Healthcare

13 pages, 1177 KiB

Open AccessPerspective

Banking on My Voice: Life with Motor Neurone Disease

by Ian Barry and Sarah El-Wahsh

Healthcare 2025, 13(14), 1770; https://doi.org/10.3390/healthcare13141770 - 21 Jul 2025

Viewed by 521

This perspective paper presents a first-person account of life with motor neurone disease (MND). Through the lens of lived experience, it explores the complex and often prolonged diagnostic journey, shaped in part by the protective grip of denial. This paper then delves into [...] Read more.

This perspective paper presents a first-person account of life with motor neurone disease (MND). Through the lens of lived experience, it explores the complex and often prolonged diagnostic journey, shaped in part by the protective grip of denial. This paper then delves into the emotional impact of MND on the individual and their close relationships, capturing the strain on identity and family dynamics. It also highlights the vital role of the multidisciplinary team in providing support throughout the journey. A central focus of the paper is the personal journey of voice banking. It reflects on the restorative experience of reclaiming a pre-disease voice through tools such as ElevenLabs^TM. This narrative underscores the critical importance of early intervention and timely access to voice banking, positioning voice not only as a tool for communication but also as a powerful anchor of identity, dignity, and agency. The paper concludes by highlighting key systemic gaps in MND care. It calls for earlier referral to speech pathology, earlier access to voice banking, access to psychological support from the time of diagnosis, and better integration between research and clinical care. Full article

(This article belongs to the Special Issue Improving Care for People Living with ALS/MND)

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27 pages, 665 KiB

Open AccessReview

On–Off Childhood? A Rapid Review of the Impact of Technology on Children’s Health

by Diana Borges, Inês Pinto, Octávio Santos, Ivone Moura, Iara Rafaela Ferreira, Ana Paula Macedo and Adriana Taveira

Healthcare 2025, 13(14), 1769; https://doi.org/10.3390/healthcare13141769 - 21 Jul 2025

Viewed by 525

Abstract

Background/Objectives: The use of digital technologies among children and adolescents has been increasing exponentially, raising concerns about the potential impacts on physical, mental, cognitive, educational, and social development. Understanding these effects is key to informing clinical and educational practices and public policies [...] Read more.

Background/Objectives: The use of digital technologies among children and adolescents has been increasing exponentially, raising concerns about the potential impacts on physical, mental, cognitive, educational, and social development. Understanding these effects is key to informing clinical and educational practices and public policies that promote digital wellbeing in childhood and adolescence. The main objective of this study was to map the latest available scientific evidence on the patterns of digital technology use by children and adolescents and its main impact, identifying risk factors, opportunities, and strategies for promoting digital wellbeing. Methods: A rapid review was carried out following the Joanna Briggs Institute (JBI) guidelines. Quantitative, qualitative, and mixed studies published between 2020 and 2025, in Portuguese or English, that addressed the use of digital technologies by children and adolescents were included. The assessment of methodological quality was based on JBI’s Critical Appraisal Tools. Results: Ten studies from diverse contexts showed an association between excessive screen time and risks of sedentary lifestyles, sleep disorders, anxiety, depression, attention difficulties, and low academic performance. Occasional benefits arose with adult mediation and educational use; parental mediation and socioeconomic background were key factors. Conclusions: The use of digital technologies is a complex and multifactorial phenomenon that requires integrated approaches; the promotion of digital literacy, public policies for equitable access to quality digital resources, and longitudinal and intercultural studies are recommended to clarify causal relationships and adapt interventions to local contexts. Full article

(This article belongs to the Special Issue Preventive Care in Healthcare—2nd Edition)

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12 pages, 2786 KiB

Open AccessArticle

Congruent-Arc Latarjet Using Subscapularis Split Approach in the Treatment of Anterior Shoulder Instability with Significant Bone Loss: A Case Series

by Ahmed Farid Mekky, Chiara Fossati, Alessandra Menon, Paolo Fici, Pietro Simone Randelli and Tarek Aly

Healthcare 2025, 13(14), 1768; https://doi.org/10.3390/healthcare13141768 - 21 Jul 2025

Viewed by 429

Abstract

Background: Recurrent anterior shoulder instability is a common problem and may be associated with glenoid bone defects. Surgical procedures, including Latarjet, are the usual treatment for anterior shoulder instability, associated with significant glenoid bone defects. The aim of this study was to evaluate [...] Read more.

Background: Recurrent anterior shoulder instability is a common problem and may be associated with glenoid bone defects. Surgical procedures, including Latarjet, are the usual treatment for anterior shoulder instability, associated with significant glenoid bone defects. The aim of this study was to evaluate the clinical outcome and glenohumeral arthritis progression in patients with recurrent anterior shoulder instability and significant bone loss treated by a modified Latarjet procedure. Methods: From July 2018 to November 2021, a prospective observational case series was carried out on 21 patients with recurrent anterior shoulder instability associated with significant bone defects treated by a modified Latarjet procedure in which the coracoid process was rotated 90° on its longitudinal axis and the subscapularis muscle was horizontally split. Patients with a glenoid defect of more than 21% were included. Post-operatively, the patients were clinically assessed using modified Rowe scoring. Glenohumeral arthritis, graft position, union, and resorption were radiologically evaluated. Results: The mean age at the time of surgery was 28.52 ± 8.0 (range: 19–45) years. The mean number of dislocations was 18.33 ± 8.67 (range: 6–35) times. The mean glenoid defect size was 26.19 ± 4.85 (range: 21–37) % and Hill–Sachs lesions were off-track in 19 cases. The mean follow-up period was 30.67 ± 7.53 (range: 16–40) months. Eighteen patients (85.7%) showed good to excellent results. The mean modified Rowe score was 85.00 ± 18.77 (range: 30–100) points. The mean external rotation loss was 8.09 ± 5.11° (range: 0–20°). No cases of recurrent instability were observed, and there was no progression of glenohumeral arthritis. Conclusions: The modified Latarjet is an effective and reliable surgical option to treat traumatic anterior shoulder instability with significant bone loss. Most of the reported complications associated with this procedure did not affect the functional outcome. Full article

(This article belongs to the Special Issue Sports Trauma: From Prevention to Surgery and Return to Sport)

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15 pages, 402 KiB

Open AccessArticle

A Comparative Study of Burden of Care, Anxiety, and Well-Being Among Family Caregivers of Elderly with Dementia: Evidence from Kuwait

by Fahad Manee, Musaed Z Alnaser, Ali Alqattan, Sheikha Almutairi and Hessa Maqtouf

Healthcare 2025, 13(14), 1767; https://doi.org/10.3390/healthcare13141767 - 21 Jul 2025

Viewed by 482

Abstract

Background and Objectives: Caring for an individual with dementia encompasses many challenges. This can lead to increased burden, anxiety, and mental health issues among those taking care of them. Limited research exists investigating the care of people with dementia in Kuwait, particularly regarding [...] Read more.

Background and Objectives: Caring for an individual with dementia encompasses many challenges. This can lead to increased burden, anxiety, and mental health issues among those taking care of them. Limited research exists investigating the care of people with dementia in Kuwait, particularly regarding the mental health of caregivers. There is a need to understand the impact of caregiver burden in this population. This study aimed to assess the level of burden of care, depression, anxiety, and well-being among caregivers of the elderly with dementia in Kuwait. Methods: This study used a descriptive and cross-sectional design. To measure the burden of care, depression, anxiety, and well-being of the caregivers, we utilized the Zarit Burden Interview, the Hospital Anxiety and Depression Scale, and the World Health Organization-Five Well-Being Index. A sensitivity analysis was conducted to compare the results of the parametric and non-parametric methods. Results: This study included 180 (65%) caregivers for the elderly with dementia and 98 (35%) without dementia. The descriptive statistics showed that caregivers for the elderly with dementia and caregivers for the elderly without dementia experienced moderate burden (17.21 ± 9.09 and 14.51 ± 8.08, respectively), borderline abnormal anxiety (9.92 ± 5.15 and 8.61 ± 4.79, respectively), borderline abnormal depression (8.69 ± 4.35 and 8.06 ± 4.24, respectively), and low mental health well-being (54.40 ± 25.10 and 58.90 ± 23.42, respectively). The t-test of independent samples and Mann–Whitney U test results showed that the burden and anxiety in the caregivers for the elderly with dementia group were statistically significantly higher than those in the caregivers for the elderly without dementia group (p = 0.015 and p = 0.039; p = 0.026 and p = 0.027, respectively). The ANOVA test and Kruskal–Wallis test revealed that the caregivers for the elderly with dementia group had statistically significant differences in burden (p < 0.001; p < 0.001), anxiety (p = 0.048; p = 0.043), depression (p = 0.017; p = 0.009), and mental health well-being (p = 0.001; p = 0.002) scores across various durations of care. The multiple linear regression showed that caregiving was a significant predictor of burden of care and anxiety, indicating that caregivers of the elderly with dementia experienced a higher burden of care than those caring for the elderly without dementia. In addition, confounders with significant influence were duration of care (p < 0.001), education level (p = 0.002), employment status (p = 0.008), and gender (p = 0.02). Conclusions: Family caregivers experienced significant levels of burden of care and anxiety when caring for the elderly with dementia. A multidimensional holistic approach is needed to provide family caregivers of the elderly with dementia with valuable interventions. Full article

(This article belongs to the Section Chronic Care)

21 pages, 257 KiB

Open AccessFeature PaperArticle

Strategies to Prevent Work Ability Decline and Support Retirement Transition in Workers with Intellectual and Developmental Disabilities

by Beatriz Sánchez, Francisco de Borja Jordán de Urríes, Miguel Ángel Verdugo, Carmen de Jesús Abena and Victoria Sanblás

Healthcare 2025, 13(14), 1766; https://doi.org/10.3390/healthcare13141766 - 21 Jul 2025

Viewed by 1031

Abstract

Background/Objectives: The aging of workers with intellectual and developmental disabilities is an emerging reality attributed to the rise in life expectancy and improved labor market access. In this study, “workers” is used as an inclusive, neutral term covering all individuals engaged in [...] Read more.

