forty participants (20 office workers and 20 retirees) from Hualien, Taiwan, were exposed to 360° VR simulations of three blue environments: a forest stream, a forest waterfall, and a beach scene. Pre- and post-session assessments included physiological indicators (blood pressure and heart rate) and emotional states measured using the Profile of Mood States (POMS) scale. Results: Significant physiological relaxation was observed among retirees. Office workers demonstrated greater emotional improvements, with noticeable variation depending on the type of virtual environment. Comparative analysis highlighted the stream landscape’s unique benefit for reducing depression and enhancing positive mood states. Thematic findings from post-session interviews further indicated that emotional responses were moderated by individual background and prior emotional experiences. Conclusions: These findings underscore the short-term therapeutic potential of virtual blue spaces for diverse user groups and reveal the influence of personal context on their effectiveness. The study supports the integration of VR-based nature exposure into personalized digital healthcare interventions and offers a foundation for future development in immersive therapeutic technologies. Full article

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14 pages, 941 KiB

Open AccessArticle

Comparison of the Frailty Phenotype and the Korean Version of the FRAIL Scale

by Dongwoo Lee, Inhye Cho and Dongmin Kwak

Healthcare 2025, 13(11), 1352; https://doi.org/10.3390/healthcare13111352 - 5 Jun 2025

Viewed by 204

Abstract

Background: Frailty is an important factor in the quality of life, because physical functions decrease with increasing frailty and cannot return to their previous state. This can lead to falls, hospitalization, dependency, and early mortality. However, the definition of and measurement tools for [...] Read more.

Background: Frailty is an important factor in the quality of life, because physical functions decrease with increasing frailty and cannot return to their previous state. This can lead to falls, hospitalization, dependency, and early mortality. However, the definition of and measurement tools for frailty remain unclear. Among these measurement tools, the frailty phenotype and frailty index are commonly used. In Korea, frailty is diagnosed using the Korean version of the FRAIL scale (K-FRAIL scale), which was developed using the frailty phenotype and frailty index. Objectives: The goals of this study were to compare the frailty phenotype and the K-FRAIL scale, and to identify measurement tools that can accurately diagnose frailty in Korea. Methods: Frailty was assessed in 40 older adults aged 65 years or older using the frailty phenotype and the K-FRAIL scale. Results: The prevalence of the frailty phenotype was observed in frail (7.5%), pre-frail (60%), and robust (32.5%) patients. In contrast, the K-FRAIL was observed in frail (0%), prefrail (22.5%), and robust (77.5%) patients. The mean score of the frailty phenotype was higher than the K-FRAIL score (p = 0.00). Conclusions: We identified a difference between the frailty phenotype and K-FRAIL. Collectively, these two measurement tools can provide different measurement frameworks depending on the measurement environment. Full article

(This article belongs to the Section Health Assessments)

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15 pages, 879 KiB

Open AccessArticle

The Burden of Treatment: Experiences of Patients Who Have Undergone Radiotherapy and Proton Beam Therapy

by Danielle Fairweather, Rachel M. Taylor, Lee Hulbert-Williams, Nick J. Hulbert-Williams and Rita Simões

Healthcare 2025, 13(11), 1351; https://doi.org/10.3390/healthcare13111351 - 5 Jun 2025

Viewed by 204

Abstract

Background/Objectives: The physical and psychosocial impacts of cancer treatment can be distressing and profound for many patients, but little is known about the specific impacts of undergoing radiotherapy and proton beam therapy (PBT). This study explores the hidden burdens of treatment and [...] Read more.

Background/Objectives: The physical and psychosocial impacts of cancer treatment can be distressing and profound for many patients, but little is known about the specific impacts of undergoing radiotherapy and proton beam therapy (PBT). This study explores the hidden burdens of treatment and aims to identify the gaps in our current understanding of patients’ experience when attending a large radiotherapy and PBT service. Methods: A qualitative study using semi-structured interviews was conducted with patients undergoing treatment. A purposive sample of participants were recruited, reflecting the main indications for radiotherapy and PBT. Semi-structured interviews were conducted between August 2023 and January 2024 either in person, virtually, or by telephone. Data were analysed using Framework Analysis. Results: In total, 20 patients were interviewed. Five themes were identified: informational needs, emotional wellbeing, logistical concerns, physical impacts, and interpersonal impacts. Patients reported additional financial burdens such as transport and staying away from home, difficulty carrying out normal responsibilities, caregiver burden, and increased anxiety. Many patients reported the post-treatment drop in healthcare interaction, which resulted in distress and isolation, difficult. Conclusions: This study indicates that there are many burdens of radiotherapy and PBT outside of the physical symptoms and side-effects of cancer treatment. Tailored support is needed to address treatment-specific concerns within the radiotherapy and PBT service, but this study also suggests that supportive interventions developed for broader cancer populations may be helpful for this patient cohort. Full article

(This article belongs to the Special Issue Patient Experience and the Quality of Health Care)

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16 pages, 1462 KiB

Open AccessSystematic Review

Oral Ulceration with Bone Sequestration: Key Insights for Clinicians and Their Relevance in Contemporary Clinical Practice—A Narrative Systematic Review

by Mariana Agra Monteiro, Lázaro Andrade Rios da Silva, Sebastião Silvério Sousa-Neto, Ricardo Luiz Cavalcanti de Albuquerque-Júnior, Cassiano Francisco Weege Nonaka, Pollianna Muniz Alves and John Lennon Silva Cunha

Healthcare 2025, 13(11), 1350; https://doi.org/10.3390/healthcare13111350 - 5 Jun 2025

Viewed by 180

Abstract

Background: Oral ulceration with bone sequestration (OUBS) is an uncommon clinical lesion characterized by painful mucosal ulceration associated with exposed and necrotic bone in the oral cavity, often without known factors inducing osteonecrosis. Despite its potential for diagnostic confusion with more serious [...] Read more.

Background: Oral ulceration with bone sequestration (OUBS) is an uncommon clinical lesion characterized by painful mucosal ulceration associated with exposed and necrotic bone in the oral cavity, often without known factors inducing osteonecrosis. Despite its potential for diagnostic confusion with more serious lesions, such as medication-related osteonecrosis, OUBS remains poorly understood and underreported. Objectives: To systematically review the literature on OUBS and identify its main clinical and radiographic characteristics to assist in early diagnosis and appropriate management. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in the PubMed, Scopus, and Web of Science databases on 27 January 2024, to identify case reports, case series, and observational studies that described OUBS. Data extraction focused on demographic information, lesion location, clinical features, radiographic findings, possible etiological factors, management, and outcomes. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized to assess the quality of the case reports and series. Data were synthesized narratively due to heterogeneity among studies. Results: Fifty-seven patients from 22 studies were included. The male-to-female ratio was 2.5:1, with most cases (71.9%) occurring in males. The mean age was 50.22 ± 11.49 years, with the highest incidence in patients aged 50–59 years (64.9%). Most cases were localized to the mandible (94.7%). Clinically, lesions were shallow ulcers (mean size: 0.75 ± 0.85 cm). Pain was the most common symptom (88.9%). Radiographs revealed no significant maxillary abnormalities, but some cases showed radiopaque areas in the mandible. Surgical interventions were most common (40.4%), with complete healing in 67.7% of cases within 4 weeks. Limitations include the predominance of case reports and series, which limits the strength of evidence. Conclusions: Recognizing OUBS can prevent misdiagnosis and unnecessary interventions. Further studies are needed to clarify its etiology and natural history. Registration: This review was registered on the PROSPERO database (registration number CRD42024541416). Full article

(This article belongs to the Special Issue Oral Medicine in Focus: Improving Diagnosis and Treatment Through Continued Education)

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15 pages, 1388 KiB

Open AccessArticle

Selective Activation of the Subscapularis Muscle: A Cross-Sectional Observational Study

by Donghyun Kim and Soonjee Park

Healthcare 2025, 13(11), 1349; https://doi.org/10.3390/healthcare13111349 - 5 Jun 2025

Viewed by 195

Abstract

Background/Objectives: Clinicians have employed various therapeutic exercises to enhance the function and strength of the subscapularis muscle (SSC). However, few studies have investigated the most effective exercise for selectively activating the SSC while minimizing compensation from surrounding shoulder musculatures. Methods: Forty healthy participants [...] Read more.

