Healthcare

19 pages, 274 KiB

Open AccessArticle

Psychological Distress and Kidney Failure as Predictors of Chemoradiotherapy Toxicity and Quality of Life in Patients with Head and Neck Cancer

by Daniela Jicman Stan, Alin-Laurentiu Tatu, Alina-Maria Lescai, Corina Popazu, Adriana Liliana Vlad, Georgian Dobrea and Alexia Anastasia Ștefania Baltă

Healthcare 2025, 13(12), 1476; https://doi.org/10.3390/healthcare13121476 - 19 Jun 2025

Viewed by 160

Abstract

Background: Quality of life (QoL) in oncology patients is shaped by the interplay of biological, psychological and treatment-related factors. While prior studies have addressed the independent effects of treatment toxicity and psychological distress, little is known about the interaction between depressive–anxious disorders, [...] Read more.

Background: Quality of life (QoL) in oncology patients is shaped by the interplay of biological, psychological and treatment-related factors. While prior studies have addressed the independent effects of treatment toxicity and psychological distress, little is known about the interaction between depressive–anxious disorders, kidney failure and haematological toxicity on QoL among patients with head and neck cancer undergoing chemoradiotherapy. Objective: This study aims to examine the combined effect of haematological toxicity, depressive–anxious disorders and chronic renal disease on the total QLQ-H&N43 score, a validated measure of QoL in patients with head and neck cancer. Methods: A total of 93 patients were included in an observational study. PROCESS macro for SPSS was used to test the three-way interaction between haematological toxicity (X), depressive–anxious disorders (W) and kidney failure (Z) on QoL (Y). Results: The three-way interaction was statistically significant (β = 31.04, p = 0.032), accounting for 18.9% of the variance in QLQ-H&N43 scores (R² = 0.1888). Patients presenting both depressive–anxious disorders and renal comorbidities reported higher QoL scores, indicating poorer quality of life in the presence of severe treatment toxicity. Conclusions: Psychological distress and kidney failure may synergistically exacerbate the negative effects of chemoradiotherapy toxicity on quality of life. These findings underscore the need for integrated care models addressing both psychological vulnerability and medical comorbidities in oncology. Full article

22 pages, 5529 KiB

Open AccessArticle

From Perception to Action: Air Pollution Awareness and Behavioral Adjustments in Pregnant Women in Serbia

by Ana Susa, Milica Zekovic, Dragana Davidovic, Katarina Paunovic, Vera Kujundzic, Sladjana Mihajlovic and Ljiljana Bogdanovic

Healthcare 2025, 13(12), 1475; https://doi.org/10.3390/healthcare13121475 - 19 Jun 2025

Viewed by 216

Abstract

In regions with sustained air pollution, the adoption of protective health behaviors is critical, particularly among pregnant women—a population marked by physiological vulnerability and heightened receptivity to preventive guidance. Understanding and supporting patient-driven behavioral change requires attention to individual perception and awareness, which [...] Read more.

In regions with sustained air pollution, the adoption of protective health behaviors is critical, particularly among pregnant women—a population marked by physiological vulnerability and heightened receptivity to preventive guidance. Understanding and supporting patient-driven behavioral change requires attention to individual perception and awareness, which are shaped by socio-economic and spatial factors, as well as access to credible information. Objectives: This study investigates how pregnant women in Serbia perceive air quality, identifies determinants that influence these perceptions, and evaluates the extent and nature of behavioral adaptations undertaken to mitigate exposure-related risks. Methods: A cross-sectional survey was conducted among 279 pregnant women using a structured, researcher-administered questionnaire. Collected data included demographic and psychosocial variables, air quality perceptions, self-reported health effects, and behavioral responses. Residential proximity to land-use attributes was assessed using GIS-based spatial analysis. Results: Most participants perceived air quality as poor (68.8%), primarily informed by unofficial sources such as mobile applications and social media. Living close to continuous urban fabric (OR = 0.180, 95% CI: 0.059–0.558, p = 0.003) and water (OR = 0.306, 95% CI: 0.127–0.738, p = 0.008) was associated with poorer perceptions, while proximity to forests (OR = 2.938, 95% CI: 1.323–6.525, p = 0.008) correlated with more favorable assessments. Despite prevalent concern, around half of respondents (50.2%) reported no behavioral modifications. Importantly, none had received guidance from healthcare professionals on the topic. Conclusions: These findings highlight critical gaps in environmental health literacy and provider engagement. Integrating tailored communication and behavioral support in existing prenatal counseling could advance health-related quality of life in this vulnerable population. Full article

(This article belongs to the Special Issue Patient-Centered Care for Enhancing Health-Related Quality of Life: Integrating Clinical, Behavioral, and Social Determinants of Health)

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Graphical abstract

17 pages, 272 KiB

Open AccessArticle

Predictors of Transphobia and Attitudes Toward Transgender Individuals Among Nurses in Türkiye: A Cross-Sectional Study

by Ezgi Şişman, Mehtap Güngör, Aila Gareayaghi, Hanife Yılmaz and Aslıhan Polat

Healthcare 2025, 13(12), 1474; https://doi.org/10.3390/healthcare13121474 - 19 Jun 2025

Viewed by 251

Abstract

Background/Objectives: Transgender individuals face significant healthcare disparities, often exacerbated by provider prejudice and knowledge gaps. Nurses, as frontline providers, play a critical role in promoting inclusive care. This study aimed to evaluate the levels and predictors of transphobia and attitudes toward transgender individuals [...] Read more.

Background/Objectives: Transgender individuals face significant healthcare disparities, often exacerbated by provider prejudice and knowledge gaps. Nurses, as frontline providers, play a critical role in promoting inclusive care. This study aimed to evaluate the levels and predictors of transphobia and attitudes toward transgender individuals among nurses in Türkiye. Methods: A cross-sectional survey was conducted with 100 registered nurses. Participants completed the Transphobia Scale, the Attitudes Toward Transgender Individuals Scale, and the Hudson & Ricketts Homophobia Scale. Additional measures included perceived knowledge, prior education on transgender health, familial attitudes, and comfort levels when working with transgender patients. Multiple linear regression analyses identified predictors of transphobia and attitudes. Results: The mean Transphobia Scale score was 41.53 (SD = 12.67), and the mean Attitudes Toward Transgender Individuals Scale score was 57.45 (SD = 16.42). Greater homophobia, negative parental attitudes, and higher perceived knowledge significantly predicted higher transphobia scores (Adjusted R²= 0.327). Prior education on transgender health was also associated with lower transphobia. Lower comfort with transgender patients was marginally associated with higher transphobia. More positive attitudes toward transgender individuals were predicted by lower transphobia, lower homophobia, and prior education (Adjusted R² = 0.526). Conclusions: Findings underscore the urgent need for structured transgender health education and culturally sensitive interventions among nurses. Addressing sociocultural factors and training gaps could enhance equitable healthcare delivery for transgender populations, particularly in culturally conservative settings like Türkiye. Full article

(This article belongs to the Collection Current Nursing Practice and Education)

19 pages, 269 KiB

Open AccessArticle

Understanding High-Risk Behavior in Mexican University Youth: Links Between Sexual Attitudes, Substance Use, and Mental Health

by Gustavo A. Hernández-Fuentes, Osiris G. Delgado-Enciso, Jessica C. Romero-Michel, Verónica M. Guzmán-Sandoval, Mario Del Toro-Equihua, José Guzmán-Esquivel, Gabriel Ceja-Espíritu, Mario Ramírez-Flores, Margarita L. Martinez-Fierro, Idalia Garza-Veloz, Fabian Rojas-Larios, Karla B. Carrazco-Peña, Rosa Tapia-Vargas, Ana C. Espíritu-Mojarro and Iván Delgado-Enciso

Healthcare 2025, 13(12), 1473; https://doi.org/10.3390/healthcare13121473 - 19 Jun 2025

Viewed by 255

Abstract

Background/Objectives: Sexual attitudes, particularly those on the erotophilia (positive openness) to erotophobia (negative fear) scales, play a critical role in shaping behaviors and health decisions. While associations between sexual behavior and substance use have been documented, limited research has explored how sexual attitudes [...] Read more.

