Healthcare

14 pages, 593 KB

Open AccessArticle

BAN Score and Distinct Early Cardiometabolic Risk Signatures in a Non-Diabetic Population: A Cross-Sectional Analysis

by Yazeed Alshuweishi, Noha A. Alshuwayer, Lama Izziddeen, Arwa Abudawood, Dalal Alfayez and Ahmed M. Basudan

Healthcare 2025, 13(18), 2384; https://doi.org/10.3390/healthcare13182384 - 22 Sep 2025

Viewed by 489

Abstract

Background: The BMI–albumin–neutrophil-to-lymphocyte (BAN) score integrates adiposity, nutritional status, and systemic inflammation, but its role in detecting early cardiometabolic changes remains unclear. This study examined associations of the BAN score with vascular, glycemic, and lipid markers in non-diabetic adults. Methods: This retrospective cross-sectional [...] Read more.

Background: The BMI–albumin–neutrophil-to-lymphocyte (BAN) score integrates adiposity, nutritional status, and systemic inflammation, but its role in detecting early cardiometabolic changes remains unclear. This study examined associations of the BAN score with vascular, glycemic, and lipid markers in non-diabetic adults. Methods: This retrospective cross-sectional study included 162 non-diabetic subjects. Associations between the BAN score and vascular, glycemic, and lipid parameters were examined using Spearman’s correlation, ROC analysis, and regression models adjusted for age, sex, smoking status, and medication use. Results: Patients had a median age of 37 years, 72.8% were female, with median BMI 33 kg/m², albumin 4.4 g/dL, and NLR 1.3. Higher BAN scores correlated with systolic blood pressure (SBP) (r = 0.23, p < 0.01), pulse pressure (PP) (r = 0.26, p < 0.001), and HbA1c (r = 0.22, p < 0.01). Compared with the lowest tertile, higher BAN tertiles showed significantly elevated SBP, PP, and HbA1c (p < 0.01). In adjusted models, each one-unit increase in BAN score was associated with higher SBP (β = 1.01, p = 0.037), PP (β = 0.66, p = 0.006), and HbA1c (β = 1.85, p = 0.008). No associations were found with the atherogenic index of plasma (AIP), Castelli risk index I (CRI-I), or Castelli risk index II (CRI-II). ROC analysis showed moderate discriminative ability for hypertension (AUC = 0.66) and HbA1c (AUC = 0.65). Conclusions: The BAN score is associated with a distinctive early cardiometabolic risk, particularly elevated SBP, widened PP, and early glycemic alterations. Further research should define the BAN score’s mechanisms and preventive utility. Full article

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13 pages, 1061 KB

Open AccessArticle

Selenoprotein S and the Causal Risk of Hypertension in Pregnancy: A Mendelian Randomization Study

by Mengqi Cai, Wenrui Lv, Yan He, Weili Liu and Yuzhen Gao

Healthcare 2025, 13(18), 2383; https://doi.org/10.3390/healthcare13182383 - 22 Sep 2025

Viewed by 473

Abstract

Background: Pregnancy-induced hypertension (PIH) affects approximately 10% of pregnancies worldwide, representing a leading cause of maternal and perinatal morbidity and mortality. The relationship between plasma selenium levels and PIH remains controversial, with observational studies limited by confounding factors. Selenoprotein S (SELENOS) has emerged [...] Read more.

Background: Pregnancy-induced hypertension (PIH) affects approximately 10% of pregnancies worldwide, representing a leading cause of maternal and perinatal morbidity and mortality. The relationship between plasma selenium levels and PIH remains controversial, with observational studies limited by confounding factors. Selenoprotein S (SELENOS) has emerged as a potential biomarker for PIH risk. As one of the carrier proteins for dietary selenium, SELENOS plays a crucial role in oxidative stress and inflammatory pathways. However, the causal relationship between the plasma levels of the SELENOS and PIH development remains unclear. This study employed Mendelian randomization (MR) to investigate the causal link between the plasma levels of the SELENOS and PIH risk, providing evidence for preventive strategies. Methods: We conducted a two-sample MR analysis using genome-wide association study (GWAS) summary statistics from the INTERVAL study and FinnGen consortium. The analysis included individuals of European ancestry, utilizing the inverse-variance weighted (IVW) method as the primary approach. Comprehensive sensitivity analyses were performed to address potential pleiotropy and strengthen causal inference. Results: The analysis encompassed 3301 samples for the plasma levels of the SELENOS and 7686 PIH cases, 1109 pre-existing hypertension (PEH) cases, 4255 gestational hypertension (GH) cases, and 83 preeclampsia (PE) cases superimposed on chronic hypertension, alongside approximately 115,000 controls. Genetic variabilities that have been found to be accompanied by elevated levels of plasma selenioprotein levels showed significant associations with increased risk of PIH [odds ratio (OR) 1.078, 95% confidence interval (CI) 1.031–1.126, p = 0.001], PEH (OR 1.232, 95% CI 1.105–1.373, p < 0.001), and GH (OR 1.111, 95% CI 1.047–1.180, p = 0.001), with suggestive associations for preeclampsia superimposed on chronic hypertension (OR 1.590, 95% CI 1.078–2.344, p = 0.019). Conclusions: This study provides robust genetic evidence for a causal relationship between the plasma levels of the SELENOS and PIH risk, establishing SELENOS as a potential modifiable risk factor with significant clinical implications. These findings support the development of personalized selenium management strategies during pregnancy and highlight the potential for early screening and targeted interventions to improve maternal and fetal outcomes. Full article

(This article belongs to the Special Issue Improving Adolescent Girls’ and Women’s Health and Nutrition)

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18 pages, 329 KB

Open AccessArticle

Fear of Death, Concept of a Good Death and Self-Compassion Among University Students in Portugal: A Cross-Sectional Study

by Marisa Pereira, Amira Mohammed Ali, Feten Fekih-Romdhane, Murat Yıldırım and Carlos Laranjeira

Healthcare 2025, 13(18), 2382; https://doi.org/10.3390/healthcare13182382 - 22 Sep 2025

Viewed by 684

Abstract

Background/Objectives: Historically, humankind has consistently regarded death as an uncomfortable topic. Although death and dying are unescapable, they are frequently overlooked in formal education, as discussing or acknowledging them is believed to provoke emotional or psychological discomfort. To the best of our knowledge, [...] Read more.