Background/Objectives: The aging of workers with intellectual and developmental disabilities is an emerging reality attributed to the rise in life expectancy and improved labor market access. In this study, “workers” is used as an inclusive, neutral term covering all individuals engaged in paid labor—whether employees, self-employed, freelancers, or those performing manual or non-manual tasks. It encompasses every form of work. It is crucial to comprehend the reality of aging workers from the perspectives of the primary individuals involved: the workers, their families, and supporting professionals. Methods: A qualitative study was developed, involving 12 focus groups and 107 participants, using NVivo 12 Pro for analysis; we used a phenomenological methodology and grounded theory. Results: A set of concrete needs was highlighted: among them, 33 were related to declining work ability due to aging and disability (WADAD), and 30 to transition to retirement. These needs were grouped into categories: workplace accommodations, coordination and collaboration, personal and family support, counseling and training, and other types of needs. Conclusions: This study establishes an empirical basis tailored to the needs of this group, enabling the development of prevention and intervention protocols that address WADAD and the transition to retirement. Full article

(This article belongs to the Special Issue Disability Studies and Disability Evaluation)

14 pages, 926 KiB

Open AccessArticle

The Effectiveness of Manual Therapy in the Cervical Spine and Diaphragm, in Combination with Breathing Re-Education Exercises, on the Range of Motion and Forward Head Posture in Patients with Non-Specific Chronic Neck Pain: A Randomized Controlled Trial

by Petros I. Tatsios, Eirini Grammatopoulou, Zacharias Dimitriadis and George A. Koumantakis

Healthcare 2025, 13(14), 1765; https://doi.org/10.3390/healthcare13141765 - 21 Jul 2025

Viewed by 761

Abstract

Background/Objectives: A randomized controlled trial (RCT) was designed to test the emerging role of respiratory mechanics as part of physiotherapy in patients with non-specific chronic neck pain (NSCNP). Methods: Ninety patients with NSCNP and symptom duration >3 months were randomly allocated to three [...] Read more.

Background/Objectives: A randomized controlled trial (RCT) was designed to test the emerging role of respiratory mechanics as part of physiotherapy in patients with non-specific chronic neck pain (NSCNP). Methods: Ninety patients with NSCNP and symptom duration >3 months were randomly allocated to three intervention groups of equal size, receiving either cervical spine (according to the Mulligan Concept) and diaphragm manual therapy plus breathing reeducation exercises (experimental group—EG1), cervical spine manual therapy plus sham diaphragmatic manual techniques (EG2), or conventional physiotherapy (control group—CG). The treatment period lasted one month (10 sessions) for all groups. The effect on the cervical spine range of motion (CS-ROM) and on the craniovertebral angle (CVA) was examined. Outcomes were collected before treatment (0/12), after treatment (1/12), and three months after the end of treatment (4/12). The main analysis comprised a two-way mixed ANOVA with a repeated measures factor (time) and a between-groups factor (group). Post hoc tests assessed the source of significant interactions detected. The significance level was set at p = 0.05. Results: No significant between-group baseline differences were identified. Increases in CS-ROM and in CVA were registered mainly post-treatment, with improvements maintained at follow-up for CS-ROM. EG1 significantly improved over CG in all movement directions except for flexion and over EG2 for extension only, at 1/12 and 4/12. All groups improved by the same amount for CVA. Conclusions: EG1, which included diaphragm manual therapy and breathing re-education exercises, registered the largest overall improvement over CG (except for flexion and CVA), and for extension over EG2. The interaction between respiratory mechanics and neck mobility may provide new therapeutic and assessment insights of patients with NSCNP. Full article

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

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13 pages, 788 KiB

Open AccessArticle

Pediatricians’ Perspectives on Task Shifting in Pediatric Care: A Nationwide Survey in Japan

by Masatoshi Ishikawa, Ryoma Seto, Michiko Oguro and Yoshino Sato

Healthcare 2025, 13(14), 1764; https://doi.org/10.3390/healthcare13141764 - 21 Jul 2025

Viewed by 444

Abstract

Background/Objectives: In Japan, task shifting reduces the working hours of pediatricians, who face excessive workloads. The status of task shifting under the Ministry of Health, Labor, and Welfare’s reforms remains unclear. This study aimed to evaluate the current status and barriers of [...] Read more.

Background/Objectives: In Japan, task shifting reduces the working hours of pediatricians, who face excessive workloads. The status of task shifting under the Ministry of Health, Labor, and Welfare’s reforms remains unclear. This study aimed to evaluate the current status and barriers of task shifting in pediatric care in Japan. Methods: A questionnaire survey was conducted among pediatricians working in hospitals in Japan. The results were compared with those from 2020. Results: Questionnaires were sent to 835 hospitals, and valid responses were received from 815 pediatricians in 316 hospitals (response rate: 37.8%). The largest group (31.0%) was 40–49 years, and 34.4% of the participants were women. Among the items surveyed, most pediatricians indicated “shifted” in “Patient transfer (transporting between hospitals using an ambulance)” and “Intravenous injection of antibiotics.” Most physicians believed task shifting improved care quality; 10.3% felt it worsened. The most common estimate for daily working hour reduction due to task shifting was “1 to <2 h” (44.9%). Precisely 15.8% of pediatricians believed that task shifting had “not progressed at all,” with rural areas and non-university hospitals showing lower task-shifting implementation. National university hospitals had a higher likelihood of task shifting than public hospitals. No significant associations were observed for the total hospital bed count or the number of full-time pediatricians. Conclusions: Task shifting in pediatric care remains underdeveloped. While many pediatricians support the concept and report modest reductions in working hours, actual implementation remains limited. Future efforts must address systemic, institutional, and regulatory challenges to facilitate meaningful task redistribution and improve healthcare delivery. Full article

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25 pages, 5160 KiB

Open AccessReview

A Technological Review of Digital Twins and Artificial Intelligence for Personalized and Predictive Healthcare

by Silvia L. Chaparro-Cárdenas, Julian-Andres Ramirez-Bautista, Juan Terven, Diana-Margarita Córdova-Esparza, Julio-Alejandro Romero-Gonzalez, Alfonso Ramírez-Pedraza and Edgar A. Chavez-Urbiola

Healthcare 2025, 13(14), 1763; https://doi.org/10.3390/healthcare13141763 - 21 Jul 2025

Viewed by 1451

Abstract

Digital transformation is reshaping the healthcare field by streamlining diagnostic workflows and improving disease management. Within this transformation, Digital Twins (DTs), which are virtual representations of physical systems continuously updated by real-world data, stand out for their ability to capture the complexity of [...] Read more.

Digital transformation is reshaping the healthcare field by streamlining diagnostic workflows and improving disease management. Within this transformation, Digital Twins (DTs), which are virtual representations of physical systems continuously updated by real-world data, stand out for their ability to capture the complexity of human physiology and behavior. When coupled with Artificial Intelligence (AI), DTs enable data-driven experimentation, precise diagnostic support, and predictive modeling without posing direct risks to patients. However, their integration into healthcare requires careful consideration of ethical, regulatory, and safety constraints in light of the sensitivity and nonlinear nature of human data. In this review, we examine recent progress in DTs over the past seven years and explore broader trends in AI-augmented DTs, focusing particularly on movement rehabilitation. Our goal is to provide a comprehensive understanding of how DTs bolstered by AI can transform healthcare delivery, medical research, and personalized care. We discuss implementation challenges such as data privacy, clinical validation, and scalability along with opportunities for more efficient, safe, and patient-centered healthcare systems. By addressing these issues, this review highlights key insights and directions for future research to guide the proactive and ethical adoption of DTs in healthcare. Full article

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16 pages, 1422 KiB

Open AccessArticle

Prevalence of Common Diabetes Mellitus Misinformation Exposure, Cognitive Attitude, and Intention to Share Information Among Patients in a Primary Care Unit

by Thanapol Pratueangpong, Napakkawat Buathong and Phoomjai Sornsenee

Healthcare 2025, 13(14), 1762; https://doi.org/10.3390/healthcare13141762 - 21 Jul 2025

Viewed by 359

Abstract

Background/Objectives: Misinformation significantly impacts self-care behaviors and treatment outcomes in patients with type 2 diabetes mellitus (T2DM). We investigated the prevalence and content of diabetes-related misinformation among Thai patients with T2DM, examining the influence on cognitive attitudes and intentions to share such information. [...] Read more.