Background/Objectives: Sexual attitudes, particularly those on the erotophilia (positive openness) to erotophobia (negative fear) scales, play a critical role in shaping behaviors and health decisions. While associations between sexual behavior and substance use have been documented, limited research has explored how sexual attitudes relate to mental health and substance use among Latin American university populations. This study aimed to examine the associations among erotophilic attitudes, mental health symptoms (anxiety and depression), substance use risk, and sexual behaviors in Mexican university students. Methods: A cross-sectional observational study was conducted between 2019 and 2023 with 1475 undergraduate students aged 17–25 years. Participants completed the Revised Sexual Opinion Survey (R-SOS) to assess sexual attitudes, the Hospital Anxiety and Depression Scale (HADS) for mental health evaluation, and adapted items from the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to measure substance use risk. Erotophilic attitudes were defined as R-SOS scores ≥ 70. Statistical tests included the Kolmogorov–Smirnov test for normality, t-tests or Mann–Whitney U tests for group comparisons, Fisher’s exact test for categorical variables, and Spearman’s correlations. Multivariate binary logistic regression was used to calculate adjusted odds ratios (AdORs) and 95% confidence intervals (CIs), with a significance level of p < 0.05. Results: Erotophilic students were more likely to be male, older, initiate sexual activity earlier, and report a greater number of sexual partners. Erotophilia was positively associated with anxiety and tobacco, alcohol and marijuana use, and negatively associated with depressive symptoms. Multivariate analysis indicated that erotophilia was independently associated with male sex, age ≥ 20, higher anxiety, lower depression, low socioeconomic status, and increased risk of tobacco and marijuana use. Lower rates of consistent condom use were also reported among erotophilic individuals. Conclusions: Erotophilia may serve as a behavioral risk marker linked to anxiety symptoms and increased substance use, but not to depression. These findings highlight the need for integrated interventions addressing sexual health, substance use, and mental well-being in university populations. Full article

(This article belongs to the Special Issue High-Risk Behavior: Impacts on the Health and Wellness of Young People)

17 pages, 428 KiB

Open AccessArticle

Enhancing Episiotomy Skills Through Interactive Online Simulation

by Hülya Tosun and Hava Özkan

Healthcare 2025, 13(12), 1472; https://doi.org/10.3390/healthcare13121472 - 18 Jun 2025

Viewed by 175

Abstract

Background/Objectives: The COVID-19 pandemic has significantly restricted clinical training for midwifery students, highlighting the need for alternative teaching methods. With the disruption of traditional face-to-face education, online simulation-based training has emerged as an effective alternative for developing essential clinical skills. The acquisition of [...] Read more.

Background/Objectives: The COVID-19 pandemic has significantly restricted clinical training for midwifery students, highlighting the need for alternative teaching methods. With the disruption of traditional face-to-face education, online simulation-based training has emerged as an effective alternative for developing essential clinical skills. The acquisition of hands-on skills has a direct impact on students’ self-confidence and clinical performance. Interactive online simulations support the learning process by enhancing both theoretical knowledge and practical competencies. This study aims to evaluate the impact of online simple simulation-based episiotomy repair training on students whose clinical practice was limited due to the COVID-19 pandemic. Methods: A mixed-method approach was used, considering the outcomes from 61 midwifery students. Data were collected via observational questionnaires, which provide an online learning readiness scale and scales for student satisfaction and self-confidence. The analysis included descriptive statistics, McNemar’s, binary logistic regression, and the Mann–Whitney U test. Results: Students who trusted themselves in both opening and repairing an episiotomy after training had more readiness for online learning (t(43) = 2.73, p = 0.009; t(43) = 2.40, p = 0.02). Students with better training performance are more likely to obtain higher scores on the final exam of the Clinical Practice module (rho = 0.33, p = 0.01). Additionally, their performance was a positive and significant predictor of achieving a full mark (b = 0.11, s.e. = 0.05, p = 0.01). Conclusions: Interactive online simulation training improved midwifery students’ hand skills and self-confidence in clinical practice. Such methods should be promoted in circumstances like COVID-19. Full article

(This article belongs to the Section TeleHealth and Digital Healthcare)

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12 pages, 923 KiB

Open AccessArticle

Beyond Low Back Pain! The Influence of Physical Activity on Mental Health, Reflected in the Functionality of People with Low Back Pain

by Franciele Parolini, Klaus Becker, Márcio Goethel, Ricardo J. Fernandes, Hélder Fonseca, Ulysses F. Ervilha, João Paulo Vilas-Boas and Rubim Santos

Healthcare 2025, 13(12), 1471; https://doi.org/10.3390/healthcare13121471 - 18 Jun 2025

Viewed by 157

Abstract

Background/Objectives: Psychological factors play a crucial role in the experience of acute low back pain and may influence functional outcomes. However, the interplay between these factors and levels of physical activity remains poorly understood. Methods: This cross-sectional observational study examined the relationship between [...] Read more.

Background/Objectives: Psychological factors play a crucial role in the experience of acute low back pain and may influence functional outcomes. However, the interplay between these factors and levels of physical activity remains poorly understood. Methods: This cross-sectional observational study examined the relationship between psychological variables and functional disability in individuals with acute low back pain, considering different levels of physical activity. Data were collected from 1021 participants through an online platform between 8 June 2022 and 8 April 2023. Standardized instruments were used to assess functional limitations, emotional distress (depression, anxiety, and stress), daily pain catastrophizing, and physical activity levels. A canonical correlation analysis was conducted to explore the multivariate associations between psychological and functional variables. Results: There was a statistically significant association between higher levels of emotional distress and greater functional impairment related to low back pain. This association was observed in both the light-physical-activity group (canonical coefficient = 0.266; p = 0.017), the moderate-physical-activity group (0.237; p = 0.092), and the vigorous-physical-activity group (0.177; p = 0.013). Participants engaging in vigorous physical activity exhibited more favorable psychological profiles and lower functional disability compared to those with lower levels of activity. Conclusions: Regular and vigorous physical activity appears to be a protective factor for mental health and may help reduce functional disability in individuals with acute low back pain. These findings underscore the importance of considering physical activity levels when addressing psychological and functional outcomes in this population. Full article

(This article belongs to the Special Issue Future Trends of Physical Activity in Health Promotion)

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19 pages, 447 KiB

Open AccessArticle

Associations of Body Mass Index and Lifestyle Factors with Suicidal Ideation, Planning, and Attempts Among Korean Adolescents: A Cross-Sectional Study

by Haitao Wang and Kyung-O Kim

Healthcare 2025, 13(12), 1470; https://doi.org/10.3390/healthcare13121470 - 18 Jun 2025

Viewed by 129

Abstract

Background: Unhealthy lifestyles constitute significant risk factors for adolescent suicide, and their detrimental effects may persist from adolescence into adulthood. This research study sought to examine how Body Mass Index (BMI), alongside various lifestyle behaviors among teenagers in Korea, correlates with suicidal thoughts, [...] Read more.

Background: Unhealthy lifestyles constitute significant risk factors for adolescent suicide, and their detrimental effects may persist from adolescence into adulthood. This research study sought to examine how Body Mass Index (BMI), alongside various lifestyle behaviors among teenagers in Korea, correlates with suicidal thoughts, the formulation of suicide plans, and actual suicide attempts. Methods: The research examined unprocessed information collected during the 2022 Korean Youth Risk Behavior Web-based Survey (KYRBS), which was administered by the Korea Disease Control and Prevention Agency (KDCA). Lifestyle factors associated with suicidal behavior were selected as independent variables. The sample was stratified according to BMI for further analysis. Logistic regression models were applied to assess the association between lifestyle factors and the risk of adolescent suicide. Results: The analysis identified significant correlations between unhealthy dietary patterns, hazardous drinking behavior, smoking, and a sleep duration of less than 5 h, all of which were associated with a heightened suicide risk among adolescents. Notably, underweight adolescents who had a sleep duration of less than 5 h demonstrated a markedly elevated risk of suicidal ideation (OR = 2.391, 95% CI [1.035–5.525]). Among overweight adolescents, frequent coffee consumption was significantly associated with both suicidal planning (OR = 1.850, 95% CI [1.133–3.020]) and suicide attempts (OR = 1.958, 95% CI [1.024–3.742]). Importantly, hazardous drinking behavior was strongly associated with suicide attempts (OR = 2.277, 95% CI [1.132–4.580]). Non-smoking behavior exhibited a significant relationship with a decreased likelihood of suicidal ideation (OR = 0.706, 95% CI [0.507–0.983]) and suicidal planning (OR = 0.528, 95% CI [0.299–0.930]). Furthermore, among obese adolescents, non-smoking behavior significantly decreased the risk of suicidal ideation compared to smoking (OR = 0.514, 95% CI [0.297–0.887]). Conclusions: The study revealed that the combined impact of unhealthy behaviors—smoking, eating an unhealthy breakfast, sleeping for less than 5 h, and hazardous drinking behavior—significantly affect suicide-related behaviors in adolescents. The interaction between BMI and lifestyle factors is a critical determinant of these behaviors. Specifically, sleep health exerts a substantial influence on suicide-related behaviors in underweight adolescents, while smoking strongly correlates with suicidal behaviors in overweight and obese adolescents. Targeted attention to the interplay of smoking, diet, sleep, and alcohol consumption with BMI is crucial for the early detection and prevention of adolescent suicide. Full article

(This article belongs to the Special Issue Research and Survey on the Mental Health of Children and Adolescents: Second Edition)

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17 pages, 341 KiB

Open AccessArticle

Breaking Barriers, Building Habits: Psychological Analysis of the Relationship Between Perceived Barriers, Financial Burden, and Social Support on Exercise Adherence Among Adults Aged 50 and Older in South Korea

by Suyoung Hwang and Eun-Surk Yi

Healthcare 2025, 13(12), 1469; https://doi.org/10.3390/healthcare13121469 - 18 Jun 2025

Viewed by 127

Abstract

Background/Objective: Sustained exercise adherence among older adults is essential for healthy aging but remains challenging due to psychological, social, and economic barriers. This study aimed to investigate how perceived exercise barriers, financial burden, constraint negotiation mechanisms, and social support influence exercise adherence among [...] Read more.