Background/Objectives: Historically, humankind has consistently regarded death as an uncomfortable topic. Although death and dying are unescapable, they are frequently overlooked in formal education, as discussing or acknowledging them is believed to provoke emotional or psychological discomfort. To the best of our knowledge, little is known about the influence of the fear of death on the lives of university students. To fill this gap, this study aimed to examine the relationship between the concept of a good death, fear of death and self-compassion among university students in Portugal. Methods: This cross-sectional study was conducted in Portugal between November 2024 and January 2025 with 310 university students using an e-survey. Personal questionnaire and the Portuguese versions of the Good Death Concept Scale, the Collett-Lester Fear of Death Scale, and the Self-Compassion Scale were used. JAMOVI statistical software (version 2.7.6.) was used for descriptive analysis, independent sample t-tests, one-way ANOVA with post hoc analysis, and Pearson correlation analysis. To identify the factors associated with fear of death, a multiple linear regression analysis was conducted. This study adhered to the STROBE checklist for reporting. Results: A total of 310 students were included. The average age was 25 ± 8.52 years, and 75.2% were female. The total mean score for fear of death was 99.22 ± 21.97, indicating relatively low fear levels. However, health sciences students presented higher fear of death rates compared with non-health counterparts. Age and gender differences were also found, with female and younger students reporting significantly higher levels of fear of death (p < 0.01). The Pearson correlation matrix indicated that fear of death is positively correlated with the concept of a good death, while negatively correlated with self-compassion (p < 0.01). Key factors influencing fear of death include age, gender, closure and control domains, and the overidentification subscale (adjusted R-Squared valued [R2] = 0.352). Conclusions: The results suggest that students are often poorly prepared to deal with death-related issues (revealing fear) and with negative thoughts and feelings about mortality. In this vein, it is necessary to implement curricular educational interventions focusing on death education as well as actively involving students in compassionate community initiatives, increasing their awareness and self-confidence about EoL care. Full article

14 pages, 568 KB

Open AccessArticle

Developing the Menstrual Myths Attitude Scale

by Gülüzar Sade and Metin Yıldız

Healthcare 2025, 13(18), 2381; https://doi.org/10.3390/healthcare13182381 - 22 Sep 2025

Viewed by 457

Abstract

Background: Menstrual myths include practices that negatively impact women’s health. Knowing attitudes toward menstrual myths is essential for protecting and improving women’s health. However, there are limited measurement tools available to determine attitudes toward menstrual myths. Methods: This study is a methodological scale [...] Read more.

Background: Menstrual myths include practices that negatively impact women’s health. Knowing attitudes toward menstrual myths is essential for protecting and improving women’s health. However, there are limited measurement tools available to determine attitudes toward menstrual myths. Methods: This study is a methodological scale development study conducted between October 2021 and January 2023 to determine individuals’ attitudes towards menstrual myths. For this purpose, the scale items prepared by making use of the literature were shaped with expert opinions, pre-application was made, and data were collected from a total of 337 women through a questionnaire and validity analyses, including exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and reliability analyses (Cronbach’s alpha), were also performed. Results: The final version of the scale included 20 items under 5 subscales (menstrual information, menstrual stigmatization, menstrual privacy, menstrual hygiene, menstruation education). Cronbach’s alpha coefficient was 0.79 for the whole scale. EFA revealed five factors explaining 52.074% of the total variance. CFA confirmed a good model fit: χ² = 2876.480; df = 496, p < 0.05; X²/sd = 1.655; RMSEA = 0.044, AGFI = 0.910, IFI = 0.928, TLI = 0.913, GFI = 0.932, and CFI = 0.927. Cronbach’s alpha was 0.790 for the total scale. Conclusions: The Attitude Towards Menstrual Myths scale is a valid and reliable tool for determining women’s attitudes toward menstrual myths. It is recommended that further testing be conducted for use by different groups, men and gender-neutral individuals. Full article

(This article belongs to the Section Women’s and Children’s Health)

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16 pages, 270 KB

Open AccessArticle

Oral Health in Palliative Care: An Exploratory Study of Public Dental Practitioners’ Perceptions in Sydney, Australia

by Ajesh George, Ariana Kong, Agnivo Sengupta, Amy R. Villarosa, Tiffany Patterson Norrie, Meera Agar, Janeane Harlum, Deborah Parker, Jennifer Wiltshire and Ravi Srinivas

Healthcare 2025, 13(18), 2380; https://doi.org/10.3390/healthcare13182380 - 22 Sep 2025

Cited by 1 | Viewed by 423

Abstract

Introduction: Oral health problems are prevalent among people receiving palliative care, affecting their quality of life. However, little is known about dental practitioners’ perspectives in this setting. Thus, this study aimed to explore the perceptions of public dental practitioners regarding the provision of [...] Read more.

Introduction: Oral health problems are prevalent among people receiving palliative care, affecting their quality of life. However, little is known about dental practitioners’ perspectives in this setting. Thus, this study aimed to explore the perceptions of public dental practitioners regarding the provision of dental care for people who receive palliative care. Methods: An exploratory focus group with 21 public dental practitioners, with a mean of 8.24 years of experience, was conducted in a public oral health service in Sydney, Australia. The focus group was transcribed and analysed using thematic analysis. Results: Three themes were identified: (1) enhancing quality of life in palliative care through improved oral health; (2) navigating the systemic and practical challenges of palliative dental care; (3) competent, collaborative, and optimised: a palliative oral care model. Participants highlighted the importance of oral health to quality of life while receiving palliative care. Nevertheless, there were several systematic and practical challenges to delivering appropriate dental care, which included competing priorities among clients, disconnects and gaps in care coordination with palliative care providers, limited training, and adapting treatment planning during appointments. Participants highlighted the need for a new model of care in the future that improved dental practitioners’ competence through comprehensive palliative dental training, included protocols to facilitate interdisciplinary collaboration, and optimised dental treatment planning and appointment scheduling. Conclusions: Public dental practitioners in this study demonstrated positive attitudes, but systemic barriers and limited training restrict their care provision. A palliative oral health care model for this setting should include palliative dental training, foster interdisciplinary collaboration, and optimise dental treatment planning. Full article

12 pages, 489 KB

Open AccessArticle

Determinants of Breastfeeding Practices Pre- and During the COVID-19 Pandemic: A Retrospective Cohort Study

by Maryam Sharfi, Nasreen Hejres, Asma Ali, Noor Aldoseri, Badreya Malalla, Maria Tolentino, Wafa Hamad Almegewly and Khulud Ahmad Rezq

Healthcare 2025, 13(18), 2379; https://doi.org/10.3390/healthcare13182379 - 22 Sep 2025

Viewed by 448

Abstract

Background/Objectives: Exclusive breastfeeding (EBF) during hospitalization is essential for infant health but remains suboptimal in many Gulf Cooperation Council (GCC) countries. Maternal factors and the COVID-19 pandemic may have influenced breastfeeding practices. Understanding these determinants is crucial for improving postnatal care. This study [...] Read more.