Background/Objectives: Misinformation significantly impacts self-care behaviors and treatment outcomes in patients with type 2 diabetes mellitus (T2DM). We investigated the prevalence and content of diabetes-related misinformation among Thai patients with T2DM, examining the influence on cognitive attitudes and intentions to share such information. Methods: We employed a mixed-methods approach, conducting initial qualitative interviews with healthcare professionals and patients with T2DM to identify key misinformation themes. These themes guided the development of a validated questionnaire that was distributed to 107 patients with T2DM. Spearman’s correlation and multiple linear regression analyses were used to assess the relationships between misinformation exposure, attitudes, and sharing intentions. Results: Misinformation was categorized into four domains: medication side effects, alternative treatments, imbalanced lifestyle, and symptom perception. Exposure to misinformation ranged from 19.6% to 94.4%, with word of mouth identified as the primary source (81.18%). Misconceptions regarding symptom perception and alternative treatments were most prevalent. Information source, especially healthcare providers (β = 0.4); personal attitudes towards misinformation (β = 0.24); and exposure level (β = 0.46) significantly influenced the intention to share misinformation. Conclusions: This study highlights the need for targeted educational interventions to address widespread misconceptions in the management of T2DM, particularly those related to symptom perception and alternative treatments. Addressing these misinformation sources may be associated with improved self-management practices and could inform strategies aimed at enhancing patient outcomes. Full article

(This article belongs to the Topic Communications Challenges in Health and Well-Being, 2nd Edition)

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16 pages, 283 KiB

Open AccessArticle

Pre-Mastectomy Breast Reconstruction Intentions in Women with Breast Cancer: Psychosocial and Personality Predictors Informing Mental Health Promotion

by Valentini Bochtsou, Eleni I. Effraimidou, Maria Samakouri, Spyridon Plakias, Maria-Eleni Zachou and Aikaterini Arvaniti

Healthcare 2025, 13(14), 1761; https://doi.org/10.3390/healthcare13141761 - 21 Jul 2025

Viewed by 911

Abstract

Background/Objectives: Despite the psychological benefits of breast reconstruction (BR) after mastectomy, uptake remains limited among women with breast cancer. This study explores psychosocial and personality predictors of BR intentions in the pre-mastectomy phase, aiming to inform strategies for mental health promotion in oncology [...] Read more.

Background/Objectives: Despite the psychological benefits of breast reconstruction (BR) after mastectomy, uptake remains limited among women with breast cancer. This study explores psychosocial and personality predictors of BR intentions in the pre-mastectomy phase, aiming to inform strategies for mental health promotion in oncology care. Methods: This cross-sectional analysis used preoperative data from a longitudinal study at a university hospital in Greece. Women with primary breast cancer scheduled for mastectomy completed a battery of validated self-report measures, including the International Personality Item Big-Five Factor Markers (IPIP-BFFM), the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 Health Survey (SF-36). Demographic, clinical, and psychosocial data were also collected. Binary logistic regression was used to examine predictors of (a) BR information-seeking and (b) BR intention. Results: Seventy-four women participated (mean age = 61.1 years). Older age predicted lower BR intention (Exp(b) = 0.897, 95% CI: 0.829–0.970) and information-seeking (Exp(b) = 0.925, 95% CI: 0.859–0.997). Single/divorced status was associated with reduced BR information-seeking (Exp(b) = 0.053, 95% CI: 0.005–0.549). Openness to experience significantly predicted both outcomes (BR information-seeking: Exp(b) = 1.115, 95% CI: 1.028–1.209); BR intention: Exp(b) = 1.095, 95% CI: 1.016–1.181). Higher physical health-related QoL scores were associated with increased BR intention (Exp(b) = 1.039, 95% CI: 1.007–1.072), whereas higher mental health-related QoL (Exp(b) = 0.952, 95% CI: 0.912–0.994) and higher depression scores (Exp(b) = 0.797, 95% CI: 0.638–0.996) were linked to decreased BR intent. No psychological factor significantly predicted information-seeking. Conclusions: These findings underscore the value of psychosocial screening and personality-informed counseling prior to surgery. By identifying individuals less likely to seek information or consider BR, pre-mastectomy assessments can contribute to tailored, mental health-promoting interventions and support informed, patient-centered surgical decision-making. Full article

(This article belongs to the Special Issue Mental Health Promotion and Illness Prevention in Vulnerable Populations—2nd Edition)

19 pages, 686 KiB

Open AccessArticle

How Stressors and Facilitators of Work–Family Dynamics Interrelate and Affect Psychological Outcomes in Farming Women: A Mixed-Methods Approach in Chile

by Gloria Mora-Guerrero, Fernanda Herrera-González, Carolina Alveal-Álamos, Jorge Constanzo-Belmar, Luis Marileo, Andrés Macadoo and Sharon Viscardi

Healthcare 2025, 13(14), 1760; https://doi.org/10.3390/healthcare13141760 - 21 Jul 2025

Viewed by 540

Abstract

Background/Objectives: This study aimed to explore how stressors and facilitators within the work–family interface (WFI) influence mental health outcomes among farming women in rural Chile. The research sought to identify key relational patterns and contextual determinants shaping psychological well-being in this population. Methods: [...] Read more.

Background/Objectives: This study aimed to explore how stressors and facilitators within the work–family interface (WFI) influence mental health outcomes among farming women in rural Chile. The research sought to identify key relational patterns and contextual determinants shaping psychological well-being in this population. Methods: An exploratory mixed-methods design was employed, involving 41 semi-structured interviews analyzed using grounded theory. Qualitative themes were quantified by calculating the percentage of occurrence per interview, allowing for comparative analysis. Pearson correlation and principal component analysis (PCA) were used to examine associations among WFI dimensions and mental health-related variables. Results: Strong and statistically significant correlations emerged between institutional and community facilitators (r = 0.664, p < 0.01) and between gender facilitators and family workload stressors (r = 0.609, p < 0.01). PCA revealed two distinct patterns: women who rely on institutional support often resist traditional family roles, while others find balance through familial support systems. The gendered distribution of caregiving and productive tasks was a key factor in psychological well-being, with some women reporting physical discomfort linked to triple workloads. Conclusions: The dynamics of the WFI in rural contexts are shaped by both sociocultural and institutional factors. The findings highlight the need for culturally sensitive mental health policies that acknowledge and respond to the lived experiences of farming women. Full article

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16 pages, 1503 KiB

Open AccessStudy Protocol

Effect of a Peripheral Neuromodulation Protocol Combined with the Application of Therapeutic Exercise in Patients Diagnosed with Urinary Incontinence—A Study Protocol for a Randomized Controlled Trial

by Jesica Leal-García, Paula Blanco-Giménez, Eloy Jaenada-Carrillero, Marta Martínez-Soler, Borja Huertas-Ramírez, Alex Mahiques-Sanchis and Juan Vicente-Mampel

Healthcare 2025, 13(14), 1759; https://doi.org/10.3390/healthcare13141759 - 21 Jul 2025

Viewed by 409

Abstract

Introduction: Overactive bladder (OAB) and urinary incontinence (UI) are prevalent, particularly in older adults, and affect quality of life. OAB involves urgency, frequency, nocturia, and urgency incontinence, often linked to involuntary detrusor contractions. Treatment guidelines recommend a stepwise approach, starting with pelvic floor [...] Read more.