Background/Objective: Sustained exercise adherence among older adults is essential for healthy aging but remains challenging due to psychological, social, and economic barriers. This study aimed to investigate how perceived exercise barriers, financial burden, constraint negotiation mechanisms, and social support influence exercise adherence among adults aged 50 and older by integrating behavioral economics, constraint negotiation theory, and social cognitive theory. Methods: A cross-sectional survey was conducted with 1000 community-dwelling older adults in South Korea using a convenience sampling method. Participants were recruited from community centers, senior welfare facilities, and public health clinics in urban and suburban areas. Data collection was conducted between 11 January and 21 April 2024, using both online (Qualtrics) and offline (paper-based) surveys. Participants completed validated instruments measuring perceived exercise barriers, financial burden, constraint negotiation mechanisms (including financial management and social support mobilization), perceived social support, and behavioral exercise adherence. The final sample used for analysis included 974 individuals (mean age = 60.24 years, SD = 6.42). Structural Equation Modeling (SEM) was used to assess direct, mediating, and moderating effects. Additional exploratory analyses (ANOVA and t-tests) examined subgroup differences. Results: SEM results showed that perceived exercise barriers (β = –0.352, p < 0.001) and financial burden (β = –0.278, p < 0.001) were negatively associated with exercise adherence. Constraint negotiation mechanisms (β = 0.231, p < 0.001) and perceived social support (β = 0.198, p < 0.001) were positively associated. Mediation analyses revealed that constraint negotiation strategies partially mediated the relationships between perceived barriers and adherence (indirect β = 0.124) and between financial burden and adherence (indirect β = 0.112). Moderation analysis confirmed that social support buffered the negative effects of financial and psychological barriers. Conclusions: Exercise adherence in later life is shaped by the dynamic interplay of structural constraints, behavioral strategies, and social reinforcement. Interventions should combine financial support with socially embedded structures that promote behavioral planning and peer accountability to sustain long-term physical activity among older adults. Full article

(This article belongs to the Special Issue Research on Health-Related Quality of Life and Well-Being Among Older People)

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9 pages, 184 KiB

Open AccessArticle

Cooled Radiofrequency Ablation of Thoracic Medial Branches for the Treatment of Chronic Thoracic Pain

by Alaa Abd-Elsayed, Alessandro Preda, Barnabas T. Shiferaw, Alexis K. Harrell and Kenneth J. Fiala

Healthcare 2025, 13(12), 1468; https://doi.org/10.3390/healthcare13121468 - 18 Jun 2025

Viewed by 187

Abstract

Background: Chronic thoracic pain is commonly caused by thoracic facet dysfunction, intercostal neuralgia, surgery, or thoracic pain secondary to cancer and is present in approximately 15% of the population. Conventional treatments, including pharmacotherapy and transcutaneous electrical nerve stimulation, are often ineffective and are [...] Read more.

Background: Chronic thoracic pain is commonly caused by thoracic facet dysfunction, intercostal neuralgia, surgery, or thoracic pain secondary to cancer and is present in approximately 15% of the population. Conventional treatments, including pharmacotherapy and transcutaneous electrical nerve stimulation, are often ineffective and are often associated with poorly tolerated adverse effects. Cooled radiofrequency ablation (c-RFA) is a minimally invasive procedure that uses radiofrequency energy delivered through a probe to lesion the targeted nerve and provide significant and lasting relief. Methods: This study was a retrospective analysis of data extracted from UW-Health Electronic Medical Health records from October 2015 through June 2024. Patient data were collected, including diagnosis, pre-operative pain score, post-operative pain score, duration of relief, age, sex, and BMI. A two-tailed paired t-test was used to analyze the pre-operative and post-operative pain scores. A p-value < 0.05 was considered significant. Results: A total of 111 thoracic c-RFA procedures were reviewed; 43 were excluded due to absent pre-operative or post-operative pain scores in medical records. A total of 68 procedures were included in the analysis, comprising 55 patients: 25 females and 30 males with an average age of 51.31 ± 18.22 years and a BMI of 29.79 ± 6.48 kg/m². Improvement in pain scores was reported in 77.94% (n = 53), 16.18% (n = 11) reported no change, and 5.88% (n = 4) reported worsening pain. Patients reported an average pre-operative pain score of 5.98 (M = 5.98, SD = 1.91) and an average post-operative pain score of 3.06 (M = 3.06, SD = 2.52); this achieved significance (p < 0.0001). Of the 77.94% (n = 53) charts that noted improvement, there is an average of 62.83 ± 28.48% reduction from their pre-operative pain scores. The average duration of relief lasted 11.85 ± 13.42 months. Conclusions: This study supports the efficacy and safety of c-RFA as a minimally invasive therapy for chronic thoracic pain refractory to conservative measures. Full article

20 pages, 510 KiB

Open AccessArticle

The Emotional Universe of Nonbinary Parents: A Hermeneutic Study

by Victoria Emilia Souviron-Dixon, Pablo Martínez-Angulo, María del Rocío Jiménez-Mérida and Pedro E. Ventura-Puertos

Healthcare 2025, 13(12), 1467; https://doi.org/10.3390/healthcare13121467 - 18 Jun 2025

Viewed by 214

Abstract

Introduction: Nonbinary individuals who do not identify as exclusively male or female often face unique emotional challenges due to societal cisheteronormativity and limited recognition of their identities. While existing research has primarily focused on anxiety, depression, and pathways to parenthood among nonbinary [...] Read more.

Introduction: Nonbinary individuals who do not identify as exclusively male or female often face unique emotional challenges due to societal cisheteronormativity and limited recognition of their identities. While existing research has primarily focused on anxiety, depression, and pathways to parenthood among nonbinary people, little attention has been paid to their comprehensive emotional experiences as parents. This study aims to explore the emotional universe of two nonbinary parents from Spain and the United States. Design: Hermeneutic study. Materials and Methods: We implemented purposive sampling, conducted semi-structured virtual interviews, and followed Ricoeur’s theory of interpretation for data analysis. We used the Universe of Emotions affective taxonomy as a starting category in this analysis. Our sample consisted of a 32-year-old white Spanish nurse (she/they/them), assigned female at birth and parent of two one-year-old toddlers, and a 34-year-old white North American physiotherapist (he/they/them) assigned female at birth and parent of a ten-year-old child. Results: Through its four themes (A story of misunderstanding: “What are you, a combat helicopter?”; Clearly, you don’t fit, so…; But (a new) family is there; No monster here: I’m, at the core, a human being), this study reveals the complex emotional journey experienced by two nonbinary parents. Conclusions: Central to this journey are three key emotions: strangeness, belonging, and acceptance. The participants describe an initial stage marked by body and social dysphoria, confusion, and rejection, followed by a transformative process in which parenthood becomes a catalyst for emotional and identity integration. This transition—from alienation to connection—reflects a broader movement from dehumanization to humanization, where the experience of parenting fosters emotional resilience, social recognition, and a renewed sense of self. Implications for the profession and/or patient care: Analyzing their emotions (both negative and positive ones), we obtained robust insights into these parents’ personal and social contexts. Therefore, we can facilitate understanding of the emotional complexity of nonbinary parents by the trans and cisgender communities. Through this understanding, nurses and the organizations they work for can improve their competence in their holistic care. Acceptance from nonbinary parents’ social contexts, of which nursing is a part, is a critical factor in their health and emotional wellbeing. Full article

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15 pages, 1003 KiB

Open AccessSystematic Review

Deep Learning Applications in Dental Image-Based Diagnostics: A Systematic Review

by Osama Khattak, Ahmed Shawkat Hashem, Mohammed Saad Alqarni, Raha Ahmed Shamikh Almufarrij, Amna Yusuf Siddiqui, Rabia Anis, Shahzad Ahmad, Muhammad Amber Fareed, Osama Shujaa Alothmani, Lama Habis Samah Alkhershawy, Wesam Waleed Zain Alabidin, Rakhi Issrani and Anshoo Agarwal

Healthcare 2025, 13(12), 1466; https://doi.org/10.3390/healthcare13121466 - 18 Jun 2025

Viewed by 164

Abstract

Background: AI has been adopted in dentistry for diagnosis, decision making, and therapy prognosis prediction. This systematic review aimed to identify AI models in dentistry, assess their performance, identify their shortcomings, and discuss their potential for adoption and integration in dental practice [...] Read more.