Background/Objectives: Exclusive breastfeeding (EBF) during hospitalization is essential for infant health but remains suboptimal in many Gulf Cooperation Council (GCC) countries. Maternal factors and the COVID-19 pandemic may have influenced breastfeeding practices. Understanding these determinants is crucial for improving postnatal care. This study aimed to identify determinants of breastfeeding practices during hospitalization before and during the COVID-19 pandemic in Bahrain. Methods: This retrospective cohort study reviewed electronic records of 321 mothers and their newborns discharged between March 2019 and March 2021 from a larger pool of 4500 cases. A structured data collection form was used to capture maternal age, parity, nationality, mode of delivery, COVID-19 period of delivery (pre-pandemic vs. pandemic), breastfeeding method, and reasons for mixed feeding. Descriptive and inferential statistical analyses were conducted to identify associations between variables. Results: Multiparous mothers had significantly higher exclusive breastfeeding rates than primiparous mothers (p = 0.016). The mode of delivery showed a strong association with breastfeeding outcomes, with vaginal births linked to higher EBF rates (p < 0.01). A notable decline in EBF was observed during the COVID-19 pandemic period, from 40% pre-pandemic to 14% during the pandemic. Conclusions: Exclusive breastfeeding during hospitalization is significantly influenced by delivery method and maternal parity. Although the COVID-19 pandemic may have contributed to reduced EBF rates, further research is required to validate these trends. These findings emphasize the importance of supportive hospital policies, particularly for first-time and cesarean mothers, and stress the need to strengthen breastfeeding practices during public health emergencies. Full article

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

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15 pages, 1330 KB

Open AccessArticle

Early Palliative Care in Patients with Glioblastoma: Co-Design of an Integrated Care Pathway

by Esmée K. J. van der Poort, Monique C. M. Baas-Thijssen, Marleen Oomes, Maaike J. Vos, Robin M. Pieterman, Martin J. B. Taphoorn, Inge de Vries, Carla Juffermans, Eline F. de Vries, Yvette M. van der Linden and Johan A. F. Koekkoek

Healthcare 2025, 13(18), 2378; https://doi.org/10.3390/healthcare13182378 - 22 Sep 2025

Viewed by 445

Abstract

Background: Glioblastoma is an incurable form of brain cancer with a median overall survival of 1.5 years. Despite its progressive nature and high symptom burden, palliative care is not consistently integrated in routine glioblastoma care. Early integration of palliative care better addresses the [...] Read more.

Background: Glioblastoma is an incurable form of brain cancer with a median overall survival of 1.5 years. Despite its progressive nature and high symptom burden, palliative care is not consistently integrated in routine glioblastoma care. Early integration of palliative care better addresses the needs of patients and caregivers, improves quality of life, and reduces inappropriate care in the end-of-life phase. This study aims to design an integrated care pathway to support the early integration of palliative care for patients with glioblastoma. Methods: We used a design thinking approach, engaging stakeholders from neuro-oncology, specialist palliative care, primary care, district nursing, healthcare administration, health insurance, health economics, and patient advocacy. The process consisted of thirteen informal interviews (with healthcare professionals, patients, and caregivers), six expert meetings, and two workshops. Results: First, we mapped existing routine glioblastoma care and identified perceived barriers to early palliative care integration, including variations in advance care planning (ACP) timing, clinicians’ hesitation, unclear referral criteria to specialist palliative care, suboptimal care coordination, and limited experience with glioblastoma in the primary care setting. Second, iterative prototyping led to the development of a care pathway with key components: initiation of ACP by the lead clinician within six weeks of diagnosis, integrated multidisciplinary team meetings for complex cases, ongoing coordination, clear referral triggers for specialist palliative care, and structured caregiver care. Conclusions: The co-designed pathway provides a feasible model for integrating early palliative care into routine care for patients with glioblastoma. Future steps include implementation and evaluation of the care pathway and development of a payment model. Full article

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12 pages, 240 KB

Open AccessArticle

Exploring Medical Doctors’ Confidence in Artificial Intelligence: The Role of Specialty, Experience, and Perceived Job Security

by Fahad Abdulaziz Alrashed, Tauseef Ahmad, Ahmad Othman Alsabih, Shimaa Mahmoud, Muneera M. Almurdi and Hamza Mohammad Abdulghani

Healthcare 2025, 13(18), 2377; https://doi.org/10.3390/healthcare13182377 - 22 Sep 2025

Viewed by 486

Abstract

Background: Artificial intelligence (AI) is increasingly integrated into healthcare, offering transformative potential across diagnostics, treatment, and clinical decision-making. As its adoption grows, understanding how medical doctors perceive and respond to AI, particularly in relation to their specialty, experience, and job security, is critical [...] Read more.

Background: Artificial intelligence (AI) is increasingly integrated into healthcare, offering transformative potential across diagnostics, treatment, and clinical decision-making. As its adoption grows, understanding how medical doctors perceive and respond to AI, particularly in relation to their specialty, experience, and job security, is critical for effective implementation and acceptance. This study investigates the confidence of medical doctors in AI technologies and their role in healthcare, focusing on the impact of specialty, experience, and perceived job security. Method: A cross-sectional survey was conducted among 187 medical doctors across various specialties in Riyadh, Saudi Arabia, with a final sample of 176 participants. The survey assessed awareness, confidence, and concerns regarding AI integration into clinical practice. The survey was conducted across multiple healthcare hospitals in Riyadh, Saudi Arabia. Hospitals from both public and private sectors were included to ensure a diverse sample of healthcare professionals from different organizational structures. Results: A statistically significant association was found between specialty and confidence level (χ² = 14.5, p = 0.001). Among specialists, the majority (80%) reported high confidence in AI use compared to 45% of general practitioners and 38% of surgeons. Conversely, moderate confidence was most common among surgeons (46%), followed by general practitioners (35%) and specialists (13%). Additionally, participants with 11–20 years of experience reported the highest confidence, whereas those aged 55+ years showed the lowest perceived impact of AI on patient outcomes. Multivariate regression analysis identified specialty as the strongest predictor of AI confidence, with specialists being four times more likely to express high confidence in AI use (β = 0.89, p = 0.001) compared to general practitioners. Job displacement concerns negatively influenced confidence in AI, while age and years of experience had less impactful effects. Conclusions: The study concludes that addressing barriers to AI adoption will be crucial for enhancing its integration into healthcare and improving patient care. These findings underscore the importance of specialty-specific training and highlight the need for targeted educational programs, particularly for lower confidence groups such as general practitioners and surgeons. Lower confidence levels in these groups may result in a hesitant or incorrect use of AI tools, potentially compromising patient safety. Therefore, equipping all healthcare professionals with the necessary knowledge and confidence is essential for the safe and effective use of AI in clinical practice. Full article