Background/Objectives: Clinicians have employed various therapeutic exercises to enhance the function and strength of the subscapularis muscle (SSC). However, few studies have investigated the most effective exercise for selectively activating the SSC while minimizing compensation from surrounding shoulder musculatures. Methods: Forty healthy participants without any shoulder complex conditions participated in this study. Individuals with a history of shoulder pain or musculoskeletal or neurological conditions affecting shoulder internal rotation were excluded. Participants performed three exercises: (1) Belly Press, (2) Lift Off, and (3) Prone Wiper, in a randomized order generated using Microsoft Excel. Ultrasound was then performed to assess the SSC and infraspinatus (IS) muscle thickness. Surface electromyography was used to record anterior deltoid (AD), pectoralis major (PM), and posterior deltoid (PD) muscle activity. Radiographic imaging was employed to evaluate the path of the instantaneous center of rotation (PICR). Data were analyzed using a one-way repeated-measures analysis of variance (ANOVA), followed by Bonferroni adjustment. Results: A significant reduction in IS thickness and PICR was observed only following the Belly Press (p < 0.05). Electromyographic activity of AD, PM, and PD increased significantly across all exercises (p < 0.05). These results demonstrate that the Belly Press most effectively allows the SSC to generate force while maintaining a stable center of rotation during shoulder movement. Conclusions: The Belly Press was most effective in selectively activating the SSC while minimizing surrounding shoulder rotator muscle activity and reducing PICR. This finding may help clinicians identify and treat patients with shoulder internal rotation injuries. Full article

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25 pages, 1036 KiB

Open AccessReview

Telepsychiatry and Artificial Intelligence: A Structured Review of Emerging Approaches to Accessible Psychiatric Care

by Artem Bobkov, Feier Cheng, Jinpeng Xu, Tatiana Bobkova, Fangmin Deng, Jingran He, Xinyan Jiang, Dinislam Khuzin and Zheng Kang

Healthcare 2025, 13(11), 1348; https://doi.org/10.3390/healthcare13111348 - 5 Jun 2025

Viewed by 230

Abstract

Background/Objectives: Artificial intelligence is rapidly permeating the field of psychiatry. It offers novel avenues for the diagnosis, treatment, and prediction of mental health disorders. This structured review aims to consolidate current approaches to the application of AI in telepsychiatry. In addition, it evaluates [...] Read more.

Background/Objectives: Artificial intelligence is rapidly permeating the field of psychiatry. It offers novel avenues for the diagnosis, treatment, and prediction of mental health disorders. This structured review aims to consolidate current approaches to the application of AI in telepsychiatry. In addition, it evaluates their technological maturity, clinical utility, and ethical–legal robustness. Methods: A systematic search was conducted across the PubMed, Scopus, and Google Scholar databases for the period spanning 2015 to 2025. The selection and analysis processes adhered to the PRISMA 2020 guidelines. The final synthesis included 44 publications, among which 14 were empirical studies encompassing a broad spectrum of algorithmic approaches—ranging from neural networks and natural language processing (NLP) to multimodal architectures. Results: The review revealed a wide array of AI applications in telepsychiatry, encompassing automated diagnostics, therapeutic support, predictive modeling, and risk stratification. The most actively employed techniques include natural language and speech processing, multimodal analysis, and advanced forecasting models. However, significant barriers to implementation persist—ethical (threats to autonomy and risks of algorithmic bias), technological (limited generalizability and a lack of explainability), and legal (ambiguous accountability and weak regulatory frameworks). Conclusions: This review underscores a growing disconnect between the rapid evolution of AI technologies and the institutional maturity of tools suitable for scalable clinical integration. Despite notable technological advances, the clinical adoption of AI in telepsychiatry remains limited. The analysis identifies persistent methodological gaps and systemic barriers that demand coordinated efforts across research, technical, and regulatory communities. It also outlines key directions for future empirical studies and interdisciplinary development of implementation standards. Full article

(This article belongs to the Special Issue Artificial Intelligence in Healthcare: Opportunities and Challenges)

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14 pages, 267 KiB

Open AccessArticle

Assessment of the Oral Health Perceptions and Behaviours of Adolescents in Bosnia and Herzegovina: A Cross Sectional Study

by Jasmin Habibovic, Kenan Demirovic, Edina Habibovic, Jasmina Mlaco Durek and Alisa Tiro

Healthcare 2025, 13(11), 1347; https://doi.org/10.3390/healthcare13111347 - 5 Jun 2025

Viewed by 202

Abstract

Background: The objective of this investigation was to assess the oral health (OH) of Bosnia and Herzegovinian adolescents in relation to differences and socioeconomic status (SES). Methods: This cross-sectional study included 306 school children from high schools located in the Tuzla Canton (Bosnia [...] Read more.

Background: The objective of this investigation was to assess the oral health (OH) of Bosnia and Herzegovinian adolescents in relation to differences and socioeconomic status (SES). Methods: This cross-sectional study included 306 school children from high schools located in the Tuzla Canton (Bosnia and Herzegovina). The sample consisted of 183 females and 123 males between 15 and 18 years old (mean of 16.82 years old). The study was conducted between December 2019 and March 2020, via an Annex 8 questionnaire from the World Health Organization (WHO), which collected information on OH behaviours, self-perceptions of oral health and dietary factors responsible for the OH of each subject. SES was categorized using five variables (occupation, education, income, place of residence and number of family members). Cross-tabulations were evaluated according to sex and socioeconomic status (SES) via the chi-square test. Results: Over 40% of the participants consumed sweets, cakes and biscuits on daily basis, whereas 41.5% of the participants visited a dentist only in the case of pain. The consumption of sweets (p = 0.024) and cakes and biscuits (p = 0.011) on a daily basis was significantly greater in female adolescents than in male adolescents. Compared with male adolescents, female adolescents reported occasional toothaches more frequently (p = 0.001) and were more dissatisfied with their dental appearance (p = 0.008) but presented a greater frequency of flossing (p = 0.001) and toothbrushing (3–5 times a day) (p = 0.0001). There was no association between the different levels (below average, average, above average) of SES and factors affecting OH status of adolescents. Conclusions: The study revealed significant sex differences in several factors affecting OH status and revealed no relationship between SES and OH behaviours or between perceptions and risk factors affecting OH in 15–18-year-old adolescents. Data obtained from this study might help in the creation of new OH prevention programs aimed at improving the OH status of adolescents in Bosnia and Herzegovina. Full article

13 pages, 1372 KiB

Open AccessArticle

Inflammatory and Angiogenic Mediators Are Differentially Ex-Pressed in Patients with Post-COVID-19 Syndrome with Normal and Abnormal Spirometry Results

by Laura Ileana Minjarez-Robles, Jesús Gilberto Arámburo-Gálvez, Oscar Gerardo Figueroa-Salcido, José Manuel Ornelas-Aguirre, Noé Ontiveros and Lilian Karem Flores-Mendoza

Healthcare 2025, 13(11), 1346; https://doi.org/10.3390/healthcare13111346 - 5 Jun 2025

Viewed by 175

Abstract

Background: Inflammatory and angiogenic mediators play a key role in post-COVID-19 syndrome pathophysiology. These mediators might be of prognostic value for pulmonary function in this syndrome. Objectives: To determine interleukin-6, -12, and -17, macrophage inflammatory protein-1A (MIP-1A), the vascular endothelial growth factor-A (VEGF-A) [...] Read more.