Background: AI has been adopted in dentistry for diagnosis, decision making, and therapy prognosis prediction. This systematic review aimed to identify AI models in dentistry, assess their performance, identify their shortcomings, and discuss their potential for adoption and integration in dental practice in the future. Methodology: The sources of the papers were the following electronic databases: PubMed, Scopus, and Cochrane Library. A total of 20 out of 947 needed further studies, and this was encompassed in the present meta-analysis. It identified diagnostic accuracy, predictive performance, and potential biases. Results: AI models demonstrated an overall diagnostic accuracy of 82%, primarily leveraging artificial neural networks (ANNs) and convolutional neural networks (CNNs). These models have significantly improved the diagnostic precision for dental caries compared with traditional methods. Moreover, they have shown potential in detecting and managing conditions such as bone loss, malignant lesions, vertical root fractures, apical lesions, salivary gland disorders, and maxillofacial cysts, as well as in performing orthodontic assessments. However, the integration of AI systems into dentistry poses challenges, including potential data biases, cost implications, technical requirements, and ethical concerns such as patient data security and informed consent. AI models may also underperform when faced with limited or skewed datasets, thus underscoring the importance of robust training and validation procedures. Conclusions: AI has the potential to revolutionize dentistry by significantly improving diagnostic accuracy and treatment planning. However, before integrating this tool into clinical practice, a critical assessment of its advantages, disadvantages, and utility or ethical issues must be established. Future studies should aim to eradicate existing barriers and enhance the model’s ease of understanding and challenges regarding expense and data protection, to ensure the effective utilization of AI in dental healthcare. Full article

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

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20 pages, 461 KiB

Open AccessArticle

Impact of a Multidimensional Community-Based Intervention on the Feeling of Unwanted Loneliness and Its Consequences: A Quasi-Experimental Study

by Alba Francisco-Sánchez, Sofía Martínez-León, Alejandro García-Pérez, Juan Andrés Báez-Hernández, Martín Rodríguez-Álvaro and Alfonso Miguel García-Hernández

Healthcare 2025, 13(12), 1465; https://doi.org/10.3390/healthcare13121465 - 18 Jun 2025

Viewed by 269

Abstract

Background/Objectives: Unwanted loneliness is the gap between the social relations a person has and those they want. The main objective of this research is to assess the impact of a multidimensional community-based intervention on the feeling of unwanted loneliness in the population [...] Read more.

Background/Objectives: Unwanted loneliness is the gap between the social relations a person has and those they want. The main objective of this research is to assess the impact of a multidimensional community-based intervention on the feeling of unwanted loneliness in the population over the age of 65 years old who live alone, are under social risk, or are socially isolated living on La Palma island. Methods: A quasi-experimental study was designed with pre- and post-intervention (at three months) measurements, with no control group or randomization. A sample comprising 90 subjects was estimated for a small–moderate (0.3) or large (0.8) effect size, with a significance level (α) of 0.05 and a power (1 − β) of 0.8. Results: The intervention was initiated with 90 participants in 8 of the 9 Basic Health Districts from the La Palma Health Area. A moderate effect size (d = −0.77; 95%CI [−1.02, −0.52]) was evidenced in self-perceived loneliness. Three months after the proposed community-based intervention, significant differences were evidenced in adequate eating habits, physical activity, support network, anxiety, depression, and perceived social support. Conclusions: Compartiendo Salud (Sharing Health) presents promising results, as it exerts positive effects on health management among older adults that live alone. The results of this intervention could serve as a model to design replicable strategies in other communities, improving the quality of life and levels of perceived social support in older adults. Full article

(This article belongs to the Section Nursing)

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14 pages, 718 KiB

Open AccessArticle

Enhancing Healthcare Integrity Using Simple Statistical Methods: Detecting Irregularities in Historical Dermatology Services Payments

by Andrej F. Plesničar, Nena Bagari Bizjak and Pika Jazbinšek

Healthcare 2025, 13(12), 1464; https://doi.org/10.3390/healthcare13121464 - 18 Jun 2025

Viewed by 124

Abstract

Background and Objectives: Healthcare payment systems face challenges such as fraud and overbilling, which often require costly and resource-intensive detection tools. In response, the utility of simple statistical tests was explored in this study as a practical alternative for identifying irregularities in dermatology [...] Read more.

Background and Objectives: Healthcare payment systems face challenges such as fraud and overbilling, which often require costly and resource-intensive detection tools. In response, the utility of simple statistical tests was explored in this study as a practical alternative for identifying irregularities in dermatology service payments within the Health Insurance Institute of Slovenia (HIIS). Materials and Methods: Ten-year-old anonymized billing data from 30 dermatology providers in Slovenia (with a population of 2 million) were analyzed to evaluate the effectiveness of the proposed methodology while aiming to avoid reputational harm to current providers. The dataset from 2014 included variables such as the “number of services charged”, “total number of points charged” (under Slovenia’s point-based tariff system at the time), “number of points per examination”, “average examination values (EUR)”, “number of first examinations”, and “total number of first/follow-up examinations”. Data credibility was assessed using Benford’s Law (for calculating χ² values and testing null hypothesis rejection at the 95% level), and Grubbs’ test, Hampel’s test, and T-test were used to identify outliers. Results: An analysis using Benford’s Law revealed significant deviations for the “number of services charged” (p < 0.005), “total number of points charged” (p < 0.01), “number of points per examination” (p < 0.0005), and “average examination values (EUR)” (p < 0.005), suggesting anomalies. Conversely, data on the numbers of “first” (p < 0.7) and “total first/follow-up examinations” (p < 0.3) were found to align with Benford’s Law, indicating authenticity. Outlier detection consistently identified two institutions with unusually high values for points per examination and average examination monetary value. Conclusions: Simple statistical tests can effectively identify potential irregularities in healthcare payment data, providing a cost-effective screening method for further investigation. Identifying outlier providers highlights areas needing detailed scrutiny to understand anomaly causes. Full article

(This article belongs to the Topic Health Services Optimization, Improvement, and Management: Worldwide Experiences)

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11 pages, 1238 KiB

Open AccessArticle

Phase Angle Trajectory Among Critical Care Patients: Longitudinal Decline Predicts Mortality Independent of Clinical Severity Scores

by Pantelis Papanastasiou, Stavroula Chaloulakou, Dimitrios Karayiannis, Avra Almperti, Georgios Poupouzas, Charikleia S. Vrettou, Vasileios Issaris, Edison Jahaj, Alice G. Vassiliou and Ioanna Dimopoulou

Healthcare 2025, 13(12), 1463; https://doi.org/10.3390/healthcare13121463 - 18 Jun 2025

Viewed by 141

Abstract

Background/Objectives: The phase angle (PhA) is an emerging biomarker reflecting the cellular integrity and nutritional status. This study aimed to explore potential associations between the PhA, clinical severity scores, and 60-day survival outcomes following an admission to the Intensive Care Unit (ICU). Methods: [...] Read more.

Background/Objectives: The phase angle (PhA) is an emerging biomarker reflecting the cellular integrity and nutritional status. This study aimed to explore potential associations between the PhA, clinical severity scores, and 60-day survival outcomes following an admission to the Intensive Care Unit (ICU). Methods: This prospective, single-center study included 43 critically ill patients admitted to the ICU at Evangelismos General Hospital between May and November 2024. Patients were stratified by their PhA (≤5.4° vs. >5.4°). The PhA was measured at admission and subsequently on days 5–7, 10–11, 13–14, and until discharge. Severity scores (SOFA and APACHE II) were recorded. Between-group differences were assessed using independent samples t-tests and Mann–Whitney U tests, as appropriate. Survival was analyzed using Kaplan–Meier curves and Cox proportional hazards models. Results: The mean age was 54.6 ± 17 years; 63.6% were male. At ICU admission, patients with a PhA > 5.4° were significantly younger (p < 0.001) and had a higher fat-free mass (p < 0.001), greater calf circumference (p < 0.001), higher extracellular water (p < 0.001), larger mid-upper arm circumference (p = 0.009), and higher resting energy expenditure per kilogram (27.4 vs. 23.1 kcal/kg, p = 0.002). The PhA declined significantly during the ICU stay (p < 0.001). The Kaplan–Meier analysis showed a significantly shorter survival in patients with a PhA ≤ 5.4° (HR: 6.32, p = 0.019), which remained significant after adjusting for sepsis (p = 0.017). In a multivariable Cox regression, both PhA and APACHE II scores independently predicted mortality. Conclusions: While limited by a small sample size and single-center design, these findings support the further exploration of the PhA as a monitoring tool in critical care. Full article

(This article belongs to the Special Issue Nutrition in Patient Care)

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17 pages, 898 KiB

Open AccessArticle

IL-6 Expression and the Confidence Interval-Based Estimation of Relevance (CIBER) Help Identify Persistent Inflammation and Cognitive Parameters of Executive Dysfunction in the Withdrawal Phase of Male Polydrug Abusers

by Jesua Guzmán-González, Alma Galvez-Contreras, Israel Jimenez-Navarro, Iris Perez-Alcaraz, Oscar Gonzalez-Perez and Rocio E. Gonzalez-Castañeda

Healthcare 2025, 13(12), 1462; https://doi.org/10.3390/healthcare13121462 - 18 Jun 2025

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Abstract

Background/Objectives: Individuals diagnosed with substance use disorders (SUD) exhibit notable deficits in executive function (EFs). Notably, the pro-inflammatory cytokine interleukin-6 (IL-6) has been associated with cognitive impairments in individuals with substance use disorders. The specific neuropsychological parameters most affected by executive dysfunction [...] Read more.