Introduction: Overactive bladder (OAB) and urinary incontinence (UI) are prevalent, particularly in older adults, and affect quality of life. OAB involves urgency, frequency, nocturia, and urgency incontinence, often linked to involuntary detrusor contractions. Treatment guidelines recommend a stepwise approach, starting with pelvic floor muscle training (PFMT), followed by pharmacological or minimally invasive therapies, such as neuromodulation. However, the combined effects of PFMT and neuromodulation have not been well established. This study aimed to evaluate the impact of combining pelvic floor exercises with neuromodulation versus PFMT with sham neuromodulation or standard physiotherapy after a 12-week intervention in individuals with OAB and UI. Methods/Materials: A double-blind, randomized controlled trial was designed with three groups: PFMT + neuromodulation, PFMT + sham, and conventional physiotherapy (control) in a 1:1:1 ratio. This study followed the CONSORT guidelines and was registered at ClinicalTrials.gov (NCT06783374). The sample size was calculated using GPower^® software, assuming a Cohen’s effect size of 1.04, a power of 0.80, an alpha of 0.05, and a 15% dropout rate, totaling 63 participants (21 per group). Participants attended 24 sessions over 12 weeks (2 sessions per week). The interventions were based on previously validated protocols. Outcomes: The primary outcomes included health-related quality of life, pelvic floor muscle function, pain, adherence, and general health. The secondary outcomes included Incontinence Quality of Life questionnaire, 3-day bladder diary, International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, kinesiophobia, and electromyographic data. Full article

(This article belongs to the Special Issue Pelvic Floor Health and Care)

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15 pages, 342 KiB

Open AccessArticle

Effect of Work Stress and Eating Behavior: A Study Among Academicians in Türkiye

by Merve İnce-Palamutoğlu, Betül Oruçoğlu, Meltem İnce-Yenilmez and Gizem Ağır

Healthcare 2025, 13(14), 1758; https://doi.org/10.3390/healthcare13141758 - 20 Jul 2025

Viewed by 413

Abstract

Background/Objectives: Occupational stress is a common issue among academics. This study aims to determine the level of work stress experienced by academics depending on their titles and the relationship between this stress and eating behaviors. Methods: The data for the study were collected [...] Read more.

Background/Objectives: Occupational stress is a common issue among academics. This study aims to determine the level of work stress experienced by academics depending on their titles and the relationship between this stress and eating behaviors. Methods: The data for the study were collected through an online survey from 649 academicians working in universities in Türkiye between January and February 2025. This is a cross-sectional study, and the snowball sampling method was used to facilitate high participation rates. Data were collected using a demographic questionnaire, the General Work Stress Scale (GWSS) to assess work stress levels, and the Turkish version of the Adult Eating Behavior Questionnaire (AEBQ-TR) to evaluate eating behaviors. Results: Among the participants, 47.6% were of normal weight, with an average BMI of 25.85 ± 4.56 kg/m². The median work stress score of male academicians (17.00) was significantly lower than that of female academicians (21.00) (p < 0.001). Similarly, the median eating behavior score was lower in male academicians (18.55) compared to females (19.78) (p < 0.001). Work stress levels decreased with increasing academic title, with professors reporting the lowest levels of stress (p < 0.001). Conclusions: The findings indicate that female academics are more likely to engage in emotional eating under stress, whereas male academics tend to alter their dietary preferences by avoiding certain foods. These results underscore the importance of stress management and the promotion of healthy eating habits among academics. Full article

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

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21 pages, 383 KiB

Open AccessArticle

Mapping the Unmet Informational Needs of Young Portuguese Female Cancer Survivors: Psychometric Validation of a Multidimensional Scale

by Luana Almeida, Ana Bártolo, Sara Monteiro, Isabel S. Silva, Ana Conde, Alexandra M. Araújo, Luiz Lourenço and Isabel M. Santos

Healthcare 2025, 13(14), 1757; https://doi.org/10.3390/healthcare13141757 - 20 Jul 2025

Viewed by 478

Abstract

Background/Objectives: Young female cancer survivors often face specific informational needs related to the physical and emotional effects of cancer and its impact on life plans, particularly fertility and parenthood. However, few tools are tailored to assess these needs during this critical life stage. [...] Read more.

Background/Objectives: Young female cancer survivors often face specific informational needs related to the physical and emotional effects of cancer and its impact on life plans, particularly fertility and parenthood. However, few tools are tailored to assess these needs during this critical life stage. This study aimed to (i) validate a multidimensional measure—the Satisfaction with Information Provided to Young Oncology Patients Scale (SIPYF-CPS)—to assess the specific informational needs of young adult female cancer survivors; and (ii) explore preferences regarding the provision of information and counseling. Methods: A total of 124 women (M[age] = 38.18; SD = 5.49; range 21–45), 76.6% diagnosed with breast cancer, participated in the study. Psychometric analyses included exploratory factor analysis and correlation coefficients to assess reliability and construct validity. Convergent validity was evaluated through standardized measures of anxiety, reproductive concerns, and quality of life. Results: A final 22-item measure demonstrated strong reliability and validity, capturing four factors: (i) Disease-Related Information, (ii) Symptoms and Functional Limitations, (iii) Implications for Fertility and Parenthood, and (iv) Support Services. Participants expressed low satisfaction with information on fertility preservation, sexual health, and support services. Lower satisfaction was moderately associated with higher anxiety and depression while positively related to quality of life. Most participants preferred phased, face-to-face communication throughout the illness trajectory. Conclusions: The SIPYF-CPS is a valid, multidimensional tool that captures the complex and evolving informational needs of young female cancer survivors. Its clinical use may promote earlier, personalized, and emotionally responsive communication—supporting psychological well-being, informed decision-making, and long-term survivorship care. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches in Cancer Healthcare)

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11 pages, 386 KiB

Open AccessArticle

Benchmarking AI Chatbots for Maternal Lactation Support: A Cross-Platform Evaluation of Quality, Readability, and Clinical Accuracy

by İlke Özer Aslan and Mustafa Törehan Aslan

Healthcare 2025, 13(14), 1756; https://doi.org/10.3390/healthcare13141756 - 20 Jul 2025

Viewed by 533

Abstract

Background and Objective: Large language model (LLM)–based chatbots are increasingly utilized by postpartum individuals seeking guidance on breastfeeding. However, the chatbots’ content quality, readability, and alignment with clinical guidelines remain uncertain. This study was conducted to evaluate and compare the quality, readability, and [...] Read more.

Background and Objective: Large language model (LLM)–based chatbots are increasingly utilized by postpartum individuals seeking guidance on breastfeeding. However, the chatbots’ content quality, readability, and alignment with clinical guidelines remain uncertain. This study was conducted to evaluate and compare the quality, readability, and factual accuracy of responses generated by three publicly accessible AI chatbots—ChatGPT-4o Pro, Gemini 2.5 Pro, and Copilot Pro—when prompted with common maternal questions related to breast-milk supply. Methods: Twenty frequently asked breastfeeding-related questions were submitted to each chatbot in separate sessions. The responses were paraphrased to enable standardized scoring and were then evaluated using three validated tools: ensuring quality information for patients (EQIP), the simple measure of gobbledygook (SMOG), and the global quality scale (GQS). Factual accuracy was benchmarked against WHO, ACOG, CDC, and NICE guidelines using a three-point rubric. Additional user experience metrics included response time, character count, content density, and structural formatting. Statistical comparisons were performed using the Kruskal–Wallis and Wilcoxon rank-sum tests with Bonferroni correction. Results: ChatGPT-4o Pro achieved the highest overall performance across all primary outcomes: EQIP score (85.7 ± 2.4%), SMOG score (9.78 ± 0.22), and GQS rating (4.55 ± 0.50), followed by Gemini 2.5 Pro and Copilot Pro (p < 0.001 for all comparisons). ChatGPT-4o Pro also demonstrated the highest factual alignment with clinical guidelines (95%), while Copilot showed more frequent omissions or simplifications. Differences in response time and formatting quality were statistically significant, although not always clinically meaningful. Conclusions: ChatGPT-4o Pro outperforms other chatbots in delivering structured, readable, and guideline-concordant breastfeeding information. However, substantial variability persists across the platforms, and none should be considered a substitute for professional guidance. Importantly, the phenomenon of AI hallucinations—where chatbots may generate factually incorrect or fabricated information—remains a critical risk that must be addressed to ensure safe integration into maternal health communication. Future efforts should focus on improving the transparency, accuracy, and multilingual reliability of AI chatbots to ensure their safe integration into maternal health communications. Full article

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14 pages, 1395 KiB

Open AccessArticle

Cost–Consequence Analysis of Semaglutide vs. Liraglutide for Managing Obese Prediabetic and Diabetic Patients in Saudi Arabia: A Single-Center Study

by Najla Bawazeer, Seham Bin Ganzal, Huda F. Al-Hasinah and Yazed Alruthia

Healthcare 2025, 13(14), 1755; https://doi.org/10.3390/healthcare13141755 - 20 Jul 2025

Viewed by 1049

Abstract

Background: Semaglutide and Liraglutide are medications in the Glucagon-like peptide-1 agonists (GLP-1 RAs) class used to manage type 2 diabetes mellitus and obesity in Saudi Arabia. Although the 1.0 mg once weekly dosage of Semaglutide does not have a labeled indication for [...] Read more.