11 pages, 558 KB

Open AccessArticle

Effect of Virtual Reality on Pain and Anxiety During Epidural Steroid Injection in Patients with Lumbar Radicular Pain: An Open-Label Randomized Trial

by Marine Javelot, Clément Chopin, Loïs Bolko, Ambre Hittinger, Marion Geoffroy, Isabelle Charlot, Fanny Adeline, Claire Coutureau, Alice Duvivier and Jean-Hugues Salmon

Healthcare 2025, 13(18), 2376; https://doi.org/10.3390/healthcare13182376 - 22 Sep 2025

Viewed by 498

Abstract

Background/Objectives: Virtual reality (VR) has been shown to reduce pain and anxiety in several specialties, but has not been investigated in the setting of steroid injections in rheumatology. We aimed to assess the impact of using a VR headset on pain and [...] Read more.

Background/Objectives: Virtual reality (VR) has been shown to reduce pain and anxiety in several specialties, but has not been investigated in the setting of steroid injections in rheumatology. We aimed to assess the impact of using a VR headset on pain and anxiety during epidural steroid injection via the sacral hiatus for lumbar radiculopathy. Methods: Patients received two injections via the sacral hiatus and were randomized into one of two groups: group 1 used the VR headset during the first injection and not during the second injection, while group 2 used the VR headset during the second injection but not the first. The primary endpoint was pain evaluated on a numeric rating scale. Secondary objectives were anxiety, measured using the STAI (State Trait Anxiety Inventory), and safety. These analyses were performed using the Mann–Whitney U test. Results: We included 116 patients over 18 years of age who were hospitalized in the Rheumatology department of the University Hospital of Reims and scheduled to receive at least two epidural steroid injections. We observed a significantly lower pain score during the first injection procedure (median 3 (IQ 1; 6) in group 1 vs. 5 (IQ 3; 7) in group 2, p = 0.045). The analysis for the second injection could not be performed by intention-to-treat due to the presence of a sequence effect. There was also a significant reduction in anxiety (p = 0.004 and p = 0.002 by per-protocol analysis). Conclusions: VR can significantly reduce pain and anxiety during epidural steroid injection via the sacral hiatus. Full article

(This article belongs to the Special Issue Pain Management Practice and Research)

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14 pages, 1101 KB

Open AccessArticle

Telemedicine-Assisted Work-Related Injuries Among Seafarers on Italian-Flagged Ships: A 13-Year Retrospective Study

by Getu Gamo Sagaro and Francesco Amenta

Healthcare 2025, 13(18), 2375; https://doi.org/10.3390/healthcare13182375 - 22 Sep 2025

Viewed by 474

Abstract

Background: Seafarers are highly susceptible to work-related injuries, which can result in serious consequences or permanent disabilities. Understanding the frequency and characteristics of occupational injuries is crucial for developing effective prevention strategies and identifying their underlying patterns and causes. This study aimed [...] Read more.

Background: Seafarers are highly susceptible to work-related injuries, which can result in serious consequences or permanent disabilities. Understanding the frequency and characteristics of occupational injuries is crucial for developing effective prevention strategies and identifying their underlying patterns and causes. This study aimed to determine the frequency and characteristics of telemedicine-assisted work-related injuries among seafarers on board Italian-flagged vessels. Methods: A retrospective descriptive study was conducted to analyze occupational injuries using medical data recorded in the Centro Internazionale Radio Medico (C.I.R.M.) database from 1 January 2010 to 31 December 2022. Injuries in the database were coded according to the 10th revision of the International Classification of Diseases (ICD-10) by the World Health Organization (WHO). Variables extracted from the database included injury type, seafarers’ age, rank, nationality, worksite, gender, date of injury, affected body region, clinical outcomes, and other demographic and occupational characteristics. Injury frequency and characteristics (e.g., location, type, and cause) were analyzed and stratified by seafarers’ rank and worksite groups. Results: The analysis included 793 seafarers who sustained injuries. Their average age was 39.15 ± 10.49 years (range: 21 to 70 years). Deck ratings and engine officers accounted for 27.9% and 20% of those who claimed injuries, respectively. 39.2% of injured seafarers were aged between 30 and 40 years. In terms of affected body parts, the most reported injuries were to the hand/wrist (33.3%), followed by the knee/lower legs (21%), and the head/eye (19%). Open wounds (38%) and burns/abrasions (14%) were the most common types of injury. Slips/falls (32%), burns/explosions (16.6%), and overexertion while lifting or carrying (14.8%) were the leading causes of injury during the study period. Nearly 35% of injuries affected workers on the deck and were due mainly to slips/falls, 19% in the engine room were due to being caught in machinery or equipment, and 32.5% in the catering department were due to burns/explosions. Conclusions: One-third of seafarers who suffered work-related injuries sustained hand and/or wrist injuries, with slips/falls being a significant cause. The results of this study emphasize the need for preventative measures in the marine sector, particularly to reduce risks associated with slips and falls, overexertion, and other injury-causing factors. Campaigns for the larger use of protective equipment are desirable to reduce occupational accidents at sea and provide better health protection for seafarers. Full article

(This article belongs to the Special Issue Injury Prevention and Trauma Management: From Vulnerable Groups to General Populations)

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11 pages, 376 KB

Open AccessArticle

Clinical Characteristics and Risk Factors for Severe Exacerbation in Never-Smokers with Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study

by Josep Montserrat-Capdevila, Pilar Vaqué Castilla, Yoseba Cánovas Zaldúa, Francesc Alòs, Joan Deniel-Rosanas, Pere Simonet, Pau Olivares-Sanzo, Jennyfer Jiménez Díaz, Sandra Moreno Garcia, Araceli Fuentes, Eugeni Paredes and Pere Godoy

Healthcare 2025, 13(18), 2374; https://doi.org/10.3390/healthcare13182374 - 22 Sep 2025

Viewed by 535

Abstract

Background: Chronic obstructive pulmonary disease (COPD) in nonsmokers is increasingly recognized, yet its clinical profile and outcomes remain less well defined compared to smoking-related COPD. The aim of this study was to compare the clinical characteristics, comorbidities, and risk factors associated with severe [...] Read more.