Background: Inflammatory and angiogenic mediators play a key role in post-COVID-19 syndrome pathophysiology. These mediators might be of prognostic value for pulmonary function in this syndrome. Objectives: To determine interleukin-6, -12, and -17, macrophage inflammatory protein-1A (MIP-1A), the vascular endothelial growth factor-A (VEGF-A) gene expression levels, the matrix metalloproteinase-9 (MMP-9) plasma levels, and the association of clinical data with pulmonary function in patients with post-COVID-19 syndrome with normal and abnormal spirometry results. Methods: Demographic/clinical data and blood samples were collected (45 patients). Pulmonary function was evaluated (spirometry), and the gene expression levels of inflammatory and angiogenic mediators (IL-6, IL-12, IL-17, MIP-1A, and VEGF-A) were determined in PBMCs (qPCR). MMP-9 plasma levels were determined (ELISA). Results: Seventeen out of forty-five patients with post-COVID-19 syndrome had abnormal spirometry values, which were associated with arterial hypertension, pneumonia, previous hospitalization, and disease severity (p < 0.05). IL-6, IL-12, and VEGF-A gene expression was upregulated in patients with post-COVID-19 syndrome compared with healthy controls. In patients with normal spirometry values, IL-17 and VEGF-A gene expression was upregulated (p < 0.05), but MIP-1A was downregulated (p < 0.05) (vs. the abnormal spirometry group). MMP-9 serum levels were increased in the normal spirometry group compared with the abnormal one (p < 0.05). Conclusions: Post-COVID-19 syndrome has a complex immune pathophysiology, but potential inflammatory and angiogenic biomarkers, such as IL-6, IL-12, IL-17, MIP-1A, and VEGF-A, are differentially expressed in this syndrome and might be prognostic predictors of post-COVID-19 syndrome associated with pulmonary function alterations. Full article

(This article belongs to the Special Issue Human Health Before, During, and After COVID-19)

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14 pages, 745 KiB

Open AccessArticle

The Effectiveness of Distance Yoga Learning in Improving Maternal Pandemic-Related Depression and Stress During Pregnancy

by Wen-Ping Lee, Min-Yu Chang, Chiu-Tzu Lin and Whei-Mei Shih

Healthcare 2025, 13(11), 1345; https://doi.org/10.3390/healthcare13111345 - 5 Jun 2025

Viewed by 183

Abstract

Background: The aim of this study was to explore the effects of distance yoga learning in improving depression and pregnancy stress in pregnant women during the pandemic. Methods: A preference-based quasi-experimental study design with an experimental group (n = 30) and a [...] Read more.

Background: The aim of this study was to explore the effects of distance yoga learning in improving depression and pregnancy stress in pregnant women during the pandemic. Methods: A preference-based quasi-experimental study design with an experimental group (n = 30) and a control group (n = 31) was used to test both self-reported depression and stress status. The experimental group received a 12-week pregnancy yoga program, including one weekly 60 min distance yoga class followed by two sessions of DVD yoga exercise at home, while the control group received only routine nursing care. Results: There were significant differences in the depression and pregnancy stress indices between the two groups. As the number of weeks of pregnancy increased, both pregnancy depression and stress tended to gradually increase (p < 0.001). However, the experimental group had less pregnancy depression than the control group (p < 0.001), while there was no significant difference between the two groups in stress (p = 0.970). Conclusions: The findings inform clinical practice regarding the use of alternative exercise options such as distance yoga classes for pregnant women’s mental health during a pandemic to reduce depression and pregnancy stress. Full article

(This article belongs to the Special Issue Healthy Lifestyle for Pregnant and Postpartum Women)

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12 pages, 950 KiB

Open AccessArticle

Evaluating the Reliability and Quality of Sarcoidosis-Related Information Provided by AI Chatbots

by Nur Aleyna Yetkin, Burcu Baran, Bilal Rabahoğlu, Nuri Tutar and İnci Gülmez

Healthcare 2025, 13(11), 1344; https://doi.org/10.3390/healthcare13111344 - 5 Jun 2025

Viewed by 178

Abstract

Background and Objectives: Artificial intelligence (AI) chatbots are increasingly employed for the dissemination of health information; however, apprehensions regarding their accuracy and reliability remain. The intricacy of sarcoidosis may lead to misinformation and omissions that affect patient comprehension. This study assessed the usability [...] Read more.

Background and Objectives: Artificial intelligence (AI) chatbots are increasingly employed for the dissemination of health information; however, apprehensions regarding their accuracy and reliability remain. The intricacy of sarcoidosis may lead to misinformation and omissions that affect patient comprehension. This study assessed the usability of AI-generated information on sarcoidosis by evaluating the quality, reliability, readability, understandability, and actionability of chatbot responses to patient-centered queries. Methods: This cross-sectional evaluation included 11 AI chatbots comprising both general-purpose and retrieval-augmented tools. Four sarcoidosis-related queries derived from Google Trends were submitted to each chatbot under standardized conditions. Responses were independently evaluated by four blinded pulmonology experts using DISCERN, the Patient Education Materials Assessment Tool—Printable (PEMAT-P), and Flesch–Kincaid readability metrics. A Web Resource Rating (WRR) score was also calculated. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). Results: Retrieval-augmented models such as ChatGPT-4o Deep Research, Perplexity Research, and Grok3 Deep Search outperformed general-purpose chatbots across the DISCERN, PEMAT-P, and WRR metrics. However, these high-performing models also produced text at significantly higher reading levels (Flesch–Kincaid Grade Level > 16), reducing accessibility. Actionability scores were consistently lower than understandability scores across all models. The ICCs exceeded 0.80 for all evaluation domains, indicating excellent inter-rater reliability. Conclusions: Although some AI chatbots can generate accurate and well-structured responses to sarcoidosis-related questions, their limited readability and low actionability present barriers for effective patient education. Optimization strategies, such as prompt refinement, health literacy adaptation, and domain-specific model development, are required to improve the utility of AI chatbots in complex disease communication. Full article

(This article belongs to the Special Issue Advancing Health Practice and Education Through Digital Health and Artificial Intelligence)

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14 pages, 522 KiB

Open AccessArticle

Turkish Translation, Cross-Cultural Adaptation, Validity, and Reliability of the Physical Activity and Social Support Scale (PASSS) in Physically Active Healthy Adults

by Yıldız Analay Akbaba, Büşra Aksan Sadıkoğlu, Kübra Nur Menengiç, Meltem Besim Atakan, Doğukan Tongar, Gulfidan Tokgoz, Alper Ayas, Sahra Şirvan Tongar and Tuğba Akgüller Eker

Healthcare 2025, 13(11), 1343; https://doi.org/10.3390/healthcare13111343 - 5 Jun 2025

Viewed by 201

Abstract

Background/Objectives: The Physical Activity and Social Support Scale (PASSS) is used to evaluate the physical activity and social support in a multidimensional way, but it has not yet been translated or culturally adapted for Turkish-speaking individuals. The aim of this study is to [...] Read more.

Background/Objectives: The Physical Activity and Social Support Scale (PASSS) is used to evaluate the physical activity and social support in a multidimensional way, but it has not yet been translated or culturally adapted for Turkish-speaking individuals. The aim of this study is to evaluate the validity and reliability of the Turkish version of the PASSS, which evaluates social support for physically active, healthy young adults. Methods: Two hundred and two individuals (98 females, 104 males; mean ± SD age, 26.5 ± 6.1 years; BMI, 23.3 ± 3.2 kg/m²) participated in the study. The PASSS was translated into Turkish using the Beaton guidelines. Multidimensional Scale of Perceived Social Support (MSPSS), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and Short Form-12 Health Survey (SF-12) were used for construct, convergent, and divergent validity. Results: The PASSS demonstrated good internal consistency (Cronbach’s α = 0.84) and excellent reliability (ICC = 0.90; 95% CI = 0.86–0.93). The PASSS showed good correlation with the MSPSS (r = 0.378, p = 0.001), fair correlation with the IPAQ-SF (r = 0.271, p = 0.001), and poor correlation with the SF-12 physical component score (PCS-12) (r = 0.15, p = 0.03); it was not correlated with the SF-12 mental component score (MCS-12) (r = 0.102 p = 0.15). We observed no ceiling and floor effects. Conclusions: The results show that the PASSS Turkish version is reliable and valid and can be utilized for physically active, healthy young Turkish adults. Full article

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24 pages, 357 KiB

Open AccessReview

Cultural Humility Training in Mental Health Service Provision: A Scoping Review of the Foundational and Conceptual Literature

by Mayio Konidaris and Melissa Petrakis

Healthcare 2025, 13(11), 1342; https://doi.org/10.3390/healthcare13111342 - 4 Jun 2025

Viewed by 346

Abstract

Background: Ongoing access and equity concerns for culturally diverse populations in mental health warrant a shift from cultural competence to cultural humility training. This review aimed to systematically assess the breadth of conceptual and training literature in peer-reviewed publications drawn from PsycINFO, CINAHL [...] Read more.