Background: Semaglutide and Liraglutide are medications in the Glucagon-like peptide-1 agonists (GLP-1 RAs) class used to manage type 2 diabetes mellitus and obesity in Saudi Arabia. Although the 1.0 mg once weekly dosage of Semaglutide does not have a labeled indication for the management of obesity, many believe that this dosage is more effective than the 3.0 mg once daily Liraglutide dosage for the management of both diabetes and obesity. Objective: To compare the effectiveness of the dosage of 1.0 mg of Semaglutide administered once weekly versus 3.0 mg of Liraglutide administered once daily in controlling HbA1c levels, promoting weight loss, and evaluating their financial implications among obese patients in Saudi Arabia using real-world data. Methods: A retrospective review of Electronic Medical Records (EMRs) from January 2021 to June 2024 was conducted on patients prescribed Semaglutide or Liraglutide for at least 12 months. Exclusion criteria included pre-existing severe conditions (e.g., cardiovascular disease, stroke, or cancer) and missing baseline data. The primary outcomes assessed were changes in HbA1c, weight, and direct medical costs. Results: Two hundred patients (100 patients on the 1.0 mg once weekly dose of Semaglutide and 100 patients on the 3.0 mg once daily dose of Liraglutide) of those randomly selected from the EMRs met the inclusion criteria and were included in the analysis. Of the 200 eligible patients (65.5% female, mean age 48.54 years), weight loss was greater with Semaglutide (−8.09 kg) than Liraglutide (−5.884 kg). HbA1c reduction was also greater with Semaglutide (−1.073%) than Liraglutide (−0.298%). The use of Semaglutide resulted in lower costs of USD −1264.76 (95% CI: −1826.82 to 33.76) and greater reductions in weight of −2.22 KG (95% CI: −7.68 to −2.784), as well as lower costs of USD −1264.76 (95% CI: (−2368.16 to −239.686) and greater reductions in HbA1c of −0.77% (95% CI: −0.923 to −0.0971) in more than 95% of the cost effectiveness bootstrap distributions. Conclusions: Semaglutide 1.0 mg weekly seems to be more effective and cost-saving in managing prediabetes, diabetes, and obesity compared to Liraglutide 3.0 mg daily. Future studies should examine these findings using a more representative sample and a robust study design. Full article

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22 pages, 840 KiB

Open AccessArticle

Relationship Between Family Support, C-Reactive Protein and Body Mass Index Among Outpatients with Schizophrenia

by Argyro Pachi, Athanasios Tselebis, Evgenia Kavourgia, Nikolaos Soultanis, Dimitrios Kasimis, Christos Sikaras, Spyros Baras and Ioannis Ilias

Healthcare 2025, 13(14), 1754; https://doi.org/10.3390/healthcare13141754 - 20 Jul 2025

Viewed by 601

Abstract

Background/Objectives: Schizophrenia has been associated with increased inflammatory and metabolic disturbances. Perceived family support potentially affects inflammatory and metabolic biomarkers. The aim of this study was to determine the interrelations between family support, C-reactive protein (CRP) and Body Mass Index (BMI) in a [...] Read more.

Background/Objectives: Schizophrenia has been associated with increased inflammatory and metabolic disturbances. Perceived family support potentially affects inflammatory and metabolic biomarkers. The aim of this study was to determine the interrelations between family support, C-reactive protein (CRP) and Body Mass Index (BMI) in a sample of outpatients with schizophrenia. Importantly, this study sought to elucidate the effect of perceived family support on inflammatory processes among patients with schizophrenia. Methods: In this cross-sectional correlation study, 206 outpatients with schizophrenia in clinical remission completed a standardized self-report questionnaire that assessed family support (Family Support Scale—FSS). Sociodemographic, clinical and laboratory data were also recorded. Results: Among the participants, 49.5% had detectable CRP values (≥0.11 mg/dL), whereas 14.6% had positive CRP levels (>0.6 mg/dL). There was a significant difference in CRP levels among the different BMI groups (normal weight/overweight vs. obese). For obese patients, the crude odds ratios (ORs) for detectable and positive CRP values were 1.980 (95% confidence interval (CI) [1.056, 3.713]) and 27.818 (95% CI [6.300, 122.838]), respectively. Significant positive correlations were observed among CRP, BMI and illness duration, while scores on the FSS were negatively associated with these variables. The results of binary logistic regression analysis indicated that both BMI and family support were significant factors in determining the likelihood of having positive CRP levels, with each unit increase in the BMI associated with a 17% (95% CI [0.025, 0.337]) increase in the odds, and with each unit increase in family support leading to an 8.6% (95% CI [0.018, 0.15]) decrease. A moderation analysis revealed that the association between family support and the probability of having positive CRP levels depends on the BMI value, but only for obese patients did the protective effect of family support significantly decrease the magnitude of the risk of having positive CRP (b = −0.1972, SE = 0.053, OR = 0.821, p = 0.000, 95% CI [−0.3010, −0.0934]). Conclusions: The effect of perceived family support on inflammatory responses becomes evident in cases where beyond metabolic complications, inflammatory processes have already been established. Increased perceived family support seems to protect against inflammation and, notably, the association between low perceived family support and increased inflammation is even stronger. Establishing the role of family involvement during the treatment of patients with schizophrenia through inflammatory processes is a novelty of this study, emphasizing the need to incorporate family therapy into psychiatric treatment plans. However, primary interventions are considered necessary for patients with schizophrenia in order to maintain their BMI within normal limits and avoid the subsequent nosological sequelae. Full article

(This article belongs to the Special Issue Physical and Mental Health Interactions: An Integral Approach to a Bidirectional Relationship)

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28 pages, 4194 KiB

Open AccessArticle

The Impact of Perceived Quality on Patients’ Adoption and Usage of Online Health Consultations: An Empirical Study Based on Trust Theory

by Shuwan Zhu, Jiahao Zhou and Nini Xu

Healthcare 2025, 13(14), 1753; https://doi.org/10.3390/healthcare13141753 - 19 Jul 2025

Viewed by 390

Abstract

Background: The outbreak of the COVID-19 pandemic has highlighted the importance of online health consultations, as they can help reduce the risk of contagion and infection. However, due to limited trust, these services have not yet gained widespread adoption and usage among patients. [...] Read more.

Background: The outbreak of the COVID-19 pandemic has highlighted the importance of online health consultations, as they can help reduce the risk of contagion and infection. However, due to limited trust, these services have not yet gained widespread adoption and usage among patients. Objective: This research aims to examine the impact of perceived quality on patients’ adoption and usage of online health consultations from three perspectives: emotional support, responsiveness, and service continuity. Additionally, this research further explores the moderating effects of online service prices on these relationships. Methods: Based on trust theory, this research constructs theoretical models and empirically tests them by using a panel dataset that comprises 1255 physicians and 65,314 physician–patient communication records. Results: The empirical results confirm that emotional support, responsiveness, and service continuity positively influence patients’ adoption and usage behaviors. Additionally, higher online service prices negatively moderate the impact of emotional support and responsiveness on adoption behavior. Moreover, increased online service prices weaken the positive relationship between emotional support and usage behavior while strengthening the positive relationship between service continuity and usage behavior. Conclusions: This research extends the existing literature on online health services and provides practical guidance for platform managers, physicians, and policymakers to improve overall service acceptance. Full article

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

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25 pages, 1283 KiB

Open AccessSystematic Review

Reinforcement Learning and Its Clinical Applications Within Healthcare: A Systematic Review of Precision Medicine and Dynamic Treatment Regimes

by Timothy C. Frommeyer, Michael M. Gilbert, Reid M. Fursmidt, Youngjun Park, John Paul Khouzam, Garrett V. Brittain, Daniel P. Frommeyer, Ean S. Bett and Trevor J. Bihl

Healthcare 2025, 13(14), 1752; https://doi.org/10.3390/healthcare13141752 - 19 Jul 2025

Viewed by 753

Abstract

Background/Objectives: Reinforcement learning (RL), a subset of machine learning, has emerged as a promising tool for supporting precision medicine and dynamic treatment regimes by enabling adaptive, data-driven clinical decision making. Despite its potential, challenges such as interpretability, reward definition, data limitations, and [...] Read more.