Background/Objectives: Individuals diagnosed with substance use disorders (SUD) exhibit notable deficits in executive function (EFs). Notably, the pro-inflammatory cytokine interleukin-6 (IL-6) has been associated with cognitive impairments in individuals with substance use disorders. The specific neuropsychological parameters most affected by executive dysfunction remain poorly understood. Methods: In this study, sixteen patients diagnosed with SUD in the withdrawal phase were compared to twenty age-matched control subjects to ascertain which aspects of EFs were most adversely impacted. Plasma levels of IL-6 were quantified using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using the Confidence Interval-Based Estimation of Relevance (CIBER) model to determine the most sensitive executive performance indicators. Results: Findings from the CIBER analysis revealed that the Wisconsin Card Sorting Test yielded the most pronounced cognitive discrepancies between males with and without SUD diagnoses. Elevated levels of IL-6 and associated executive dysfunction were observed to persist in males with SUD throughout the withdrawal phase. Conclusions: Notably, cognitive flexibility emerged as the most sensitive parameter indicative of executive dysfunction, suggesting its potential utility in tailoring clinical interventions for SUD patients during this critical recovery period. Full article

(This article belongs to the Special Issue The Impact and Relationship of Lifestyle Behaviors and Mental Health)

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16 pages, 473 KiB

Open AccessArticle

The Role of Physical Activity and Exercise in Enhancing Resilience and Delaying Frailty in Saudi Arabia

by Abdulaziz M. Alodhialah, Ashwaq A. Almutairi and Mohammed Almutairi

Healthcare 2025, 13(12), 1461; https://doi.org/10.3390/healthcare13121461 - 18 Jun 2025

Viewed by 157

Abstract

Background: Frailty is a major public health concern among older adults, leading to increased morbidity and functional decline. Physical activity and psychological resilience have been identified as potential protective factors against frailty, yet their combined effects remain understudied in Saudi Arabia. Objective: This [...] Read more.

Background: Frailty is a major public health concern among older adults, leading to increased morbidity and functional decline. Physical activity and psychological resilience have been identified as potential protective factors against frailty, yet their combined effects remain understudied in Saudi Arabia. Objective: This study aimed to examine the associations between physical activity, resilience, and frailty among older adults in Riyadh. Methods: A cross-sectional study was conducted with 240 elderly participants aged 60 years and above. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ), frailty was measured using the Fried Frailty Phenotype, and resilience was evaluated with the Connor–Davidson Resilience Scale (CD-RISC-10). Logistic regression analysis was performed to identify correlates of frailty. Results: Higher physical activity levels were significantly associated with greater resilience (r = 0.61, p = 0.002) and lower frailty (OR = 0.64, p = 0.002). Advancing age, multiple comorbidities, and poor self-rated health were positively associated with frailty, while greater grip strength was inversely associated with it (OR = 0.67, p = 0.002). Conclusions: Physical activity and resilience appear to be independently associated with reduced odds of frailty among older adults in Riyadh. These findings underscore the potential benefits of integrated physical and psychological health strategies in promoting healthy aging. However, due to the cross-sectional design, causal relationships cannot be inferred. Longitudinal and intervention-based studies are needed to further explore these associations. Full article

(This article belongs to the Special Issue Frailty and Resilience Across Aging: A Holistic Approach to Elderly Care)

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11 pages, 468 KiB

Open AccessSystematic Review

Systematic Review of Lead Exposure and Its Effects on Caries and Aesthetics in Children and Adolescents

by Gianina Tapalaga, Livia Stanga and Ioan Sîrbu

Healthcare 2025, 13(12), 1460; https://doi.org/10.3390/healthcare13121460 - 18 Jun 2025

Viewed by 154

Abstract

Background: Early childhood dental decay remains a pervasive chronic condition, and environmental toxicants—particularly lead—may exacerbate its development. This systematic review was designed to synthesize evidence on how lead exposure correlates with both the occurrence of carious lesions and aesthetic alterations in children’s [...] Read more.

Background: Early childhood dental decay remains a pervasive chronic condition, and environmental toxicants—particularly lead—may exacerbate its development. This systematic review was designed to synthesize evidence on how lead exposure correlates with both the occurrence of carious lesions and aesthetic alterations in children’s primary teeth. Methods: A comprehensive search was conducted in PubMed, Scopus, and Web of Science through April 2025, selecting observational investigations that assessed the link between lead levels and primary-tooth decay in pediatric cohorts. Thirteen eligible studies, encompassing 44,846 participants aged 2–19 years, were included for qualitative synthesis. Aesthetics were screened using author-defined enamel-defect or discoloration endpoints; however, only three studies reported compatible metrics, precluding quantitative pooling. Heterogeneity in exposure matrices likewise ruled out meta-analysis. Results: Most studies reported a statistically significant association between higher lead burden and greater prevalence or severity of caries in primary teeth. Blood lead concentrations across studies ranged from means of 1.53 μg/dL to geometric means of 7.2 μg/dL. Notably, elevated lead was linked to increased decayed, missing, or filled surfaces—with an adjusted risk ratio of 1.14 (95% CI: 1.02–1.27) at levels below 5 μg/dL—and adjusted mean ratios of up to 2.14 for decayed or filled teeth when blood lead reached 5–10 μg/dL. Conclusions: Current evidence suggests that children’s exposure to lead may heighten the risk of caries and detract from the aesthetic quality of primary teeth. However, variability in study design, lead quantification methods, and confounder adjustment limit the consistency of findings. Mitigating lead exposure in early life could represent a valuable preventive strategy against dental decay in susceptible pediatric populations. Full article

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21 pages, 323 KiB

Open AccessArticle

It Takes a Village: Unpacking Contextual Factors Influencing Caregiving in Urban Poor Neighbourhoods of Bangalore, South India

by Eunice Lobo, Giridhara Rathnaiah Babu, Debarati Mukherjee, Onno C. P. van Schayck and Prashanth Nuggehalli Srinivas

Healthcare 2025, 13(12), 1459; https://doi.org/10.3390/healthcare13121459 - 18 Jun 2025

Viewed by 231

Abstract

Background: Caregivers in urban settings often face unique challenges in providing nurturing care. This qualitative study explores the complex realities of caregiving among mothers and grandmothers in urban poor neighbourhoods of Bangalore, South India. Grounded in Bronfenbrenner’s ecological systems theory, this is [...] Read more.

Background: Caregivers in urban settings often face unique challenges in providing nurturing care. This qualitative study explores the complex realities of caregiving among mothers and grandmothers in urban poor neighbourhoods of Bangalore, South India. Grounded in Bronfenbrenner’s ecological systems theory, this is the first study in urban India that examines how caregivers’ perceptions, along with individual and systemic factors, shape caregiving practices in this setting. Methods: In-depth interviews (IDIs) were conducted with 22 mothers and grandmothers of 4–6-year-old children from the urban MAASTHI cohort in Bangalore, South India. Topic guides were developed, pre-tested, and piloted. IDIs were conducted in local languages (Kannada and Hindi). Transcripts were coded using NVivo 12 plus and analyzed via a thematic analysis approach using Bronfenbrenner’s ecological systems framework to organize themes. Findings: At the microsystem level, caregivers engaged with children through storytelling and play, though competing demands like household chores often constrained these interactions. Disciplining techniques varied, and the absence of fathers placed additional burdens on mothers. The mesosystem revealed the critical role of extended family in providing support. At the exosystem level, unsafe neighbourhoods limited children’s opportunities for outdoor play. The macrosystem highlighted how religious values provided moral frameworks for parenting and the presence of stigma against single mothers. The chronosystem explored declining social support over time and challenges. Conclusions: These findings emphasize that caregiving inequities are not isolated but structurally embedded, demanding interventions that address sociocultural, economic, and spatial barriers to equitable support for caregivers, particularly those in disadvantaged settings. It calls for context-sensitive interventions, including community-based parenting programmes including maternal well-being, strengthening community and public support systems, improving safe play spaces, and longitudinal research. By amplifying marginalized caregivers’ voices, this research highlights the need for policies that support nurturing care in low-resource settings to break intergenerational cycles of disadvantage. Full article

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18 pages, 1859 KiB

Open AccessArticle

Multimorbidity Patterns and Depression: Bridging Epidemiological Associations with Predictive Analytics for Risk Stratification

by Xiao Wang, Nan Zheng and Mei Yin

Healthcare 2025, 13(12), 1458; https://doi.org/10.3390/healthcare13121458 - 18 Jun 2025

Viewed by 136

Abstract

Background: Late-life depression is a critical public health concern, particularly among older adults with chronic multimorbidity. Existing studies often focus on single-disease associations, neglecting the complex interplay of coexisting conditions. Understanding how multimorbidity patterns contribute to depression risk and identifying high-risk subgroups through [...] Read more.