Background: Ongoing access and equity concerns for culturally diverse populations in mental health warrant a shift from cultural competence to cultural humility training. This review aimed to systematically assess the breadth of conceptual and training literature in peer-reviewed publications drawn from PsycINFO, CINAHL plus, Google Scholar and Scopus, from 2007–2018, utilizing cultural humility as the key search term and its relevance to service provision. Methods: This method utilized a five-stage scoping review framework. Results: Results were that a total of 246 publications were extracted. Following employing an abstract review method and removing duplicates, this resulted in a full-text review of 56 publications. The emerging themes included the following: culturally informed conceptual frameworks; culturally diverse training approaches; racial inequalities in mental health services; culturally informed national and international perspectives; race and international transcultural mental health. Conclusions: Conclusions were that including cultural humility principles in service provision and training enables greater self-awareness towards racial bias and negative cultural stereotypes at both practice and organizational levels, ultimately aimed at enhancing mental health service provision by mitigating the structural barriers encountered by service users. Full article

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

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11 pages, 190 KiB

Open AccessArticle

The Usability of Neurological Occupational Therapy Case Studies Generated by ChatGPT

by Si-An Lee and Jin-Hyuck Park

Healthcare 2025, 13(11), 1341; https://doi.org/10.3390/healthcare13111341 - 4 Jun 2025

Viewed by 132

Abstract

Background/Objectives: Case-based learning is essential in occupational therapy education, but developing standardized cases requires significant resources. This study explores the usability of AI-generated case studies using ChatGPT. Methods: A four-stage process was applied: (1) prompt development based on existing frameworks, (2) [...] Read more.

Background/Objectives: Case-based learning is essential in occupational therapy education, but developing standardized cases requires significant resources. This study explores the usability of AI-generated case studies using ChatGPT. Methods: A four-stage process was applied: (1) prompt development based on existing frameworks, (2) case generation ensuring diversity and relevance, (3) expert evaluation using a 5-point Likert scale, and (4) data analysis. Five neurological cases were generated and reviewed by ten experts. Results: Experts rated the cases highly in clinical realism (4.22/5), information comprehensiveness (4.56/5), and educational value (4.44/5). The AI-generated cases successfully provided structured occupational therapy scenarios, assessment results, and clinical questions. Conclusions: Five AI-generated occupational therapy cases were developed and reviewed by occupational therapy experts to evaluate their clinical realism, comprehensiveness, and educational value. While expert feedback was favorable, the effectiveness of these cases for student learning has not yet been empirically tested. Full article

(This article belongs to the Special Issue Artificial Intelligence and Machine Learning in Rehabilitation)

11 pages, 433 KiB

Open AccessArticle

Exploring the Efficacy of Vessilen^® in Treating Bladder Pain Syndrome/Interstitial Cystitis: A Prospective Study

by Mariachiara Palucci, Marta Barba, Alice Cola and Matteo Frigerio

Healthcare 2025, 13(11), 1340; https://doi.org/10.3390/healthcare13111340 - 4 Jun 2025

Viewed by 191

Abstract

Background/Objectives: Bladder pain syndrome (BPS), or painful bladder syndrome (PBS)/interstitial cystitis (IC), is a chronic inflammatory condition characterized by symptoms like pain, urgency, urinary incontinence, and sometimes urinary retention, which significantly affect patients’ quality of life. The etiology of PBS/IC remains unclear and [...] Read more.

Background/Objectives: Bladder pain syndrome (BPS), or painful bladder syndrome (PBS)/interstitial cystitis (IC), is a chronic inflammatory condition characterized by symptoms like pain, urgency, urinary incontinence, and sometimes urinary retention, which significantly affect patients’ quality of life. The etiology of PBS/IC remains unclear and may be multifactorial, with no definitive treatment currently available. The challenge lies in finding new therapeutic strategies. Various intravesical treatments, such as heparin, hyaluronic acid, and botulinum toxin, are commonly used for PBS/IC. In this study, we aimed to evaluate the anti-inflammatory effects of intravesical Vessilen^® (a new formulation consisting of 2% adelmidrol and 0.1% sodium hyaluronate) in patients with IC/PBS or other bladder disorders. Methods: This was a pilot study conducted at a tertiary-level urogynecology center. Two validated questionnaires were administered to patients before and after treatment: the Visual Analogue Scale (VAS) and the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS Long Form). The Patient Global Impression (PGI) scale was used to assess symptom severity. Results: Among the 25 patients who completed six weekly instillations, a significant decrease in bladder symptoms was observed, as indicated by both the ICIQ-FLUTS scale (89.3 vs. 61.3; p = 0.021) and VAS score (4.4 vs. 2.6; p < 0.001). Additionally, 80% of patients reported symptom improvement (PGI-I score ≤ 3). Conclusions: Intravesical Vessilen^® (adelmidrol + sodium hyaluronate) appears to be an innovative therapeutic approach for PBS/IC and other chronic inflammatory bladder disorders due to its anti-inflammatory and antinociceptive properties. Full article

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15 pages, 982 KiB

Open AccessArticle

Ranking Nursing Diagnoses by Predictive Relevance for Intensive Care Unit Transfer Risk in Adult and Pediatric Patients: A Machine Learning Approach with Random Forest

by Manuele Cesare, Mario Cesare Nurchis, Nursing and Public Health Group, Gianfranco Damiani and Antonello Cocchieri

Healthcare 2025, 13(11), 1339; https://doi.org/10.3390/healthcare13111339 - 4 Jun 2025

Viewed by 285

Abstract

Background/Objectives: In hospital settings, the wide variability of acute and complex chronic conditions—among both adult and pediatric patients—requires advanced approaches to detect early signs of clinical deterioration and the risk of transfer to the intensive care unit (ICU). Nursing diagnoses (NDs), standardized [...] Read more.

Background/Objectives: In hospital settings, the wide variability of acute and complex chronic conditions—among both adult and pediatric patients—requires advanced approaches to detect early signs of clinical deterioration and the risk of transfer to the intensive care unit (ICU). Nursing diagnoses (NDs), standardized representations of patient responses to actual or potential health problems, reflect nursing complexity. However, most studies have focused on the total number of NDs rather than the individual role each diagnosis may play in relation to outcomes such as ICU transfer. This study aimed to identify and rank the specific NDs most strongly associated with ICU transfers in hospitalized adult and pediatric patients. Methods: A retrospective, monocentric observational study was conducted using electronic health records from an Italian tertiary hospital. The dataset included 42,735 patients (40,649 adults and 2086 pediatric), and sociodemographic, clinical, and nursing data were collected. A random forest model was applied to assess the predictive relevance (i.e., variable importance) of individual NDs in relation to ICU transfers. Results: Among adult patients, the NDs most strongly associated with ICU transfer were Physical mobility impairment, Injury risk, Skin integrity impairment risk, Acute pain, and Fall risk. In the pediatric population, Acute pain, Injury risk, Sleep pattern disturbance, Skin integrity impairment risk, and Airway clearance impairment emerged as the NDs most frequently linked to ICU transfer. The models showed good performance and generalizability, with stable out-of-bag and validation errors across iterations. Conclusions: A prioritized ranking of NDs appears to be associated with ICU transfers, suggesting their potential utility as early warning indicators of clinical deterioration. Patients presenting with high-risk diagnostic profiles should be prioritized for enhanced clinical surveillance and proactive intervention, as they may represent vulnerable populations. Full article

(This article belongs to the Special Issue Transforming Care Through Clinical Nursing Information Systems and Standardized Nursing Terminologies: Optimizing Data-Driven Care in Hospital and Community Settings)

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19 pages, 1718 KiB

Open AccessReview

Harnessing Extended Reality for Neurocognitive Training in Chronic Pain: State of the Art, Opportunities, and Future Directions

by Javier Guerra-Armas, Alberto Roldán-Ruiz, Mar Flores-Cortes and Daniel S. Harvie

Healthcare 2025, 13(11), 1338; https://doi.org/10.3390/healthcare13111338 - 4 Jun 2025

Viewed by 485

Abstract

Chronic pain is a significant burden affecting more than 30% of people worldwide. Within the multiple biopsychosocial factors affected in people suffering from chronic pain, neurocognitive impairments represent a significant but often under-recognized aspect of the chronic pain experience that impacts daily life [...] Read more.