Background/Objectives: Reinforcement learning (RL), a subset of machine learning, has emerged as a promising tool for supporting precision medicine and dynamic treatment regimes by enabling adaptive, data-driven clinical decision making. Despite its potential, challenges such as interpretability, reward definition, data limitations, and clinician adoption remain. This review aims to evaluate the recent advancements in RL in precision medicine and dynamic treatment regimes, highlight clinical fields of application, and propose practical frameworks for future integration into medical practice. Methods: A systematic review was conducted following PRISMA guidelines across PubMed, MEDLINE, and Web of Science databases, focusing on studies from January 2014 to December 2024. Articles were included based on their relevance to RL applications in precision medicine and dynamic treatment regime within healthcare. Data extraction captured study characteristics, algorithms used, specialty area, and outcomes. Results: Forty-six studies met the inclusion criteria. RL applications were concentrated in endocrinology, critical care, oncology, and behavioral health, with a focus on dynamic and personalized treatment planning. Hybrid and value-based RL methods were the most utilized. Since 2020, there has been a sharp increase in RL research in healthcare, driven by advances in computational power, digital health technologies, and increased use of wearable devices. Conclusions: RL offers a powerful opportunity to augment clinical decision making by enabling dynamic and individualized patient care. Addressing key barriers related to transparency, data availability, and alignment with clinical workflows will be critical to translating RL into everyday medical practice. Full article

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

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13 pages, 388 KiB

Open AccessArticle

Benchmarking ChatGPT-3.5 and OpenAI o3 Against Clinical Pharmacists: Preliminary Insights into Clinical Accuracy, Sensitivity, and Specificity in Pharmacy MCQs

by Esraa M. Alsaudi, Sireen A. Shilbayeh and Rana K Abu-Farha

Healthcare 2025, 13(14), 1751; https://doi.org/10.3390/healthcare13141751 - 19 Jul 2025

Viewed by 615

Abstract

Objective: This proof-of-concept study aimed to evaluate and compare the clinical performance of two AI language models (ChatGPT-3.5 and OpenAI o3) in answering clinical pharmacy multiple-choice questions (MCQs), benchmarked against responses from specialist clinical pharmacists in Jordan, including academic preceptors and hospital-based clinicians. [...] Read more.

Objective: This proof-of-concept study aimed to evaluate and compare the clinical performance of two AI language models (ChatGPT-3.5 and OpenAI o3) in answering clinical pharmacy multiple-choice questions (MCQs), benchmarked against responses from specialist clinical pharmacists in Jordan, including academic preceptors and hospital-based clinicians. Methods: A total of 60 clinical pharmacy MCQs were developed based on current guidelines across four therapeutic areas: cardiovascular, endocrine, infectious, and respiratory diseases. Each item was reviewed by academic and clinical experts and then pilot-tested with five pharmacists to determine clarity and difficulty. Two ChatGPT models—GPT-3.5 and OpenAI o3—were tested using a standardized prompt for each MCQ, entered in separate sessions to avoid memory retention. Their answers were classified as true/false positives or negatives and retested after two weeks to assess reproducibility. Simultaneously, 25 licensed pharmacists (primarily from one academic institution and several hospitals in Amman) completed the same MCQs using validated references (excluding AI tools). Accuracy, sensitivity, specificity, and Cohen’s Kappa were used to compare AI and human performance, with statistical analysis conducted using appropriate tests at a significance level of p ≤ 0.05. Results: OpenAI o3 achieved the highest accuracy (83.3%), sensitivity (90.0%), and specificity (70.0%), outperforming GPT-3.5 (70.0%, 77.5%, 55.0%) and pharmacists (69.7%, 77.0%, 55.0%). AI performance declined significantly with increasing question difficulty. OpenAI o3 showed the highest accuracy in the cardiovascular domain (93.3%), while GPT-3.5 performed best in infectious diseases (80.0%). Reproducibility was higher for GPT-3.5 (81.6%, κ = 0.556) than OpenAI o3 (76.7%, κ = 0.364). Over two test rounds, GPT-3.5’s accuracy remained stable, whereas OpenAI o3’s accuracy decreased from 83.3% to 70.0%, indicating some variability. Conclusions: OpenAI o3 shows strong promise as a clinical decision-support tool in pharmacy, especially for low- to moderate-difficulty questions. However, inconsistencies in reproducibility and limitations in complex cases highlight the importance of cautious, supervised integration alongside human expertise. Full article

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16 pages, 261 KiB

Open AccessArticle

A Six-Year Longitudinal Study of Psychological Distress, Depression, Anxiety, and Internet Addiction Among Students at One Medical Faculty

by Meltem Akdemir, Yonca Sonmez, Yesim Yigiter Şenol, Erol Gurpinar and Mehmet Rifki Aktekin

Healthcare 2025, 13(14), 1750; https://doi.org/10.3390/healthcare13141750 - 19 Jul 2025

Viewed by 397

Abstract

Background: Medical education is considered one of the most academically and emotionally demanding training programs. Throughout their education, medical students are exposed to various factors that can lead to psychological distress, depression, and anxiety. The aim of this longitudinal study was to [...] Read more.

Background: Medical education is considered one of the most academically and emotionally demanding training programs. Throughout their education, medical students are exposed to various factors that can lead to psychological distress, depression, and anxiety. The aim of this longitudinal study was to examine the changes in psychological distress, depression, anxiety levels and internet addiction among medical students throughout their six-year education and to identify the contributing factors. Methods: The study cohort consisted of 282 students who enrolled in the medical faculty in the 2017–2018 academic year. A questionnaire including sociodemographic characteristics, the General Health Questionnaire-12 (GHQ-12), Beck Depression Inventory (BDI), State–Trait Anxiety Inventory (STAI), and Young Internet Addiction Test (IAT) was administered to the students during the first week of their education. The same questionnaire was readministered at the end of the third and sixth years. Friedman’s variance analysis was used to compare measurement data across the three time points, while Cochran’s Q Test was employed for categorical variables. Results: The median scores of the GHQ-12, BDI, S-Anxiety, and IAT significantly increased from the first to the sixth year (p < 0.05). The prevalence of depressive symptoms, S-Anxiety, and risky internet use significantly increased from the first to the final year, particularly between the third and sixth years. According to logistic regression analysis based on sixth-year data, students whose fathers were university graduates, who had been diagnosed with COVID-19, and who were dissatisfied with their social lives were found to be at increased risk for psychological distress and depression. Students with high parental expectations were found to be at risk of depression and S-anxiety. Those dissatisfied with their occupational choice were at risk for both psychological distress and S-anxiety. Conclusions: It was found that the mental health of medical students deteriorated during their education, especially during the clinical years. Given that these students will be responsible for protecting and improving public health in the future, it is essential to prioritize their own mental well-being. Interventions aimed at preserving the mental health of medical students should be planned. Full article

(This article belongs to the Section Preventive Medicine)

13 pages, 438 KiB

Open AccessStudy Protocol

A Smartphone Application Based on Dialectical Behavior Therapy Skills for Binge Eating Episodes: Study Protocol for a Randomized Controlled Trial

by Telma Cruz, Tiago B. Ferreira, Debra L. Safer, Cristiana Duarte and Mariana V. Martins

Healthcare 2025, 13(14), 1749; https://doi.org/10.3390/healthcare13141749 - 19 Jul 2025

Viewed by 611

Abstract

Background/Objectives: With the rapid progression of technology, applications have been proposed as a promising alternative to conventional psychotherapeutic treatment. Nonetheless, research on unguided self-help applications for binge eating remains scarce, with most existing studies utilizing cognitive behavioral therapy (CBT) principles. Therefore, this [...] Read more.

Background/Objectives: With the rapid progression of technology, applications have been proposed as a promising alternative to conventional psychotherapeutic treatment. Nonetheless, research on unguided self-help applications for binge eating remains scarce, with most existing studies utilizing cognitive behavioral therapy (CBT) principles. Therefore, this paper presents the protocol for a randomized controlled trial designed to evaluate the efficacy and acceptability of eMOTE, a standalone application designed specifically for women in Portugal who binge eat. eMOTE, adapted from dialectical behavior therapy (DBT), is unique in that it focuses on teaching emotion regulation skills while also integrating core CBT strategies. Methods: At least 68 females who self-report binge eating episodes will be randomized into an intervention group with access to eMOTE for eight weeks or a delayed waitlist, which will have access to eMOTE after the T1 assessment. Assessments will be conducted at baseline (T0), post-intervention (T1), and at 2-month follow-up (T2). The primary outcomes will include objective and subjective binge eating frequency and binge eating symptomatology, while secondary outcomes will assess global levels of ED psychopathology, shape concern, weight concern, eating concern, dietary restraint, compensatory behaviors, mindfulness, emotion regulation difficulties, intuitive eating, psychological distress, and body mass index. Conclusions: This study will contribute to the limited literature on the use of smartphone technology as an alternative to traditional psychotherapy. Furthermore, this standalone application will offer insights into the use of emotion regulation and food monitoring components designed for adult females experiencing binge eating episodes. Full article

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15 pages, 445 KiB

Open AccessArticle

Assessing the Alignment Between the Humpty Dumpty Fall Scale and Fall Risk Nursing Diagnosis in Pediatric Patients: A Retrospective ROC Curve Analysis

by Manuele Cesare, Fabio D’Agostino, Deborah Hill-Rodriguez, Danielle Altares Sarik and Antonello Cocchieri

Healthcare 2025, 13(14), 1748; https://doi.org/10.3390/healthcare13141748 - 19 Jul 2025

Viewed by 636

Abstract

Background/Objectives: Falls in hospitalized pediatric patients are frequent and can lead to serious complications and increased healthcare costs. Nurses typically assess fall risk using structured tools such as the Humpty Dumpty Fall Scale (HDFS), alongside nursing diagnoses such as Fall risk ND, [...] Read more.