Background: Chronic obstructive pulmonary disease (COPD) in nonsmokers is increasingly recognized, yet its clinical profile and outcomes remain less well defined compared to smoking-related COPD. The aim of this study was to compare the clinical characteristics, comorbidities, and risk factors associated with severe exacerbations in nonsmoking COPD patients versus smokers. Methods: We conducted a prospective cohort study including 2376 patients with a diagnosis of COPD from the Lleida Health Region (Catalonia, Spain). Patients were followed for 2 years (2021–2022). Severe exacerbation was defined as hospital admission due to worsening COPD symptoms. Clinical variables were collected at baseline, and logistic regression analysis was performed to identify risk factors for severe exacerbation in the COPD-NS subgroup. Results: A total of 2376 COPD patients were included, of whom 966 (40.7%) were never-smokers. During the two-year follow-up, 165 patients (6.9%) required hospitalization for a severe exacerbation, nearly half of whom were never-smokers (48.5%). In multivariate analysis restricted to COPD never-smokers, the following independent predictors of hospitalization were identified: atrial fibrillation (OR: 2.35; 95% CI: 1.37–3.93), bronchiectasis (OR: 1.91; 95% CI: 1.08–3.28), and lower lung function measured by FVC (OR: 0.64; 95% CI: 0.45–0.89) and FEV1/FVC ratio (OR: 0.64; 95% CI: 0.45–0.89). Female gender was associated with a lower risk (OR: 0.44; 95% CI: 0.21–0.88). The predictive model demonstrated moderate discrimination (AUC = 0.71). Conclusions: COPD-NS patients represent a large proportion of the COPD population and present distinct clinical features. Although the incidence of severe exacerbation is similar to that of smokers/ex-smokers, risk factors such as atrial fibrillation and bronchiectasis have a stronger impact in this subgroup. Early identification of these factors may help guide more targeted clinical management strategies. Full article

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18 pages, 302 KB

Open AccessArticle

Association Between Sleep, Beliefs About Sleep, and Executive Functioning in a College Student Sample: The Moderating Role of Dysfunctional Beliefs

by Kate Schneider, Gillian Falletta and D. Erik Everhart

Healthcare 2025, 13(18), 2373; https://doi.org/10.3390/healthcare13182373 - 22 Sep 2025

Viewed by 539

Abstract

Background/Objectives: Sleep is integral to cognitive functioning, yet many college students experience poor sleep, often influenced by dysfunctional beliefs about sleep. Dysfunctional beliefs can exacerbate sleep issues and negatively impact executive functioning (EF). Distinct EF facets, including inhibition, working memory, and cognitive flexibility, [...] Read more.

Background/Objectives: Sleep is integral to cognitive functioning, yet many college students experience poor sleep, often influenced by dysfunctional beliefs about sleep. Dysfunctional beliefs can exacerbate sleep issues and negatively impact executive functioning (EF). Distinct EF facets, including inhibition, working memory, and cognitive flexibility, may differ in their sensitivity to sleep disruptions. While research suggests links between sleep and EF, less is known about how sleep-related beliefs may moderate this relationship and how sleep can affect the various EF facets. Utilizing an undergraduate population, this study examined how sleep quality/quantity affects the different EF facets, how this relationship differs between subjective and objective measurements, and whether dysfunctional beliefs about sleep moderate the relationship. Methods: Undergraduate students (N = 212, ages 18–23) completed self-report measures assessing dysfunctional beliefs about sleep (DBAS-16), sleep quality (ISI), and sleep quantity (self-reported sleep duration). Objective EF was measured using computerized CNS Vital Signs tasks targeting inhibition (Stroop Test), working memory (4-Part Continuous Performance Test), and cognitive flexibility (Shifting Attention). Subjective EF was measured using individual subscales on the Behavioral Rating Inventory of Executive Functioning—Adult Version (BRIEF-A). Results: Moderation analyses were conducted via linear regression. When measured objectively, neither sleep quantity nor insomnia severity (sleep quality) significantly affected any EF facets, and dysfunctional beliefs about sleep did not have any significant moderation effect. When measured subjectively, insomnia severity (sleep quality), but not sleep quantity, significantly predicted inhibition and cognitive flexibility; in contrast, neither predictor significantly predicted working memory. Regarding specific predictors, dysfunctional sleep beliefs were found to exert significant effect over all three facets; this effect was diminished when insomnia severity was included in the model. Regarding moderation, dysfunctional beliefs about sleep moderated the relationship between sleep quantity and all three EF facets. Conclusions: The impact of sleep quality, sleep quantity, and dysfunctional beliefs about sleep varies depending on whether the facets of EF are measured subjectively or objectively. Dysfunctional beliefs about sleep may exacerbate the perceived effect of short sleep duration on daytime cognitive functioning. In addition, insomnia severity may account for the effects of dysfunctional sleep beliefs on perceived inhibitory control and cognitive flexibility; however, working memory may be more resistant to the effects of sleep disturbances and dysfunctional sleep beliefs. Clinical implications of these results and future directions are discussed. Full article

(This article belongs to the Special Issue Recent Advances in Sleep Disorder)

13 pages, 217 KB

Open AccessArticle

Impact of COVID-19 on A1c Management and Telehealth Use Among a Type 2 Diabetes Mellitus Population in the Outpatient Setting

by Megan Jodray, Annesha White, Kimberly G. Fulda, Haley McKeefer, Fan Zhang, Chinemerem Opara and Yan Xiao

Healthcare 2025, 13(18), 2372; https://doi.org/10.3390/healthcare13182372 - 22 Sep 2025

Viewed by 399

Abstract

Background: The COVID-19 pandemic disrupted routine healthcare delivery, raising concerns about chronic disease management, particularly for individuals with type 2 diabetes mellitus (T2DM). This study evaluated the pandemic’s impact on glycemic control and telehealth utilization in an underserved outpatient population. Methods: A retrospective [...] Read more.

Background: The COVID-19 pandemic disrupted routine healthcare delivery, raising concerns about chronic disease management, particularly for individuals with type 2 diabetes mellitus (T2DM). This study evaluated the pandemic’s impact on glycemic control and telehealth utilization in an underserved outpatient population. Methods: A retrospective cohort analysis used de-identified electronic health record and claims data from a family medicine clinic in central Texas. The study included 387 adults with T2DM who had at least one A1c measurement in both the pre-pandemic period (1 March 2019–13 March 2020) and COVID-19 era (14 March 2020–31 March 2021). Outcomes included A1c control (<8.0%), prescription trends, and telehealth use. A case series examined individual-level patterns. Results: A significantly higher percentage of patients achieved A1c control during the COVID-19 era (75.2%) compared to the pre-pandemic period (68.7%, p < 0.05), despite a decline in prescriptions for diabetes medications and supplies. Telehealth visits increased substantially. Patients who maintained or improved glycemic control often had uninterrupted access to medications and telehealth. Conclusion: This study is novel in its focus on a safety-net outpatient clinic serving a predominantly low-income, diverse population in central Texas, an underserved group often underrepresented in diabetes research. By combining a retrospective cohort analysis with a descriptive case series, the study offers both population-level trends and individual-level insights into how medication access and telehealth engagement influenced glycemic control during the pandemic. These findings highlight the potential of telehealth to support diabetes management during healthcare disruptions and underscore the importance of maintaining medication access in vulnerable populations. Full article