Background: Late-life depression is a critical public health concern, particularly among older adults with chronic multimorbidity. Existing studies often focus on single-disease associations, neglecting the complex interplay of coexisting conditions. Understanding how multimorbidity patterns contribute to depression risk and identifying high-risk subgroups through integrated statistical and machine learning approaches remain underexplored, limiting targeted prevention strategies. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), latent class analysis (LCA) was employed to cluster multimorbidity patterns. Associations between these patterns and depression were analyzed using multivariable logistic regression, while predictive performance and interaction effects were evaluated via an XGBoost machine learning model. Results: Four distinct multimorbidity patterns were identified: cardio-metabolic, digestive–joint, respiratory, and cardiovascular–digestive pattern. All clusters showed significant independent associations with depression, with the cardiovascular–digestive pattern exhibiting the strongest association (OR = 4.56). However, the digestive–joint pattern demonstrated the highest predictive effects for depression. Sociodemographic factors—low income, limited education, female gender, and rural residence—emerged as robust predictors, amplifying depression risk in older adults with multimorbidity. Conclusions: This study bridges epidemiological insights with predictive analytics to inform depression risk stratification. We recommend routine depression screening for all individuals with cardiovascular–digestive diseases and prioritize screening for women with digestive–joint diseases. Additionally, low-income and rural-dwelling older adults with chronic conditions warrant heightened clinical vigilance. These findings provide a framework for integrating multimorbidity profiling into depression prevention protocols, addressing both biological and socioeconomic determinants. Full article

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10 pages, 215 KiB

Open AccessCommunication

Rapid Response and Containment of an NDM-Producing Klebsiella Pneumoniae Outbreak in a Hematology Ward: Case Study from an Italian Hospital

by Ilaria Tocco Tussardi, Gloria Stevanin, Livio Montesarchio, Francesca Palladini, Irene Aprili, Emanuela Zandonà, Cristina Tecchio and Stefano Tardivo

Healthcare 2025, 13(12), 1457; https://doi.org/10.3390/healthcare13121457 - 17 Jun 2025

Viewed by 128

Abstract

Antimicrobial resistance (AMR) constitutes a critical threat to global public health, with carbapenem-resistant Enterobacterales (CRE) presenting significant challenges due to their resistance to last-line antibiotics. Among these, New Delhi metallo-beta-lactamase (NDM)-producing Klebsiella pneumoniae (KP) is of particular concern. This study describes an outbreak [...] Read more.

Antimicrobial resistance (AMR) constitutes a critical threat to global public health, with carbapenem-resistant Enterobacterales (CRE) presenting significant challenges due to their resistance to last-line antibiotics. Among these, New Delhi metallo-beta-lactamase (NDM)-producing Klebsiella pneumoniae (KP) is of particular concern. This study describes an outbreak of NDM-producing KP in the hematology unit of the University Hospital of Verona, Italy. This represents the second reported hospital outbreak of this strain in Italy, and the first to occur within a hematology ward. The outbreak involved four patients, all of whom were identified through active surveillance and microbiological screening. In response, a multidisciplinary team implemented a series of infection prevention and control (IPC) measures, which included enhanced environmental cleaning, strict hand hygiene protocols, patient isolation, and the development of a tailored IPC checklist. The outbreak was effectively contained within three weeks following the identification of the last case. This outcome underscores the importance of rapid and coordinated responses to NDM-producing KP outbreaks. This case study emphasizes the necessity of robust IPC protocols, rapid intervention, and continuous staff education in mitigating the spread of multidrug-resistant pathogens in healthcare settings. It further highlights the urgent need for healthcare systems to be adequately prepared and resilient in addressing the growing threat of AMR. Full article

(This article belongs to the Special Issue Collaborative Approaches to Risk Management and Infection Control: A Patient Perspective)

17 pages, 2359 KiB

Open AccessArticle

The Treatment of Psychotic and Bipolar Disorders Within the South African Context: Perspectives of a Clinical Pharmacist

by Kudzai D. Kahwenga, Lindiwe Mnukwa and Elmien Bronkhorst

Healthcare 2025, 13(12), 1456; https://doi.org/10.3390/healthcare13121456 - 17 Jun 2025

Viewed by 136

Abstract

Background: The effective management of psychotic and bipolar disorders in tertiary care can improve patient outcomes, yet the role of clinical pharmacists in optimising psychotropic medication use remains underexplored in South Africa. This study aims to investigate the role and interventions of clinical [...] Read more.

Background: The effective management of psychotic and bipolar disorders in tertiary care can improve patient outcomes, yet the role of clinical pharmacists in optimising psychotropic medication use remains underexplored in South Africa. This study aims to investigate the role and interventions of clinical pharmacists in managing psychotic and bipolar disorders within a tertiary hospital in South Africa. Methods: A quantitative, descriptive study was conducted among 60 adult patients admitted to the psychiatric and internal medicine wards diagnosed with psychotic and/or bipolar disorder. A previously validated, standardised pharmaceutical care form was utilised for a purposive sample of inpatient files. Medication-related problems were identified, and appropriate interventions were suggested. Prescriptions were also assessed for adherence to treatment guidelines, including the South African Standard Treatment Guidelines, the American Psychiatric Association guidelines, and the National Institute for Health and Care Excellence guidelines. Results: The study included 60 patients (37 females) with a mean age of 37 years. Diagnoses included schizophrenia (28.8%), bipolar disorder (27.5%), and stimulant-induced psychosis (19.3%). Sixty-two medication-related problems were identified, leading to 77 proposed interventions, of which 65 were implemented. Among the prescriptions, 75% (n = 45) adhered to the South African Standard Treatment guidelines, 76% (n = 46) adhered to the NICE guidelines, and 71% (n = 43) adhered to the APA guidelines. Conclusions: Clinical pharmacists identified a number of medication-related problems in patients with psychotic and bipolar disorders, and their proposed interventions were largely accepted. The findings highlight the pharmacist’s role in optimising medication therapy and adherence to guidelines, suggesting that improved treatment monitoring is necessary in this setting. Full article

(This article belongs to the Special Issue Advances in Pharmacy Practice and Medication Use among Patients)

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18 pages, 302 KiB

Open AccessArticle

How Does the Basic Urban–Rural Medical Insurance Affect Resident Health Inequality? Evidence from China

by Xiaohong Pu, Riyun Hou, Sichang He and Weike Zhang

Healthcare 2025, 13(12), 1455; https://doi.org/10.3390/healthcare13121455 - 17 Jun 2025

Viewed by 114

Abstract

Background: Health inequality is seen as a challenge for implementing the Healthy China Strategy. This study analyzes the income-related health inequality among urban–rural resident basic medical insurance (URRBMI) participants. Methods: This study utilized data from the 2019 China Household Finance Survey (CHFS), and [...] Read more.

Background: Health inequality is seen as a challenge for implementing the Healthy China Strategy. This study analyzes the income-related health inequality among urban–rural resident basic medical insurance (URRBMI) participants. Methods: This study utilized data from the 2019 China Household Finance Survey (CHFS), and the concentration index (CI) was employed to estimate the effects of income-related health inequality on participants. Results: Our findings provide clear evidence that health inequality among participants has fluctuated—narrowing, widening, and then narrowing again—in the areas of the contribution, medical treatment, and reimbursement of URRBMI, respectively. Overall, the analysis indicates a widening of health inequality post-reimbursement, with results remaining consistent. A heterogeneity analysis shows that health inequality is most pronounced among women and those with less than a middle school education. Finally, our study reveals a pro-rich trend in the actual utilization of medical services among participants, with persistent disparities in outpatient and inpatient service usage even after standardization, further exacerbating income-related health inequality. Conclusions: We recommend that the URRBMI design take participants’ income levels into account, with policies favoring disadvantaged individuals to enhance their medical security, improve access to healthcare services, and ultimately reduce health inequality. Full article

(This article belongs to the Special Issue The Digital Divide in Healthcare: Exploring Inequalities and Solutions)

19 pages, 393 KiB

Open AccessArticle

The Effect of Core Stabilization Exercises on Upper Extremity Function and Balance in Children with Cerebral Palsy: A Randomized Controlled Trial

by Kübra Ecem Küçük and Cigdem Cekmece

Healthcare 2025, 13(12), 1454; https://doi.org/10.3390/healthcare13121454 - 17 Jun 2025

Viewed by 95

Abstract

Aim: This study explores the effects of core stabilization exercises on balance and upper extremity functions—both unilateral and bilateral—in children with cerebral palsy (CP). Method: Thirty-six children with CP (aged 5–12) were randomly assigned to a study group (n = 18) or [...] Read more.