Background/Objectives: Falls in hospitalized pediatric patients are frequent and can lead to serious complications and increased healthcare costs. Nurses typically assess fall risk using structured tools such as the Humpty Dumpty Fall Scale (HDFS), alongside nursing diagnoses such as Fall risk ND, which are based on clinical reasoning. However, the degree of alignment between the HDFS and the nursing reasoning-based diagnostic approach in assessing fall risk remains unclear. This study aims to assess the alignment between the HDFS and Fall risk ND in identifying fall risk among hospitalized pediatric patients. Methods: A retrospective observational study was conducted in a tertiary pediatric hospital in Italy, including all pediatric patients admitted in 2022. Fall risk was assessed within 24 h from hospital admission using two approaches, the HDFS (risk identified with the standard cutoff, score ≥ 12) and Fall risk ND, based on the nurse’s clinical reasoning and recorded through the PAIped clinical nursing information system. Discriminative performance was analyzed using receiver operating characteristic curve analysis. The area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. A confusion matrix evaluated classification performance at the cutoff (≥12). Results: Among 2086 inpatients, 80.9% had a recorded Fall risk ND. Of the 1853 patients assessed with the HDFS, 52.7% were classified as at risk (HDFS score ≥ 12). The HDFS showed low discriminative ability in detecting patients with a Fall risk ND (AUC = 0.568; 95% CI: 0.535−0.602). The PPV was high (85.1%), meaning that most patients identified as at risk by the HDFS were also judged to be at risk by nurses through Fall risk ND. However, the NPV was low (20.1%), indicating that many patients with low HDFS scores were still diagnosed with Fall risk ND by nurses. Conclusions: The HDFS shows limited ability to discriminate pediatric patients with Fall risk ND, capturing a risk profile that does not fully align with nursing clinical reasoning. This suggests that standardized tools and clinical reasoning address distinct yet complementary dimensions of fall risk assessment. Integrating the HDFS into a structured nursing diagnostic process—guided by clinical expertise and supported by continuous education—can strengthen the effectiveness of fall prevention strategies and enhance patient safety in pediatric settings. Full article

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15 pages, 259 KiB

Open AccessArticle

Resilience and Perceived Social Support in Cancer Survivors: Validity, Levels, and Sociodemographic Correlates of CD-RISC-25 and MSPSS Scales

by Goran Malenković, Jelena Malenković, Sanja Tomić, Silvija Lučić, Armin Šljivo, Fatima Gavrankapetanović-Smailbegović and Slobodan Tomić

Healthcare 2025, 13(14), 1747; https://doi.org/10.3390/healthcare13141747 - 19 Jul 2025

Viewed by 457

Abstract

Background and Objectives: Resilience and perceived social support are crucial factors influencing the psychological well-being among breast cancer survivors. Understanding their levels and interrelations can inform psychosocial interventions aimed at improving survivorship outcomes. This study aimed to examine the relationship between resilience [...] Read more.

Background and Objectives: Resilience and perceived social support are crucial factors influencing the psychological well-being among breast cancer survivors. Understanding their levels and interrelations can inform psychosocial interventions aimed at improving survivorship outcomes. This study aimed to examine the relationship between resilience and perceived social support, evaluate the psychometric properties, and explore their associations with key sociodemographic factors among breast cancer survivors. Materials and Methods: A total of 253 women in clinical remission, at least six months post-primary treatment, were recruited from the University Clinical Center of Vojvodina. Participants completed sociodemographic and clinical questionnaires, the Connor–Davidson Resilience Scale (CD-RISC-25), and the Multidimensional Scale of Perceived Social Support (MSPSS). Results: Participants reported moderate levels of resilience (Mdn = 75, IQR = 19). Among resilience domains, Hardiness (Mdn = 22, IQR = 7) and Coping (Mdn = 14, IQR = 4) scored highest, while Optimism (Mdn = 6, IQR = 3) was the lowest. A significant positive correlation was found between resilience and fertility-related quality of life (ρ = 0.454, p < 0.01), while a negative correlation was observed between resilience and fertility-related stress (ρ = −0.275, p < 0.01). Adaptive coping strategies, particularly from the Practical Management Branch of the CIQ, were positively associated with resilience and quality of life, while avoidance coping was linked to higher stress and lower well-being. Conclusions: Breast cancer survivors in this Serbian cohort reported moderate resilience and social support, with a strong interrelationship between the two. These findings underscore the importance of strengthening social support networks as a potential pathway to enhance resilience and psychological well-being in cancer survivorship care. Full article

15 pages, 245 KiB

Open AccessArticle

Migraine Among University Students: Prevalence, Characteristics, and Sociodemographic Influences

by Maria Axiotidou, Hariklia Proios, Theodoros Karapanayiotides and Doxa Papakonstantinou

Healthcare 2025, 13(14), 1746; https://doi.org/10.3390/healthcare13141746 - 18 Jul 2025

Viewed by 490

Abstract

Background: Migraine is a highly prevalent and disabling neurological disorder among university students that has significant impacts on personal and socioeconomic levels. Despite its impact, migraine remains underdiagnosed and undertreated. Objective: This study aimed to estimate the prevalence of probable migraine [...] Read more.

Background: Migraine is a highly prevalent and disabling neurological disorder among university students that has significant impacts on personal and socioeconomic levels. Despite its impact, migraine remains underdiagnosed and undertreated. Objective: This study aimed to estimate the prevalence of probable migraine among university students in Greece and explore its association with sociodemographic data. Methods: A cross-sectional, questionnaire-based study was conducted between September 2023 and January 2024 among university students in Greece using a convenience sampling method. The Headache Screening Questionnaire—English Version (HSQ-EV) was used to screen for probable migraine, along with additional questions assessing demographic characteristics. Descriptive statistics and bivariate analyses were performed. Results: The prevalence of probable migraine was 20%. Female students were more likely to experience migraine compared to males. Migraine was also statistically significantly associated with marital status and employment status. In a multivariate logistic regression model including sex assigned at birth, age, educational level, marital status, and employment status, older age was independently associated with higher odds of migraine. Conclusions: Migraine is a prevalent health issue among university students in Greece, with clear gender and sociodemographic associations. Future studies with larger, more representative sample sizes and the use of validated diagnostic tools are needed to understand its determinants and inform targeted interventions. Full article

27 pages, 4187 KiB

Open AccessArticle

Assessing Occupational Work-Related Stress and Anxiety of Healthcare Staff During COVID-19 Using Fuzzy Natural Language-Based Association Rule Mining

by Abdulaziz S. Alkabaa, Osman Taylan, Hanan S. Alqabbaa and Bulent Guloglu

Healthcare 2025, 13(14), 1745; https://doi.org/10.3390/healthcare13141745 - 18 Jul 2025

Viewed by 335

Abstract

Background/Objective: Frontline healthcare staff who contend diseases and mitigate their transmission were repeatedly exposed to high-risk conditions during the COVID-19 pandemic. They were at risk of mental health issues, in particular, psychological stress, depression, anxiety, financial stress, and/or burnout. This study aimed to [...] Read more.

Background/Objective: Frontline healthcare staff who contend diseases and mitigate their transmission were repeatedly exposed to high-risk conditions during the COVID-19 pandemic. They were at risk of mental health issues, in particular, psychological stress, depression, anxiety, financial stress, and/or burnout. This study aimed to investigate and evaluate the occupational stress of medical doctors, nurses, pharmacists, physiotherapists, and other hospital support crew during the COVID-19 pandemic in Saudi Arabia. Methods: We collected both qualitative and quantitative data from a survey given to public and private hospitals using methods like correspondence analysis, cluster analysis, and structural equation models to investigate the work-related stress (WRS) and anxiety of the staff. Since health-related factors are unclear and uncertain, a fuzzy association rule mining (FARM) method was created to address these problems and find out the levels of work-related stress (WRS) and anxiety. The statistical results and K-means clustering method were used to find the best number of fuzzy rules and the level of fuzziness in clusters to create the FARM approach and to predict the work-related stress and anxiety of healthcare staff. This innovative approach allows for a more nuanced appraisal of the factors contributing to work-related stress and anxiety, ultimately enabling healthcare organizations to implement targeted interventions. By leveraging these insights, management can foster a healthier work environment that supports staff well-being and enhances overall productivity. This study also aimed to identify the relevant health factors that are the root causes of work-related stress and anxiety to facilitate better preparation and motivation of the staff for reorganizing resources and equipment. Results: The results and findings show that when the financial burden (FIN) of healthcare staff increased, WRS and anxiety increased. Similarly, a rise in psychological stress caused an increase in WRS and anxiety. The psychological impact (PCG) ratio and financial impact (FIN) were the most influential factors for the staff’s anxiety. The FARM results and findings revealed that improving the financial situation of healthcare staff alone was not sufficient during the COVID-19 pandemic. Conclusions: This study found that while the impact of PCG was significant, its combined effect with FIN was more influential on staff’s work-related stress and anxiety. This difference was due to the mutual effects of PCG and FIN on the staff’s motivation. The findings will help healthcare managers make decisions to reduce or eliminate the WRS and anxiety experienced by healthcare staff in the future. Full article

(This article belongs to the Special Issue Depression, Anxiety and Emotional Problems Among Healthcare Workers)

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19 pages, 318 KiB

Open AccessArticle

Exploring Ukrainian Refugee Women’s Beliefs and Concerns About Healthcare Systems, with a Focus on HPV Immunization Practices: A Mixed-Methods Study on Forcibly Displaced Populations in Romania

by Teodora Achimaș-Cadariu, Andrei Pașca, Delia Nicoară and Dan Lucian Dumitrașcu

Healthcare 2025, 13(14), 1744; https://doi.org/10.3390/healthcare13141744 - 18 Jul 2025

Viewed by 497

Abstract

Objectives: Scarce data are available regarding preventive medicine in forcibly displaced populations especially regarding non-communicable diseases like neoplasia, while even more limited data are available on Ukrainian refugees in Romania. To address this research gap, the present analysis was performed to investigate [...] Read more.