(This article belongs to the Collection COVID-19: Impact on Public Health and Healthcare)

14 pages, 1413 KB

Open AccessArticle

Inflammatory Profile and Risk of Post-Intervention Infection in Relation to Myocardial Necrosis Markers

by Alexandra Manuela Buzle, Larisa Renata Pantea-Roșan, Mădălina Ioana Moisi, Priscilla Matache, Marc Cristian Ghitea, Evelin Claudia Ghitea, Maria Flavia Gîtea, Timea Claudia Ghitea and Mircea Ioachim Popescu

Healthcare 2025, 13(18), 2371; https://doi.org/10.3390/healthcare13182371 - 21 Sep 2025

Viewed by 394

Abstract

Background: Post-procedural infection worsens outcomes in acute coronary syndrome (ACS). High-sensitivity cardiac troponin (hs-cTn) reflects myocardial injury, but its utility for infection risk prediction after percutaneous coronary intervention (PCI) is uncertain. Objective: This study aimed to evaluate whether high-sensitivity troponin (hs-cTn) levels are [...] Read more.

Background: Post-procedural infection worsens outcomes in acute coronary syndrome (ACS). High-sensitivity cardiac troponin (hs-cTn) reflects myocardial injury, but its utility for infection risk prediction after percutaneous coronary intervention (PCI) is uncertain. Objective: This study aimed to evaluate whether high-sensitivity troponin (hs-cTn) levels are associated with the risk of infection and systemic inflammation. Methods: We performed an exploratory pilot study of consecutive ACS patients undergoing PCI (n = 181) at a tertiary interventional cardiology unit in Romania. Herein, hs-cTn was measured at 24- and 48-h post-PCI. The primary outcome was in-hospital infection (clinical and/or microbiological documentation), with the acknowledgment that nearly half were clinically diagnosed without microbiological confirmation. We assessed discrimination for hs-cTn48h using ROC analysis and explored associations with systemic markers (CRP, ESR, and leukocytes) and NT-proBNP using Spearman correlations. Results: Infections occurred in 9/181 patients (5.0%; 95% CI, 2.6–9.2). Notably, hs-cTn48h showed AUC = 0.49 (approx. 95% CI, 0.30–0.68) for infection discrimination. Correlations between hs-cTn48h and inflammatory markers were weak and non-significant (CRP ρ = 0.126, p = 0.091; ESR ρ = 0.119, p = 0.111; fibrinogen ρ = 0.134, p = 0.073), whereas hs-cTn48h correlated modestly with NT-proBNP (ρ = 0.232, p = 0.002). Conclusions: In this cohort, hs-cTn48h did not predict in-hospital infection after PCI in ACS. These negative findings highlight that troponin should be interpreted primarily as a marker of myocardial necrosis, not infectious risk. Larger multicenter studies with microbiological adjudication and broader biomarker panels are warranted. Full article

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23 pages, 650 KB

Open AccessSystematic Review

Understanding the Relationship Between Alcohol Consumption and HIV Risk Behaviors in U.S. Adolescents: A Systematic Review of Youth Risk Behavior Survey Findings (2005–2021)

by Shahin Davoudpour, Madeline Kerr and Gregory L. Phillips II

Healthcare 2025, 13(18), 2370; https://doi.org/10.3390/healthcare13182370 - 21 Sep 2025

Viewed by 537

Abstract

Background/Objectives: Alcohol use is a significant public health concern for adolescents, not only for its direct health impacts but also for its association with other health risk behaviors. In particular, alcohol use has been linked to sexual behaviors that may increase the [...] Read more.

Background/Objectives: Alcohol use is a significant public health concern for adolescents, not only for its direct health impacts but also for its association with other health risk behaviors. In particular, alcohol use has been linked to sexual behaviors that may increase the risk of HIV transmission. This systematic review aims to provide a deeper understanding of the relationships between various alcohol- and HIV-related risk behaviors among adolescents by synthesizing existing literature that exclusively uses Youth Risk Behavior Survey (YRBS) data. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted in PubMed, Web of Science, and PsycINFO. Eligible studies were peer-reviewed, published in English, and analyzed associations between alcohol use (age at first drink, alcohol use, binge drinking) and HIV risk behaviors (number of sexual partners, condom use, HIV testing) using YRBS data from the 2005–2021 collection years. Two authors independently screened 1133 records for eligibility, with 17 studies included in the final review. Results: The included studies consistently found a significant positive association between the frequency of alcohol use and binge drinking and a greater number of sexual partners. However, the evidence for an association between alcohol use and condom non-use was mixed. Limited evidence suggests that age of first alcohol use is not correlated with condom non-use. A key finding was the wide variation in study methodology, including the use of lifetime versus recent and dichotomized versus ordinal measures. Additionally, few studies were guided by a theoretical framework. Conclusions: The findings support a consistent link between alcohol use and having a greater number of sexual partners but highlight mixed evidence regarding condom use and little evidence for an association with HIV testing. This review demonstrates a need for more nuanced, theory-driven analyses that better utilize the multidimensional data available in the YRBS to capture the complex nature of risk behaviors. Full article

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22 pages, 6026 KB

Open AccessArticle

Spatio-Temporal Modelling and Forecasting of the Prolonged Measles Outbreak in Romania: Insights and Challenges

by Valerian-Ionuț Stoian, Aurora Stănescu, Mihaela Debita, Mariana Daniela Ignat, Raisa Eloise Barbu, Mădălina Nicoleta Matei, Alexia Anastasia Ștefania Baltă, Valentin Bulza, Liliana Baroiu and Cătălin Pleșea Condratovici

Healthcare 2025, 13(18), 2364; https://doi.org/10.3390/healthcare13182364 - 21 Sep 2025

Viewed by 605

Abstract

Background/Objectives: Measles is a highly contagious viral disease that continues to have a profound effect on morbidity in Romania. Identifying temporal and spatial trends in how the disease spreads among the country’s counties and regions, both in the same disease generation as well [...] Read more.