Chronic pain is a significant burden affecting more than 30% of people worldwide. Within the multiple biopsychosocial factors affected in people suffering from chronic pain, neurocognitive impairments represent a significant but often under-recognized aspect of the chronic pain experience that impacts daily life and healthcare. Multiple neurocognitive domains, including attention, executive function, learning, and memory, have been commonly associated with chronic pain. Within novel approaches, extended reality (XR) has been highlighted for its potential in chronic pain management. XR offers unique features to enhance traditional neurocognitive interventions, including dual tasks, gamification, ecological validity, and enriched experience, to increase engagement and motivation in rehabilitation. This systematic–narrative hybrid literature review aims to shed light on the potential benefits, challenges, and future directions of XR technology to address neurocognitive impairments associated with chronic pain. While preliminary evidence suggests that XR-based neurocognitive training may be beneficial in overcoming neurocognitive impairments found in chronic pain, some challenges still need to be addressed for effective translation into clinical practice. Within a transdiagnostic approach, XR-based neurocognitive training appears to be valuable across different diagnoses in chronic pain, wherein XR may emerge as a promising first-line intervention toward personalized multimodal management for chronic pain. Despite the rapid development of substantial growing evidence for XR, enhanced methodological rigor and reporting quality are recommended in future studies. More research is needed to fully understand the mechanisms and optimal application of XR-based neurocognitive training in different chronic pain conditions. Full article

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32 pages, 717 KiB

Open AccessArticle

Long-Term-Effects of Training-Accompanied Myofascial Self-Massage on Health Complaints, Symptoms of Overload, and Training Compatibility in Recreational Cyclists

by Doris Posch, Markus Antretter, Michael Zach, Martin Faulhaber and Martin Burtscher

Healthcare 2025, 13(11), 1337; https://doi.org/10.3390/healthcare13111337 - 4 Jun 2025

Viewed by 227

Abstract

Background/Objectives: Cycling has become a popular recreational sport, but it can lead to injuries and overload syndromes. The goal of this study is to evaluate the effectiveness of a training-accompanied myofascial self-massage intervention on two primary outcomes: injury occurrence and perceived training intensity. [...] Read more.

Background/Objectives: Cycling has become a popular recreational sport, but it can lead to injuries and overload syndromes. The goal of this study is to evaluate the effectiveness of a training-accompanied myofascial self-massage intervention on two primary outcomes: injury occurrence and perceived training intensity. Methods: To achieve this goal, we conducted a randomized controlled trial (RCT) with 35 cyclists. A difference-in-differences (DiD) regression analysis was employed to analyze the effects of the intervention. Results: The DiD analysis revealed, on the one hand, no statistically significant effect of the intervention on the overall injury score. On the other hand, the intervention group showed a significantly smaller increase in perceived training intensity compared to the control group, supporting the hypothesis that myofascial self-massage decreases the perception of training intensity. In one of our strongest models, which estimated the impact of the intervention from baseline to the second post-test, we observed an adjusted R-squared value of 0.89 and an interaction term coefficient of 1.35 at a significance level of p < 0.01. This indicates that, on average, the increase in perceived training intensity was 1.35 points higher (on a scale of 0 to 10) in the control group than in the intervention group. Conclusions: This study found no evidence to support the effectiveness of a training-accompanied myofascial self-massage in reducing injury levels, but it demonstrated that the intervention may reduce perceived training intensity. Future studies with larger sample sizes and more objective injury tracking methods are needed to further explore these findings and their long-term implications for injury prevention in cycling. Full article

(This article belongs to the Special Issue Sports Injury Prevention)

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9 pages, 225 KiB

Open AccessArticle

Low- and Very-Low-Calorie Diets and Medication Use in Hospitalized Patients with Obesity: A Cross-Sectional Study

by Sérgio de Queiroz Braga, Márcia Cristina Almeida Magalhães Oliveira, Matheus Jorgetti Chamorro, Najara Araújo de Jesus, Rodrigo Almeida Magalhães Oliveira, Dandara Almeida Reis da Silva, Domingos Lázaro Souza Rios and Magno Merces

Healthcare 2025, 13(11), 1336; https://doi.org/10.3390/healthcare13111336 - 4 Jun 2025

Viewed by 242

Abstract

Background: Obesity is a growing global health concern associated with numerous comorbidities and high medication burden. This study aimed to evaluate the impact of low- and very-low-calorie diets (LCD/VLCD), combined with intensive lifestyle changes, on comorbidities and medication use in hospitalized patients [...] Read more.

Background: Obesity is a growing global health concern associated with numerous comorbidities and high medication burden. This study aimed to evaluate the impact of low- and very-low-calorie diets (LCD/VLCD), combined with intensive lifestyle changes, on comorbidities and medication use in hospitalized patients with class II and III obesity. Methods: A retrospective cohort study was conducted using medical records of patients hospitalized for 3–6 months at a specialized obesity hospital in Brazil. Prescription data for antihypertensive, hypoglycemic, and lipid-lowering drugs were compared at admission, 3, and 6 months. Descriptive statistics, chi-squared tests, and t-tests were used to compare medication use and weight change over time. Results: Among 246 patients, the proportion of those using antihypertensives decreased from 74.4% at admission to 44.7% at 6 months (p < 0.02), with significant reductions also observed at 3 months (p < 0.001). Hypoglycemic prescriptions also declined at 3 months (p = 0.01), but not significantly at 6 months. Lipid-lowering medication use showed no significant changes. Average weight loss was 11% at 3 months and 21.3% at 6 months. Conclusions: Hospitalization with LCD/VLCD and lifestyle therapy was associated with a short-term reduction in medication burden, especially antihypertensives, supporting the potential of inpatient multidisciplinary strategies for severe obesity management. Full article

(This article belongs to the Section Chronic Care)

12 pages, 658 KiB

Open AccessArticle

Effect of Instant Messaging-Based Integrated Healthcare on Medical Service Use and Care Outcomes in Patients with Disabilities

by Han-Chin Hsieh, Yan-Yuh Lee, Nai-Ching Chen, Ya-Chuan Hu and Lin-Yi Wang

Healthcare 2025, 13(11), 1335; https://doi.org/10.3390/healthcare13111335 - 3 Jun 2025

Viewed by 200

Abstract

Objectives: We aimed to investigate how receiving integrated healthcare services from a case manager via instant messaging affected patients with disabilities. Methods: This database-matched case–control study was conducted at one medical center. Patients with officially certified disabilities were recruited and assigned to [...] Read more.