Aim: This study explores the effects of core stabilization exercises on balance and upper extremity functions—both unilateral and bilateral—in children with cerebral palsy (CP). Method: Thirty-six children with CP (aged 5–12) were randomly assigned to a study group (n = 18) or control group (n = 18). Both groups received four weeks of physiotherapy and occupational therapy. The study group additionally performed ~45 min of daily core stabilization exercises. Outcome measures included the Box and Block Test (BBT), Assisting Hand Assessment (AHA), Pediatric Berg Balance Scale (PBBS), and Trunk Control Measurement Scale (TCMS). (ClinicalTrials.gov ID: NCT06973213). Results: No significant baseline differences were found between the groups (p > 0.05). Post-intervention, the study group showed significant improvements in PBBS (p = 0.011), TCMS static sitting (p = 0.003), dynamic reaching (p = 0.037), and total score (p = 0.044). Between-group differences remained non-significant for BBT, AHA, and TCMS selective movement control (p > 0.05). Within-group analysis revealed significant gains in BBT (median = 7), PBBS (median = 8), TCMS total (median = 12), static sitting (median = 3.5), and selective movement (median = 6) (all p < 0.001). AHA showed a near-significant trend (median = 6, p = 0.051). Conclusions: Core stabilization exercises significantly enhance balance and unilateral upper extremity function in children with CP. However, they show limited impact on bimanual function. Integration of these exercises into rehabilitation programs may optimize motor outcomes. Full article

(This article belongs to the Special Issue Integrated Care Services for Cerebral Palsy: Multidisciplinary Approaches, Challenges, and Emerging Solutions)

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24 pages, 1017 KiB

Open AccessArticle

Digitalization in Dentistry: Dentists’ Perceptions of Digital Stressors and Resources and Their Association with Digital Stress in Germany—A Qualitative Study

by Julia Sofie Gebhardt, Volker Harth, David A. Groneberg and Stefanie Mache

Healthcare 2025, 13(12), 1453; https://doi.org/10.3390/healthcare13121453 - 17 Jun 2025

Viewed by 154

Abstract

Background: The digital transformation in dentistry is increasingly reshaping treatment procedures, offering new opportunities and advancements. While digitalization promises enhanced efficiency and quality of care through the standardization, acceleration, and simplification of workflows, it also introduces challenges related to mental health. Studies [...] Read more.

Background: The digital transformation in dentistry is increasingly reshaping treatment procedures, offering new opportunities and advancements. While digitalization promises enhanced efficiency and quality of care through the standardization, acceleration, and simplification of workflows, it also introduces challenges related to mental health. Studies investigating digitization-associated stressors and resources, as well as health- and work-related outcomes, in the dental sector are still rare. In the context of ongoing digitalization, further studies are needed to examine the need for and the current status of the implementation of measures preventing techno-stress and stress-related outcomes. This study explores the use of digital tools in dental practices and their relationship to the techno-stress among German dentists. It identifies key stressors and resources associated with digital technologies, aiming to inform preventive measures, as well as training and support strategies to mitigate digital stress. Methods: A qualitative study was employed, involving ten problem-centered, guideline-based expert interviews with German dentists. The interviews were analyzed using MAXQDA software, following the focused interview analysis framework by Kuckartz and Rädiker. Coding and thematic analysis adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and qualitative research quality criteria by Mayring. Results: This study identified a dual impact of digitalization in dentistry. On the one hand, digital tools significantly enhance workflow efficiency, diagnostic accuracy, and patient outcomes. On the other hand, they pose challenges like technostress, high financial costs, and the need for continuous learning. Findings reveal that the perceived usefulness of digital technologies is closely linked to the level of techno-stress experienced, while the amount, intuitiveness, and ease of use significantly influence stress levels. Conclusions: Digital transformation offers substantial benefits for dental practices but requires a balanced approach to implementation. Participants highlighted the need for proactive measures, such as targeted training, technical support, and stress-reducing interventions to reduce techno-stress levels. The digital transformation must be supported by coordinated efforts across academia, industry, and policy to strengthen digital competencies—creating a healthier, more resilient digital work environment. Future research should focus on the causal relationship between techno-stress and adverse long-term consequences, such as burnout or mental disorders, among dentists. Full article

(This article belongs to the Special Issue Contemporary Oral and Dental Health Care: Issues and Challenges)

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14 pages, 595 KiB

Open AccessArticle

The Effect of Integrative Treatment on Improving Functional Level in Stroke Patients: A Retrospective Chart Review

by Daegil Kwon, Sun Hee Ahn, Ki-cheul Shon and Hyun Jung Jung

Healthcare 2025, 13(12), 1452; https://doi.org/10.3390/healthcare13121452 - 17 Jun 2025

Viewed by 78

Abstract

Objectives: This study aimed to evaluate the effects of integrative treatment on functional recovery in stroke patients by comparing medical records of those receiving Western rehabilitation treatment only versus integrative treatment in a single hospital. Methods: Medical records of 174 stroke patients were [...] Read more.

Objectives: This study aimed to evaluate the effects of integrative treatment on functional recovery in stroke patients by comparing medical records of those receiving Western rehabilitation treatment only versus integrative treatment in a single hospital. Methods: Medical records of 174 stroke patients were analyzed, divided into three groups based on Korean medicinal treatment frequency: Western rehabilitation only (WO), Western rehabilitation with low-frequency Korean medicine (WLK), and Western rehabilitation with high-frequency Korean medicine (WHK). Patients were further categorized into subacute (last 3 months) and chronic (last 6 months) stroke groups. Functional recovery was assessed using tools like the Berg Balance Scale (BBS), Modified Barthel Index (MBI), and others. Results: Overall, BBS and MBI scores showed significant improvements in WLK and WHK groups compared to the WO group. In subacute patients at 3 months post-treatment (MPT), BBS scores increased by 1.7 ± 2.0 (WO), 3.3 ± 4.8 (WLK), and 5.6 ± 5.2 (WHK), with significant differences between WO and WHK (p < 0.05). In chronic patients at 6 MPT, BBS scores rose by 0.4 ± 1.1 (WO), 1.8 ± 1.7 (WLK), and 5.3 ± 6.4 (WHK), again significant between WO and WHK (p < 0.05). MBI scores in subacute patients at 3 MPT increased by 0.7 ± 2.1 (WO), 2.5 ± 2.9 (WLK), and 3.9 ± 5.5 (WHK), with significant differences between WO and WHK (p < 0.05). Conclusions: Integrative treatment with Korean medicine significantly enhanced balance, daily activity performance, and functional levels in stroke patients compared to Western rehabilitation alone. Full article

(This article belongs to the Special Issue Chronic Disease Management for Older Adults)

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31 pages, 2581 KiB

Open AccessArticle

Start Time End Time Integration (STETI): Method for Including Recent Data to Analyze Trends in Kidney Cancer Survival

by Thobani Chaduka, Daniel Berleant, Michael A. Bauer, Peng-Hung Tsai and Shi-Ming Tu

Healthcare 2025, 13(12), 1451; https://doi.org/10.3390/healthcare13121451 - 17 Jun 2025

Viewed by 96

Abstract

Background/Objectives: Accurately estimating survival times is critical for clinical decision-making, treatment evaluation, resource allocation, and other purposes. Yet data from relatively recent diagnosis cohorts is strongly affected by right censoring that biases average survival times downward. For example, 5-, 10-, or 20-year survival [...] Read more.

Background/Objectives: Accurately estimating survival times is critical for clinical decision-making, treatment evaluation, resource allocation, and other purposes. Yet data from relatively recent diagnosis cohorts is strongly affected by right censoring that biases average survival times downward. For example, 5-, 10-, or 20-year survival time averages are not available until 5, 10, or 20 years later, which may be in the future, thus presenting a challenge to obtain in the present. An approach to addressing this problem is described in this report. Here it is demonstrated for kidney cancer survival but could also be applied to survival questions for other types of cancer, other diseases, stage progression times, and similar problems in medicine and other fields in which there is a need for up-to-date analyses of survival improvement trends. Methods: This study introduces STETI, an approach to survival estimation that integrates information about survival times of diagnosis year cohorts with information about survival times of death year cohorts. By leveraging data from death year cohorts in addition to the more familiar diagnosis year cohorts, STETI incorporates recent survival data often excluded by traditional approaches due to right censoring, caused when the post-diagnosis time period of interest has not yet elapsed. Using data from SEER, we explain how the proposed approach integrates diagnosis year cohorts with the death year cohorts of recent years. We demonstrate that incorporating death year cohorts addresses an important source of right censorship that is inherent in diagnosis year cohorts from relatively recent years. This permits survival time trend analysis that accounts for recent improvements in survival time that would be difficult to account for using diagnosis year cohorts alone. We tested linear and exponential models to demonstrate the method’s ability to derive survival time trends using valuable data that would otherwise risk being left unused. Conclusions: Improved survival estimation can better support personalized treatment planning, healthcare benchmarking, and research into cancer subtypes as well as other domains. To this end, we introduce a hybrid analytical approach that addresses an important source of right censorship. Demonstrating it within the domain of kidney cancer is expected to help pave the way to other applications in oncology and beyond, and offers a case study of STETI, an approach to quantifying and projecting trends in survival time associated with therapeutic advancements. Full article

(This article belongs to the Section Health Informatics and Big Data)

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10 pages, 232 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Emergency Air Medical Transport of Pediatric Patients in the Penghu Islands

by Hung-Hsiang Fang, Chuang-Yen Huang, Po-Chang Hsu, Chia-Cheng Sung, Sheng-Ping Li and Chung-Yu Lai

Healthcare 2025, 13(12), 1450; https://doi.org/10.3390/healthcare13121450 - 17 Jun 2025

Viewed by 71

Abstract

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted healthcare systems worldwide. As a result, remote areas such as the Penghu Islands have encountered unique challenges related to pediatric care. This study examined the effects of the pandemic on the emergency [...] Read more.