Background/Objectives: Measles is a highly contagious viral disease that continues to have a profound effect on morbidity in Romania. Identifying temporal and spatial trends in how the disease spreads among the country’s counties and regions, both in the same disease generation as well as one generation apart (2-week case lag), aided by forecasting tools, could provide valuable insights into tailoring public health interventions. Methods: A big data analysis has been performed on notified measles cases from January 2020 to December 2024 using Python v3.13 grouping cases based on location (using the Nomenclature of territorial units for statistics) and time of the onset of the disease. Results: Feedback loops among both counties and macroregions have been identified (for example Centru-Brașov and București-Ilfov with a correlation factor of 0.77) while monthly forecasting for 2025 and 2026, explored using both the SARIMA and the Holt-Winters models (MAE 1616.74 and 1281.99, respectively), shows the measles might continue to be a burden, with the Holt–Winters models exhibiting slightly more reliable monthly forecast data nationwide, helping to define a solid basis for future predictions and decisions. Conclusions: The spatial feedback loops, both interregional or within the same region, coupled with the trend of lowering vaccination rates, contribute to the persistent emergence of new measles cases which might continue throughout 2025 and 2026 based on the forecasting, distinct from previous outbreaks which followed a specific cadence. Full article

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25 pages, 1022 KB

Open AccessArticle

From Research to Practice: Implementing an Evidence-Based Intervention for Nurse Well-Being in a Healthcare System

by Amanda K. Bailey, Hong Tao and Amanda T. Sawyer

Healthcare 2025, 13(18), 2369; https://doi.org/10.3390/healthcare13182369 - 20 Sep 2025

Viewed by 1381

Abstract

Background: In response to the high prevalence of burnout in nursing, a hospital research team developed, studied, and implemented RISE (Resilience, Insight, Self-Compassion, Empowerment), a novel psychoeducational group program designed to reduce distress and promote well-being among professional caregivers, specifically nurses and nurse [...] Read more.

Background: In response to the high prevalence of burnout in nursing, a hospital research team developed, studied, and implemented RISE (Resilience, Insight, Self-Compassion, Empowerment), a novel psychoeducational group program designed to reduce distress and promote well-being among professional caregivers, specifically nurses and nurse leaders. Pilot studies and randomized controlled trials showed positive results, and thus, the program was operationalized. Methods: This quality improvement/quality assurance (QI/QA) project involved scaling the program and gathering data to evaluate implementation and impact on well-being indicators. The intervention involves structured weekly (8–9 weeks) 90-min group sessions integrating mindfulness, cognitive-behavioral techniques, and acceptance and commitment therapy. Eight licensed mental health providers were trained and delivered the program. Implementation outcomes included adoption/stakeholder engagement, fidelity, provider satisfaction, participant engagement, and sustainability. Participant outcomes were measured through validated scales and participant feedback forms. The implementation process was examined at the participant, provider, and organizational levels to identify barriers and enabling factors. Results: The program was implemented in seven acute care hospitals. From January 2023 to December 2024, 160 participants completed the program. Effective implementation strategies included intensive training and supervision of qualified providers, multi-departmental collaborations, and rigorous fidelity monitoring. Quality improvement processes addressed challenges such as early attrition and administrative burden. Evaluation data from pre- and post-intervention surveys demonstrated statistically significant improvements in psychological outcomes, with high satisfaction reported by both participants and providers. Conclusion: The findings support the effective implementation of the program as part of a broader organizational strategy to address nurse burnout and workforce mental health. Lessons, implications, and future directions for healthcare leaders are discussed. Full article

(This article belongs to the Special Issue Promoting the Health of Caregivers: Addressing Physical, Psychosocial, and Spiritual Well-Being Across Acute and Chronic Care Settings)

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15 pages, 267 KB

Open AccessArticle

Factors Affecting Return to Work of Patients with Chronic Coronary Syndrome: A Prospective Study

by Corina Oancea, Despina Mihaela Gherman, Rodica Simona Capraru, Sorina Maria Aurelian, Mirela Maria Nedelescu and Florina Georgeta Popescu

Healthcare 2025, 13(18), 2368; https://doi.org/10.3390/healthcare13182368 - 20 Sep 2025

Viewed by 491

Abstract

Background/Objectives: Return to work is an important goal of cardiac rehabilitation, yet individuals recovering from cardiovascular disease often face significant challenges in achieving it. As a result, a significant proportion of individuals with coronary artery disease experience work disability, negatively impacting both [...] Read more.

Background/Objectives: Return to work is an important goal of cardiac rehabilitation, yet individuals recovering from cardiovascular disease often face significant challenges in achieving it. As a result, a significant proportion of individuals with coronary artery disease experience work disability, negatively impacting both their economic well-being and quality of life while imposing a substantial financial burden on society. This less-studied issue is often treated as a secondary outcome in research, resulting in return to work findings that are frequently underreported. As such, this study aimed to identify the factors associated with adequate levels of functional capacity enabling the engagement in professional work and to develop a model for predicting the potential return to work of patients with coronary artery disease. Methods: During 2024, we enrolled 250 consecutive patients with chronic coronary syndrome less than 65 years of age who were referred to the National Institute for Medical Assessment and Work Capacity Rehabilitation (INEMRCM) for medical evaluation to establish eligibility-to-work disability benefits. Patients underwent a revascularization procedure either using PTCA or CABG, with a few having had no revascularization until the moment of assessment. Detailed demographic, socioeconomic, and clinical data were collected via interviews. Logistic regression was used to develop a multivariable model for predicting return to work. Results: Six months after discharge from the INEMRCM, around 20% of participants had returned to work. A better functional status was determinant for individuals’ re-employment (p = 0.026) along with an absence of cardiovascular comorbidities (p = 0.045) and holding a higher-skilled occupation (p = 0.037). The multivariate analysis identified professional specialization and the absence of cardiovascular comorbidities as the strongest predictors of return to work. Conclusions: Cardiac patients with coexisting cardiovascular conditions engaged in less-specialized types of work tend to experience poorer return to work outcomes. As such, individuals in this category should be carefully assessed and prioritized in the development of targeted rehabilitation programs. Full article

7 pages, 176 KB

Open AccessCommentary

Commentary on Sources of Attention-Deficit/Hyperactivity Overdiagnosis Among U.S. Adults

by Samuel R. Weber

Healthcare 2025, 13(18), 2367; https://doi.org/10.3390/healthcare13182367 - 20 Sep 2025

Viewed by 873

Abstract

Diagnosis of adult attention-deficit/hyperactivity disorder (ADHD) has risen precipitously in recent years in the United States. This has been accompanied by a corresponding increase in rates of stimulant medication prescriptions, resulting in prescription drug shortages. These data raise concern that adult ADHD may [...] Read more.