Objectives: We aimed to investigate how receiving integrated healthcare services from a case manager via instant messaging affected patients with disabilities. Methods: This database-matched case–control study was conducted at one medical center. Patients with officially certified disabilities were recruited and assigned to either the LINE-based group or the control group, which accessed services in the traditional manner. Their baseline characteristics were collected through chart reviews. Medical service utilization data—including their number of outpatient visits, prescribed medications, and hospitalizations—were obtained at baseline and 3, 6, and 12 months into the intervention. In the LINE group, quality of life, caregiver burden, and perceived social support were also assessed. A repeated-measures ANOVA was used to analyze within- and between-group differences over time. Results: Both the LINE group and the control group contained 66 patients. The number of outpatient visits (p < 0.001) and quantity of medication taken (p = 0.026) were significantly lower in the LINE group than in the control group. Furthermore, the caregiver burden in the LINE group (p = 0.024) was significantly lower 12 months after receiving integrated healthcare services. Conclusions: Providing integrated healthcare services via instant messaging enabled patients with disabilities to access medical services promptly and efficiently, thus enhancing the accessibility of healthcare and improving care for the disabled population. Full article

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19 pages, 531 KiB

Open AccessArticle

Occupational Stressors and Workplace Challenges Faced by Seafarers in Lithuania: A Cross-Sectional Study

by Birute Strukcinskiene, Arturas Razbadauskas, Rasa Grigoliene, Aistė Jeriomenkaite, Jonas Jurgaitis, Vytenis Punys, Vyte Kontautiene, Asta Beniusiene, Dalia Martisauskiene, Erika Zuperkiene, Maria Papadakaki, Donata Zuperkaite and Agnieszka Genowska

Healthcare 2025, 13(11), 1334; https://doi.org/10.3390/healthcare13111334 - 3 Jun 2025

Viewed by 230

Abstract

Background/Objectives: Seafarers are a particularly isolated workforce, as they are on-site only with their colleagues, both on and off duty. Long-term duties in the sea environment, irregular working hours, changing time zones, and lack of sleep are some of the many factors that [...] Read more.

Background/Objectives: Seafarers are a particularly isolated workforce, as they are on-site only with their colleagues, both on and off duty. Long-term duties in the sea environment, irregular working hours, changing time zones, and lack of sleep are some of the many factors that negatively affect the physical and mental health of seafarers. This study aimed to explore the occupational stressors faced by seafarers in Lithuania using the HSE Management Standards Indicator Tool (HSE-MSIT). Methods: In 2023, a quantitative study, using a paper survey, of seafarers’ occupational stressors was conducted in Klaipeda city, Lithuania. A total of 385 Lithuanian seafarers participated in the study. Results: The greatest sources of stress at work were identified as changes at work, relationships, peer support, and management support. Role clarity, demands, and work control were not strong stressors for the seafarers. Analysis of perceived stress levels revealed notable differences between groups with different work experience and job positions. Analysis of years of service (0–11 years vs. 12+ years) found that seafarers with shorter service experienced more stress in terms of demands (p = 0.005), role clarity (p = 0.004), work control (p = 0.035), and relationships (p = 0.02). Based on job position (senior vs. junior), junior seafarers experienced significantly higher stress in the demands (p = 0.001) and role clarity (p = 0.009) subscales. The study revealed that job position and years of work had weak negative correlations with stress indicators at work. The Demands subscale was moderately positively correlated with relationships and change at work. The Relationships subscale was moderately positively correlated with peer support and change at work. Role clarity was moderately negatively correlated with change at work and relationships. Conclusions: Overall, changes at work, relationships, peer support, and management support in the working environment emerged as key factors of perceived stress among seafarers. Junior seafarers and seafarers with shorter years of service experienced higher stress at work. These findings may help in the development of targeted stress management and training strategies tailored to different profiles of seafarers. Full article

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

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10 pages, 237 KiB

Open AccessArticle

Barriers to Healthcare Access During the Coronavirus Disease 2019 (COVID-19) Pandemic: A Cross-Sectional Study Among Romanian Patients with Chronic Illnesses and Confirmed SARS-CoV-2 Infection

by Adrian Militaru, Petru Armean, Nicolae Ghita and Despina Paula Andrei

Healthcare 2025, 13(11), 1333; https://doi.org/10.3390/healthcare13111333 - 3 Jun 2025

Viewed by 210

Abstract

Background/Objectives: The COVID-19 pandemic presented unprecedented challenges to healthcare systems worldwide, significantly impacting individuals with chronic conditions who depend on continuous medical care. In Romania, the pandemic revealed systemic vulnerabilities, particularly in ensuring access to services for older adults and rural populations. This [...] Read more.

Background/Objectives: The COVID-19 pandemic presented unprecedented challenges to healthcare systems worldwide, significantly impacting individuals with chronic conditions who depend on continuous medical care. In Romania, the pandemic revealed systemic vulnerabilities, particularly in ensuring access to services for older adults and rural populations. This study aimed to assess perceived barriers to healthcare access and service quality among Romanian patients with chronic diseases and a confirmed history of COVID-19, within the framework of the country’s multi-tiered healthcare system. Methods: A cross-sectional study was conducted between January and March 2025, involving 16 adult participants diagnosed with at least one chronic illness. Data were collected using a 30-item questionnaire administered by the principal investigator after obtaining informed consent. The instrument explored access to services, challenges related to remote consultations, and satisfaction with nursing care. Descriptive and comparative analyses were carried out based on age group and area of residence. Due to the small sample size, the results are considered exploratory and context-specific. Results: Most participants reported disrupted access to healthcare services, especially within public sector facilities. Rural residents experienced longer delays in receiving care than those in urban areas. Digital health tools were perceived as barriers by 75% of respondents aged 60 and above, while younger participants adapted more easily. Overall satisfaction with nursing care was moderate to high (mean score: 3.56/5), with the highest ratings observed among patients aged 30–60 years. Conclusions: This study highlights significant barriers to healthcare access among Romanian patients with chronic illnesses and a confirmed COVID-19 diagnosis during the pandemic. The key challenges included digital exclusion and rural–urban disparities. The findings underscore the need for targeted strategies to enhance digital health literacy, adapt care delivery models, and strengthen healthcare system resilience in future public health emergencies. Full article

10 pages, 215 KiB

Open AccessArticle

Association Between Oral Function and Oral-Related Quality of Life in Independent Community-Dwelling Elderly People in Taiwan

by Masayo Fukuda, Hiromi Izuno, Misao Sawada, Takako Ujihashi, Hinako Takano, Shoko Hori, Jumpei Okawa, Takahiro Ono and Kazuhiro Hori

Healthcare 2025, 13(11), 1332; https://doi.org/10.3390/healthcare13111332 - 3 Jun 2025

Viewed by 208

Abstract

Background/Objectives: Oral health is an important element of overall health and quality of life. However, few studies have evaluated the association between quality of life (QOL) and oral function, including tongue and lip movements. This study aimed to investigate the relationship between oral-related [...] Read more.

Background/Objectives: Oral health is an important element of overall health and quality of life. However, few studies have evaluated the association between quality of life (QOL) and oral function, including tongue and lip movements. This study aimed to investigate the relationship between oral-related QOL and oral function, including tongue and lip movements, in independent elderly people. Methods: The participants were 143 community-dwelling elderly people in Taiwan (40 men, 103 women; 76.4 ± 6.4 years). We used the General Oral Health Assessment Index (GOHAI) to evaluate oral-related QOL. The items used to evaluate oral function were as follows: the speed of tongue movement from side to side, maximum tongue pressure, maximum lip pressure, the repeated saliva swallowing test, oral diadochokinesis (speed and dexterity when pronouncing /pa/, /ta/, and /ka/), and masticatory performance. In addition, we surveyed the number of remaining teeth, denture use, and awareness of problems at mealtimes. For the analysis, we compared the GOHAI score for each group, divided by cutoff values. Results: The univariate analysis revealed significant differences in the GOHAI score according to denture use, the number of remaining teeth, the state of occlusal support areas, the speed of tongue movement from side to side, oral diadochokinesis /ta/ and /ka/, and masticatory performance. The logistic regression analysis revealed that oral diadochokinesis /ka/ was a significant explanatory variable for low GOHAI scores (odds ratio = 13.145). Conclusions: Our results imply that lower oral-related QOL was associated with slow motor function at the rear area of the tongue. Full article

(This article belongs to the Special Issue Oral Health and Rehabilitation in the Elderly Population)

13 pages, 230 KiB

Open AccessArticle

Mediating Role of Health Literacy in Relationship Between Frailty and Medical Costs in Community-Dwelling Older Adults

by Hee-Sun Kim and Jinhee Kim

Healthcare 2025, 13(11), 1331; https://doi.org/10.3390/healthcare13111331 - 3 Jun 2025

Viewed by 184

Abstract

This study aims to examine the mediating effects of health literacy on the relationship between frailty and medical costs among community-dwelling older adults. Methods: This study conducted a secondary data analysis of the research data that were constructed by linking the Korean Frailty [...] Read more.