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted healthcare systems worldwide. As a result, remote areas such as the Penghu Islands have encountered unique challenges related to pediatric care. This study examined the effects of the pandemic on the emergency air medical transport (EAMT) of pediatric patients from the Penghu Islands to Taiwan. Materials and Methods: This retrospective study analyzed 40 pediatric patients who received EAMT from the Penghu Islands to Taiwan between January 2017 and December 2022. This study compared patients before and during the COVID-19 pandemic and focused on patient demographics, reasons for EAMT, and clinical outcomes. Due to the small sample size, non-parametric statistical methods were applied, including the Mann–Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. Results: Among the 40 pediatric patients analyzed, the median age decreased from 3 years (IQR, 0–5 years) before the pandemic to 1 year (IQR, 0–5 years) during the pandemic. While the overall increase in hospital length of stay during the pandemic was not statistically significant, a significant prolongation was observed in preschool-aged children and neonates without trauma (20 days vs. 9 days; p < 0.05). The lack of specialist physicians became an increasingly prominent factor for EAMT during the pandemic (p = 0.056). The most common medical reasons for EAMT were critical illness (35%), neonatal diseases (30%), and neurological conditions (27.5%), with similar distributions across both time periods. Conclusions: The COVID-19 pandemic heightened existing healthcare disparities in the Penghu Islands, particularly by increasing reliance on EAMT due to a shortage of pediatric specialists. Hospital stays for preschool children and neonates significantly increased during the pandemic, suggesting delayed or prolonged care. These findings underscore the need to strengthen local pediatric infrastructure, decentralize specialist services, and improve emergency preparedness to better support vulnerable populations in remote areas during future public health emergencies. Full article

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19 pages, 2530 KiB

Open AccessArticle

Usability of Mixed Reality for Naloxone Training: Iterative Development and Field Testing of ReviveXR

by Wasantha Jayawardene, Roy Magnuson, Chesmi Kumbalatara, Matthew Kase, Amy Park, Alana Goodson, Scott Barrows, Rebecca Bolinski and Joanna Willett

Healthcare 2025, 13(12), 1449; https://doi.org/10.3390/healthcare13121449 - 17 Jun 2025

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Abstract

Background/Objectives: The increased availability of naloxone underscores the urgent need for scalable, effective training interventions. While current training modalities show promise, critical challenges persist, particularly regarding the development of interactive, self-efficacious platforms that mitigate anxiety in real-world overdose response, especially among laypersons. Therefore, [...] Read more.

Background/Objectives: The increased availability of naloxone underscores the urgent need for scalable, effective training interventions. While current training modalities show promise, critical challenges persist, particularly regarding the development of interactive, self-efficacious platforms that mitigate anxiety in real-world overdose response, especially among laypersons. Therefore, this study aimed to develop and evaluate the usability and acceptability of a novel, self-paced mixed reality-based training tool (ReviveXR). Methods: ReviveXR was designed using the Apple Vision Pro spatial computing headset and Unity platform, employing mixed reality technology to facilitate interaction with virtual overdose scenarios while maintaining awareness of the physical environment. The intervention included a simulated tutorial and interactive modules on overdose response, rescue breathing, and chest compressions. Field testing was conducted in two rounds across various settings with a heterogeneous sample (N = 25), including individuals who use drugs, bystanders, first responders, and technology specialists. Data collection involved pre- and post-intervention surveys and qualitative interviews. Results: Participants demonstrated significant improvements in knowledge related to overdose recognition, naloxone administration, rescue breathing, and chest compressions. ReviveXR increased participants’ confidence and intent to help overdose victims while reducing uncertainty during overdose reversal. Participants were predominantly from rural areas and primarily identified as White and male. Qualitative feedback emphasized the platform’s heightened engagement, realism, patient responsiveness, and capacity to enhance knowledge acquisition and behavioral preparedness compared with conventional training approaches. Conclusions: ReviveXR offers a scalable, cost-effective, engaging alternative to traditional naloxone training programs, demonstrating strong feasibility across diverse environments and participants. ReviveXR holds considerable promise for expanding and enhancing community overdose response capacities and training healthcare professionals and first responders. Full article

(This article belongs to the Special Issue Healthcare Innovations in Global Mental Health and Addiction Treatment)

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24 pages, 810 KiB

Open AccessArticle

Evaluating the Association Between Risk Factors of Obstructive Sleep Apnea with Oral Dysfunction and Lifestyle Behavior in Korean Adults Using Data from the Eighth Cycle of the National Health and Nutrition Examination Survey: A Cross-Sectional Study

by Won-Jae Jo, Jung-Min Kim, Eun-Seo Choi, Seung-U Lee and Ju Seok Ryu

Healthcare 2025, 13(12), 1448; https://doi.org/10.3390/healthcare13121448 - 17 Jun 2025

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Abstract

Background/Objectives: Research on oral dysfunctions as contributing factors to obstructive sleep apnea (OSA) is needed to prevent and treat OSA. This study aimed to explore the association of OSA with oral dysfunction and examine its impact on nutrient intake, physical activity, and [...] Read more.

Background/Objectives: Research on oral dysfunctions as contributing factors to obstructive sleep apnea (OSA) is needed to prevent and treat OSA. This study aimed to explore the association of OSA with oral dysfunction and examine its impact on nutrient intake, physical activity, and handgrip strength. Methods: This cross-sectional study analyzed data from the Eighth cycle Korea National Health and Nutrition Examination Survey (KNHANES, 2019–2021). The OSA group included diagnosed individuals and those over 40 years with symptoms such as snoring, fatigue, or witnessed breathing pauses during sleep. The non-OSA group included individuals not meeting these criteria. Using 1:1 propensity score matching to control for confounders (sex, age, lifestyle factors), 7636 participants were included. Oral dysfunction was assessed based on chewing problems, complaints of chewing discomfort, and speech difficulties. Nutrient intake, physical activity, and handgrip strength were analyzed using the Rao–Scott χ² test, complex sample t-test, and complex sample logistic regression. Results: The OSA group demonstrated significantly more oral dysfunction elements than the non-OSA group (p < 0.001). Higher energy intake was observed in the OSA group, with no significant differences in macronutrient intake. Physical activity levels were similar between groups; however, OSA participants without oral problems had higher handgrip strength (p < 0.05). Regression analysis showed increased OSA risk correlated with greater oral dysfunction and lower protein intake. Conclusions: This study revealed a strong association between oral dysfunction and OSA risk. Focusing on the assessment and early intervention of oral dysfunctions that influence OSA risk factors may aid in the early detection and prevention of OSA. Full article

(This article belongs to the Section Nutrition and Public Health)

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25 pages, 899 KiB

Open AccessSystematic Review

The Impact of AI Scribes on Streamlining Clinical Documentation: A Systematic Review

by Maxime Sasseville, Farzaneh Yousefi, Steven Ouellet, Florian Naye, Théo Stefan, Valérie Carnovale, Frédéric Bergeron, Linda Ling, Bobby Gheorghiu, Simon Hagens, Samuel Gareau-Lajoie and Annie LeBlanc

Healthcare 2025, 13(12), 1447; https://doi.org/10.3390/healthcare13121447 - 16 Jun 2025

Viewed by 277

Abstract

Background: Burnout among clinicians, including physicians, is a growing concern in healthcare. An overwhelming burden of clinical documentation is a significant contributor. While medical scribes have been employed to mitigate this burden, they have limitations such as cost, training needs, and high turnover [...] Read more.

Background: Burnout among clinicians, including physicians, is a growing concern in healthcare. An overwhelming burden of clinical documentation is a significant contributor. While medical scribes have been employed to mitigate this burden, they have limitations such as cost, training needs, and high turnover rates. Artificial intelligence (AI) scribe systems can transcribe, summarize, and even interpret clinical conversations, offering a potential solution for improving clinician well-being. We aimed to evaluate the effectiveness of AI scribes in streamlining clinical documentation, with a focus on clinician experience, healthcare system efficiency, and patient engagement. Methods: We conducted a systematic review following Cochrane methods and PRISMA guidelines. Two reviewers conducted the selection process independently. Eligible intervention studies included quantitative and mixed-methods studies evaluating AI scribe systems. We summarized the data narratively. Results: Eight studies were included. AI scribes demonstrated positive effects on healthcare provider engagement, with users reporting increased involvement in their workflows. The documentation burden showed signs of improvement, as AI scribes helped alleviate the workload for some participants. Many clinicians have found AI systems to be user-friendly and intuitive, although some have expressed concerns about scribe training and documentation quality. A limited impact on reducing burnout was found, although documentation time improved in some studies. Conclusions: Most of the studies reported in this review involved small sample sizes and specific healthcare settings, limiting the generalizability of the findings to other contexts. Accuracy and consistency can vary significantly depending on the specific technology, model training data, and implementation approach. AI scribes show promise in improving documentation efficiency and clinician workflow, although the evidence remains limited and heterogeneous. Broader and real-world evaluations are needed to confirm their effectiveness and inform responsible implementations. Full article

(This article belongs to the Special Issue Artificial Intelligence in Health Services Research and Organizations)

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Healthcare, Volume 13, Issue 12 (June-2 2025) – 122 articles

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