Objectives: Scarce data are available regarding preventive medicine in forcibly displaced populations especially regarding non-communicable diseases like neoplasia, while even more limited data are available on Ukrainian refugees in Romania. To address this research gap, the present analysis was performed to investigate Ukrainian refugee women’s beliefs, attitudes, and opinions towards the Romanian and Ukrainian healthcare system in a comparison model while focusing on the HPV immunization rates and factors influencing the uptake for themselves and their children. Methods: Participants were recruited using the snowball sampling method through their General Practitioner (GP) and a health mediator. Results: In total, 105 women completed the online or physical survey. The mean age was 50 years. In total, 40% of women had not been to a gynecological check-up in 3 or more years, and more than 56% had never been screened. Only four were vaccinated against HPV, and none remembered which type of vaccine was dispensed or how many doses were utilized. The primary hindrances to accessing health services or immunization programs were language barriers, financial burdens, and a lack of information. Respondents’ general distrust of health systems and healthcare workforces were recurrent themes. Relationship status, living arrangements, and previous engagement in screening practices influenced immunization rates. Perceiving the healthcare officials as proactive concerning optional vaccination programs such as HPV immunization and actively receiving recommendations drove respondents to pursue vaccination. Conclusions: This analysis offers a foundational insight into the specific needs of refugee women. It can guide the development of effective public health interventions to improve health outcomes and vaccination rates among Ukrainian refugees in Romania. Tailored preventive campaigns with adequate native language information and prompts from medical experts in designated centers should be deployed to ensure inclusive tactics for vulnerable populations. Full article

(This article belongs to the Special Issue Focus on the Sexual and Reproductive Health of Migrant and Refugee Populations)

14 pages, 777 KiB

Open AccessArticle

Turkish Validity and Reliability Study of the Short Version of the Questionnaire for Assessing the Childbirth Experience (QACE)

by Cevriye Emir and Candan Ozturk

Healthcare 2025, 13(14), 1743; https://doi.org/10.3390/healthcare13141743 - 18 Jul 2025

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Abstract

Objective: The mother’s birth experience is crucial in identifying her care needs. The “Questionnaire for Assessing the Childbirth Experience” (QACE) consists of four subscales designed to assess a mother’s childbirth experience. However, psychometric evaluations of the QACE have not been conducted in Turkey. [...] Read more.

Objective: The mother’s birth experience is crucial in identifying her care needs. The “Questionnaire for Assessing the Childbirth Experience” (QACE) consists of four subscales designed to assess a mother’s childbirth experience. However, psychometric evaluations of the QACE have not been conducted in Turkey. This study aims to adapt and assess the validity and reliability of the “Questionnaire for Assessing the Childbirth Experience” short version for the Turkish maternal population. Methods: This methodological study included 205 mothers who gave birth in a public hospital. Data were collected using an Introductory Information Form and the Questionnaire for Assessing the Childbirth Experience (QACE). Results: The content validity index (CVI) for Item 9 was calculated as 0.875, while the remaining 12 items obtained a CVI of 1.00. The internal consistency of the scale, as measured by Cronbach’s alpha coefficient (α = 0.758), indicated an acceptable level of reliability across all items. During the Exploratory Factor Analysis (EFA), one item (Item 13) was excluded due to cross-loading. The remaining 12 items were grouped into four distinct subscales. Conclusions: The short version of the QACE demonstrates acceptable psychometric properties and serves as a valid and reliable instrument for assessing childbirth experiences among Turkish women. Full article

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21 pages, 1245 KiB

Open AccessSystematic Review

Application of Conservative Methods Based on Exercise in Reducing the Kyphotic Angle: A Meta-Analysis

by Vanja Dimitrijević, Bojan Rašković, Miroslav P. Popović, Dragan Marinković, Miloš Kojić, Siniša Nikolić, Nikola Jevtić and Borislav Obradović

Healthcare 2025, 13(14), 1742; https://doi.org/10.3390/healthcare13141742 - 18 Jul 2025

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Abstract

Background: The aim of this research was to evaluate the size of the effect of conservative methods based on exercises on the reduction in the kyphotic angle through a meta-analysis. Methods: In our research, we followed the Cochrane guidelines and the PRISMA guidelines. [...] Read more.

Background: The aim of this research was to evaluate the size of the effect of conservative methods based on exercises on the reduction in the kyphotic angle through a meta-analysis. Methods: In our research, we followed the Cochrane guidelines and the PRISMA guidelines. In October 2024, we searched the following databases: Scopus, Pub Med, Web of Science, and Cochrane Library. The following keywords were used for the search: (“Kyphosis” OR “Hyperkyphosis” OR “Kyphotic angle” OR “Spinal curve” OR “Sagittal spinal”) AND (“Conservative methods” OR “Conservative treatment” OR “Corrective exercise” OR “Physical exercise” OR “Exercise therapy” OR “Training”). The risk of bias was assessed for each randomized trial using the Cochrane Risk of Bias Tool and the Methodological Index for Non-Randomized Studies (MINORS). The study’s main outcome and estimated effects were the kyphotic angle. R 4.3.2 software with the meta package was used for analyses, and standardized mean difference (SMD) and 95% confidence interval (CI), a randomized model for continuous outcomes, were used as effect size. Results: Twenty-one studies were included in the qualitative analysis, while 19 studies were included in the quantitative analysis. Depending on the analysis, the effect sizes ranged from (SMD = 0.27 to SMD = 0.73). Heterogeneity ranged from 0% to 58%, while the quality of evidence (GRADE) ranged from very low to moderate. Conclusions: Our meta-analysis indicates the positive effects of applying conservative methods based on exercise in subjects without and with osteoporosis diagnosed with hyperkyphosis. Full article

(This article belongs to the Special Issue Physical and Rehabilitation Medicine—2nd Edition)

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17 pages, 787 KiB

Open AccessArticle

Assessing Stress and Shift Quality in Nursing Students: A Pre- and Post-Shift Survey Approach

by Haneen Ali and Yasin Fatemi

Healthcare 2025, 13(14), 1741; https://doi.org/10.3390/healthcare13141741 - 18 Jul 2025

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Abstract

Background: Nursing students often experience heightened levels of stress during clinical training due to the dual demands of academic and clinical responsibilities. These stressors, compounded by environmental and organizational factors, can adversely affect students’ well-being, academic performance, and the quality of patient care [...] Read more.

Background: Nursing students often experience heightened levels of stress during clinical training due to the dual demands of academic and clinical responsibilities. These stressors, compounded by environmental and organizational factors, can adversely affect students’ well-being, academic performance, and the quality of patient care they deliver. Aim: This study aimed to identify the key stressors influencing nursing students’ perceptions of single-shift quality (SSQ) during clinical training and to examine how well students can predict the quality of their shift based on pre-shift expectations. Methodology: A cross-sectional survey design was implemented, collecting pre- and post-shift data from 325 nursing students undergoing clinical training in Alabama. The survey measured 13 domains related to workload, environmental conditions, organizational interactions, coping strategies, and overall satisfaction. Paired t tests and linear regressions were used to assess changes in perception and identify key predictors of SSQ. Results: This study found significant discrepancies between students’ pre- and post-shift evaluations across multiple domains, including internal environment, organizational interaction with clinical faculty/preceptors, and coping strategies (p < 0.001). Students also accurately predicted stable factors such as patient characteristics and external environment. Pre-shift expectations did not significantly predict post-shift experiences. Post-shift perceptions revealed that stress-coping strategies and collegiality were the strongest predictors of shift quality. Conclusion: Students enter clinical shifts with optimistic expectations that often do not align with actual experiences, particularly regarding support and stress management. The SSQ framework offers a valuable tool for identifying gaps in clinical training and guiding interventions that foster resilience and better alignment between expectations and real-world practice. Full article

(This article belongs to the Special Issue Health Services, Health Literacy and Nursing Quality)

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