This study aims to examine the mediating effects of health literacy on the relationship between frailty and medical costs among community-dwelling older adults. Methods: This study conducted a secondary data analysis of the research data that were constructed by linking the Korean Frailty and Aging Cohort Data (KFACD) and the National Health Insurance Database (NHID). Frailty was measured using the Modified Fried Phenotype. Medical costs were calculated using insurance-covered medical costs, including both inpatient and outpatient medical costs, from January 1 to December 31 of the year when the participants were enrolled in the Korean Frailty and Aging Cohort Study. Health literacy was assessed using questions from the Behavioral Risk Factor Surveillance System (BRFSS) conducted by the US Centers for Disease Control and Prevention. To examine the mediating role of health literacy in the relationship between frailty and medical costs, Baron and Kenny’s method was used. Linear regression was applied to estimate the association between frailty and health literacy, and Poisson regression was used to model the relationship between frailty, health literacy, and medical costs. Results: Frailty showed a negative correlation with health literacy (r = −0.27, p < 0.001) and a positive correlation with medical costs (r = 0.15, p < 0.001). Health literacy had a negative correlation with medical costs (r = −0.07, p = 0.008). We verified that health literacy played a partial mediating role in the relationship between frailty and medical costs. Conclusions: To reduce medical costs in older adults, intervention measures to improve health literacy as well as prevention and management measures for frailty should be considered simultaneously. In addition, primary medical institutions’ active participation in such projects is needed. Full article

14 pages, 814 KiB

Open AccessArticle

Ecological Beeswax Breast Pads Promote Breastfeeding in First-Time Mothers from the Valencian Community (Spain): A Randomized Trial

by Irene Pastor-Pagés, Verónica Ausina-Marquez, María Mercedes Rizo-Baeza, Ernesto Cortés-Castell and Ana Noreña-Peña

Healthcare 2025, 13(11), 1330; https://doi.org/10.3390/healthcare13111330 - 3 Jun 2025

Viewed by 250

Abstract

Introduction. Scientific societies emphasize the benefits of breastfeeding. The effectiveness of education, information, and support during pregnancy has been demonstrated. However, further research is needed on the prevention and treatment of nipple damage, which is a major cause of breastfeeding cessation. Objective. To [...] Read more.

Introduction. Scientific societies emphasize the benefits of breastfeeding. The effectiveness of education, information, and support during pregnancy has been demonstrated. However, further research is needed on the prevention and treatment of nipple damage, which is a major cause of breastfeeding cessation. Objective. To determine whether the use in clinical practice of beeswax breast pads in combination with the WHO (World Health Organization) health education program improves continuation of breastfeeding among first-time mothers over a 6-month follow-up period compared with the use of the WHO health education program alone. Material and methods. A prospective randomized control study was conducted in 122 first-time mothers who were seen in the midwifery office between 2017 and 2021 in several health centers in Alicante and Valencia. Data were collected through a prepartum health questionnaire, in the first weeks postpartum, and at 3 and 6 months postpartum. Results. A higher percentage of mothers in the intervention group continued breastfeeding at 6 months compared to the control group (76.3% versus 57.1%). The continuity of breastfeeding is only significant in relation to the use of the breast areolas, with values, respectively, at 3 and 6 months OR (odds ratio) = 3.129 (95% CI; 1.249–7.839; p = 0.015) and OR = 2.282 (95% CI, 1.038–5.016; p = 0.040). The NNT (number needed to treat) at 3 months = 5 (95% CI 3–13; p = 0.004) and at 6 months = 5 (95% CI 3–26; p = 0.025) Conclusions. The use of organic beeswax breast pads in combination with the WHO health education program improves initiation and maintenance of exclusive breastfeeding among first-time mothers and the perception of their health status compared to the health education program alone. Full article

(This article belongs to the Special Issue Healthy Lifestyle for Pregnant and Postpartum Women)

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13 pages, 274 KiB

Open AccessArticle

The Virtual-Body Project Reduces Eating Disorder Symptoms Among Young Adult Brazilian Women: A Pilot Study

by Karin Louise Lenz Dunker, Ana Carolina Soares Amaral and Pedro Henrique Berbert de Carvalho

Healthcare 2025, 13(11), 1329; https://doi.org/10.3390/healthcare13111329 - 3 Jun 2025

Viewed by 300

Abstract

Background/Objectives: Dissonance-based (DB) eating disorder (ED) prevention programs have been showing their efficacy in reducing ED symptoms among adolescents, young adults, and older people. Several meta-analyses showed that the Body Project is the most effective ED prevention program for at-risk women; however, the [...] Read more.

Background/Objectives: Dissonance-based (DB) eating disorder (ED) prevention programs have been showing their efficacy in reducing ED symptoms among adolescents, young adults, and older people. Several meta-analyses showed that the Body Project is the most effective ED prevention program for at-risk women; however, the program presents high costs when delivered in-person and recruitment on a large scale is limited, suggesting the evaluation of its efficacy when delivered virtually. Thus, we investigated the efficacy of the v-Body Project (i.e., a virtual DB ED prevention program) among young adult Brazilian women. Methods: A pilot study delivered the v-Body Project to 85 Brazilian women (M_age = 22.55, SD = 2.07, age range = 18–25). Measures of ED symptoms, body dissatisfaction, the thin ideal internalization, negative affect, self-esteem, and body appreciation were applied at baseline, post-intervention, and at 1-month and 6-months follow-up. Results: Results demonstrated improvements in all outcomes at post-intervention. Large effect sizes were found for ED symptoms, body dissatisfaction, thin–ideal internalization, negative affect, and body appreciation (Cohen’s d = 0.74–1.31) and were maintained up to 6-months. A small effect size was identified for self-esteem (Cohen’s d = 0.40), while the efficacy was maintained up to 6-months. Conclusions: Results support the efficacy of the v-Body Project up to 6-months, providing a tool with lower costs for participants and the advantage of large-scale application for ED prevention programs. Strategies are needed to implement this protocol within the Brazilian public health system, including the training of facilitators and the broader dissemination of the intervention. Full article

(This article belongs to the Special Issue Prevention and Intervention in Eating Disorders)

13 pages, 361 KiB

Open AccessSystematic Review

Effects of Virtual Reality on Adults Diagnosed with Chronic Non-Specific Low Back Pain: A Systematic Review

by Rocío García-de-la-Banda-García, David Cruz-Díaz, Juan Francisco García-Vázquez, María del Mar Martínez-Lentisco and Felipe León-Morillas

Healthcare 2025, 13(11), 1328; https://doi.org/10.3390/healthcare13111328 - 3 Jun 2025

Viewed by 369

Abstract

Background/Objectives: Non-specific low back pain represents a high number of primary care consultations, generating a great social and economic cost. There is a higher prevalence in women, and it may be associated with multiple factors. One of the most innovative tools in rehabilitation [...] Read more.

Background/Objectives: Non-specific low back pain represents a high number of primary care consultations, generating a great social and economic cost. There is a higher prevalence in women, and it may be associated with multiple factors. One of the most innovative tools in rehabilitation is virtual reality-based therapy. Virtual reality positively affects the motivation of participants and generates greater adherence to treatment, so this factor could lead to long-term functional improvement. The objective of this review is to update the effectiveness of virtual reality programs on pain, disability, kinesiophobia, and changes in the thoracoabdominal musculature in patients with chronic nonspecific low back pain. Methodology: PubMed, PEDro, SCOPUS, Web of Science, and the Cochrane Library were used in this systematic review. The research question was formulated using PICOS. The Physiotherapy Evidence Database (PEDro) scale was used. Inclusion criteria were randomized clinical trials, participants were men and/or women over 18 years of age who were diagnosed with chronic non-specific low back pain, and articles that included virtual reality as a treatment. Articles with a level of evidence lower than 5/10 on the PEDro scale were excluded. Results: A total of 14 studies were included with sample sizes between 34 and 188 participants. Studies showed significant improvements in pain reduction, kinesiophobia, and disability (inflammation and motor control). Some studies showed long-term benefits, with effects maintained up to 18 months post-intervention, especially in the reduction in pain and its interference with daily activities. Conclusions: The findings of this systematic review support the efficacy of virtual reality as an effective and safe therapeutic option for the treatment of chronic non-specific low back pain. Full article

(This article belongs to the Special Issue Neuromodulation and Neuroplasticity in Chronic Pain: New Therapeutic Tools)

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19 pages, 1287 KiB

Open AccessArticle

Effectiveness of a Digital Game-Based Physical Activity Program (AI-FIT) on Health-Related Physical Fitness in Elementary School Children

by Se-Won Park, Dong-Ha Lim, Je-Hyun Kim, Sung-Hun Kim and Yeon-Oh Han

Healthcare 2025, 13(11), 1327; https://doi.org/10.3390/healthcare13111327 - 3 Jun 2025

Viewed by 273

Abstract

Objectives: This study empirically examined the effects of a digital game-based physical activity program (AI-FIT) on elementary school children’s health-related physical fitness while exploring the role of educational technology (EdTech) as a practical solution to post-pandemic physical inactivity. Methods: This study was conducted [...] Read more.

Objectives: This study empirically examined the effects of a digital game-based physical activity program (AI-FIT) on elementary school children’s health-related physical fitness while exploring the role of educational technology (EdTech) as a practical solution to post-pandemic physical inactivity. Methods: This study was conducted over a 12-week period, from September to December 2024, with 40 students (grades 4 to 6) from an elementary school located in a mid-sized city in South Korea. The participants had a mean age of 10.8 years (SD = 0.69). The experimental group (n = 20) participated in the AI-FIT program, while the control group (n = 20) received regular physical education classes. To ensure baseline equivalence between the groups, propensity score matching was employed. Health-related physical fitness was assessed through pre- and post-tests, including flexibility, muscular endurance, cardiorespiratory endurance, explosive power, and Physical Activity Promotion System (PAPS) grade. Analyses were conducted using both dependent (paired) and independent t-tests, along with effect size calculations (Cohen’s d), to examine within-group and between-group differences. In addition, gender-based subgroup analyses were performed to examine potential differences in responsiveness to the intervention. Intervention: Results indicated that the AI-FIT program had a large effect on flexibility (d = 0.90) and muscular endurance (d = 0.80) and a moderate-to-large effect on PAPS grade (d = 0.69). In contrast, no statistically significant improvements were observed in cardiorespiratory endurance or explosive power. Conclusions: These findings suggest that a digital program integrating AI-based personalized exercise prescriptions and gamification elements can effectively enhance the health-related fitness of elementary students. Moreover, this study supports the educational efficacy of EdTech-based interventions in physical education settings. Full article

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29 pages, 4999 KiB

Open AccessSystematic Review

Integrating Acupuncture and Herbal Medicine into Assisted Reproductive Technology: A Systematic Review and Meta-Analysis of East Asian Traditional Medicine

by Xiangping Peng, Bo Wu, Siyu Zhou, Yinghan Xu, Atsushi Ogihara, Shoji Nishimura, Qun Jin and Gerhard Litscher

Healthcare 2025, 13(11), 1326; https://doi.org/10.3390/healthcare13111326 - 3 Jun 2025

Viewed by 418

Abstract

Background: Assisted reproductive technologies (ARTs) are essential in treating infertility but often face limited success due to low implantation and live birth rates. East Asian traditional medicine (EATM), including acupuncture and herbal medicine (HM), may enhance physiological responses during ART cycles. This study [...] Read more.

Background: Assisted reproductive technologies (ARTs) are essential in treating infertility but often face limited success due to low implantation and live birth rates. East Asian traditional medicine (EATM), including acupuncture and herbal medicine (HM), may enhance physiological responses during ART cycles. This study evaluated the effectiveness and safety of EATM in improving clinical pregnancy and live birth outcomes in women undergoing ART. Methods: This review, registered in PROSPERO (CRD42023411712), systematically searched 11 databases up to 31 March 2023. We included randomized controlled trials (RCTs) comparing EATM interventions to control groups. Data extraction and quality assessment were performed independently by two authors. Meta-analysis used the inverse-variance method in Stata 12.0. A total of 37 RCTs involving 10,776 women (aged 29–38) were analyzed. Studies addressed infertility causes including polycystic ovary syndrome, tubal blockage, diminished ovarian reserve, and unexplained infertility. Acupuncture therapies included body, electro-, laser, and auricular acupuncture. Herbal treatments were administered as powders, pills, granules, decoctions, and ointments based on traditional Chinese formulas. Results: EATM interventions were associated with significant improvements in clinical pregnancy and live birth rates. Acupuncture increased clinical pregnancy rates (CPR: RR 1.316, 95% CI 1.171–1.480) and live birth rates (LBR: RR 1.287, 95% CI 1.081–1.533). HM also enhanced CPRs (RR 1.184) and LBRs (RR 1.147). Subgroup analysis showed true acupuncture and HM were more effective than sham or placebo. No significant differences in adverse events were found. Conclusions: EATM, particularly acupuncture and HM, appears to be a safe and effective complementary therapy that can be used to improve ART outcomes. Future research should focus on developing standardized acupuncture and herbal protocols to optimize integration with ART. Full article

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Open AccessArticle

Comparative Analysis of Mustardé, Fascioperichondrial Flap, and Combined Otoplasty Techniques: Clinical Outcomes and Recurrence Rates in 365 Patients

by Ahmet Hamdi Kepekçi

Healthcare 2025, 13(11), 1325; https://doi.org/10.3390/healthcare13111325 - 3 Jun 2025

Viewed by 181

Abstract

Background/Objectives: Prominent ear deformity is one of the most common congenital anomalies and may lead to substantial aesthetic and psychosocial distress, particularly in children and young adults. This study evaluated the clinical outcomes of three frequently used otoplasty techniques, Mustardé sutures, fascioperichondrial flap, [...] Read more.

Background/Objectives: Prominent ear deformity is one of the most common congenital anomalies and may lead to substantial aesthetic and psychosocial distress, particularly in children and young adults. This study evaluated the clinical outcomes of three frequently used otoplasty techniques, Mustardé sutures, fascioperichondrial flap, and their combination, concerning recurrence rates, complications, and patient satisfaction. Methods: This retrospective analysis included data from 365 patients who underwent otoplasty between 2017 and 2023 at a single institution, with all procedures performed by the same surgeon. Patients were categorized into three groups based on the surgical technique employed: Mustardé (n = 71), fascioperichondrial flap (n = 232), and a combined technique (n = 62). The primary outcome was the recurrence rate, while secondary outcomes included the type of suture material, complication rates, and aesthetic satisfaction. Results: The lowest recurrence rate was observed in the fascioperichondrial flap group (6.5%), followed by the combined group (8.5%) and the Mustardé group (29.6%). Logistic regression analysis revealed that the flap technique was associated with a 3.79-fold reduction in recurrence risk compared with the Mustardé method (p = 0.033). Overall complication rates were low across all groups. Hematoma occurred only in the flap group (1.3%), while suture extrusion and granuloma formation were exclusive to the Mustardé group. The highest aesthetic satisfaction was reported in the combined technique group. Conclusion: The fascioperichondrial flap method demonstrated statistically superior outcomes in minimizing recurrence and complications in prominent ear surgery. While the Mustardé technique demands careful patient selection due to its higher recurrence risk, the combined approach appears particularly beneficial for complex auricular deformities. The robust sample size and surgical standardization in this study provide valuable insights for surgical decision making in otoplasty. To our knowledge, this is one of the largest single-surgeon case series evaluating recurrence and complication outcomes in otoplasty. Full article

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Healthcare, Volume 13, Issue 11 (June-1 2025) – 140 articles

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