Diagnosis of adult attention-deficit/hyperactivity disorder (ADHD) has risen precipitously in recent years in the United States. This has been accompanied by a corresponding increase in rates of stimulant medication prescriptions, resulting in prescription drug shortages. These data raise concern that adult ADHD may be overdiagnosed. This article examines factors that can contribute to adult ADHD overdiagnosis. Sources of overdiagnosis include lack of adherence to DSM-5-TR diagnostic criteria, poor diagnostic practices, malingering, electronic distractions, cultural shifts in how the term “ADHD” has been used, and other health conditions that impair attention. More rigorous diagnostic practices are necessary to ensure appropriate diagnoses and treatments are offered. Adopting such practices will help optimize patient outcomes. Such practices include ruling out other conditions that impair attention, taking a careful developmental history, gathering information from collateral sources, and evaluating the patient for functional impairments. Full article

27 pages, 1256 KB

Open AccessArticle

Perceptions of Stress, Well-Being, and Intervention Preferences Among Parents Affected by Major Stressors

by Nada M. Goodrum, Julie K. Nguyen, Diamonde McCollum, E. Rebekah Siceloff, Brianna Tennie, Sara delMas and Ronald J. Prinz

Healthcare 2025, 13(18), 2366; https://doi.org/10.3390/healthcare13182366 - 20 Sep 2025

Viewed by 503

Abstract

Background/Objectives: Children’s social–emotional difficulties and unhealthy lifestyle behaviors co-occur but are rarely addressed concurrently in parent-based interventions. These problems are exacerbated by family stressors (e.g., parental trauma, mental health, substance misuse, illness, financial strain, racism), which further compound existing health and healthcare [...] Read more.

Background/Objectives: Children’s social–emotional difficulties and unhealthy lifestyle behaviors co-occur but are rarely addressed concurrently in parent-based interventions. These problems are exacerbated by family stressors (e.g., parental trauma, mental health, substance misuse, illness, financial strain, racism), which further compound existing health and healthcare inequities for families experiencing marginalization who are more likely to face major stressors. Yet, most parent-based interventions do not sufficiently address parents’ own stress and self-regulation. To inform prevention efforts to address these gaps, this mixed methods formative needs assessment explored strengths, challenges, and intervention preferences of parents dealing with major stressors, informing parent-based prevention to improve child social–emotional and physical health. Method: A sociodemographically diverse sample of parents/caregivers (N = 46) who had a child aged 3–9 years and ≥ two major stressors completed surveys assessing child well-being, parenting, parental stress, self-regulation, and intervention preferences. A subsample (n = 24) completed qualitative interviews further exploring these areas. Results: Parents expressed high interest in programming on emotion regulation, mindfulness, dealing with trauma, and reducing stress while strengthening children’s social–emotional and physical health. Conclusions: Results underscore the need to address caregivers’ own emotion-related skills to promote children’s well-being. Findings inform implementation and evaluation of a preventive program to improve child health, promote positive parenting, and address parental stress through self-regulation and coping. By aligning with community needs and preferences, parenting interventions that simultaneously address parental well-being and stress may be a promising avenue for improving equitable access to and quality of healthcare for families experiencing marginalization and stress. Full article

(This article belongs to the Special Issue Increasing Access to and Quality of Healthcare Services to Promote Community Health Equity)

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15 pages, 1242 KB

Open AccessArticle

Multidisciplinary Professionals’ Perceptions of Home-Visit Oral Care for Older Adults in Integrated Community Care: A Focus Group Interview Study

by Se-Rim Jo, Bo-Ram Shin and Jong-Hwa Jang

Healthcare 2025, 13(18), 2365; https://doi.org/10.3390/healthcare13182365 - 20 Sep 2025

Viewed by 423

Abstract

Background/Objectives: With the acceleration of population ageing the need for integrated support in healthcare and caregiving is increasing, and the societal demand for improved service quality is also increasing. This study aims to explore how multidisciplinary professionals perceive the implementation of home-visit [...] Read more.

Background/Objectives: With the acceleration of population ageing the need for integrated support in healthcare and caregiving is increasing, and the societal demand for improved service quality is also increasing. This study aims to explore how multidisciplinary professionals perceive the implementation of home-visit oral care (HVOC) within the Integrated Community Care in Older Adults model, in order to inform the design of future integrated oral health programs. Methods: The study participants comprised 16 individuals: eight dental hygienists with experience in HVOC and eight multidisciplinary healthcare providers. Focus group interviews were conducted with these participants, and the data were analysed using Colaizzi’s phenomenological method to derive key themes and categories. Results: The analysis revealed four main thematic categories: (1) cognitive aspects (understanding of geriatric diseases and families); (2) technical aspects (effective communication and competence in oral care); (3) value-based aspects (empathy, patient-centredness, professional pride); (4) multidisciplinary organisational efforts (establishing interprofessional collaboration systems and integrated platforms). Conclusions: HVOC services provided by dental hygienists were found to promote oral health among older adults. To ensure the sustainability and effectiveness of such services, a customised integrated care model based on multidisciplinary collaboration should be established. Full article

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

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27 pages, 829 KB

Open AccessReview

Psychiatric Risk Governance Across Jurisdictions: A Comparative Analysis of Involuntary Treatment, Community Treatment Orders, and Forensic Mental Health Services

by Matteo Lippi, Laura Leondina Campanozzi, Giuseppe D’Andrea, Donato Morena, Francesca Orsini, Felice Marco Damato, Giuseppe Fanelli, Yasin Hasan Balcioglu, Howard Ryland, Thomas Fovet, Birgit Völlm, Javier Vicente-Alba, Charles L. Scott, Paola Frati, Vittoradolfo Tambone and Raffaella Rinaldi

Healthcare 2025, 13(18), 2363; https://doi.org/10.3390/healthcare13182363 - 20 Sep 2025

Viewed by 845

Abstract

Background: This article presents an international comparative review of involuntary psychiatric care, Community Treatment Orders (CTOs), and forensic mental health services, with operational implications for Italy. Italy has a community-based model inspired by the “Basaglia Law” (Law No. 180/1978), emphasizing deinstitutionalization and [...] Read more.

Background: This article presents an international comparative review of involuntary psychiatric care, Community Treatment Orders (CTOs), and forensic mental health services, with operational implications for Italy. Italy has a community-based model inspired by the “Basaglia Law” (Law No. 180/1978), emphasizing deinstitutionalization and continuity of care. Nevertheless, risk governance gaps persist for high-complexity patients, imposing a disproportionate legal and clinical burden on mental health professionals. This group includes individuals who refuse treatment despite meeting criteria for compulsory admission, patients at elevated risk with substantial management complexity, and offenders with a current or suspected psychiatric disorder. Methods: We conducted a comparative legal and policy review across seven jurisdictions (Italy, England and Wales (UK), France, Germany, Spain, the United States, and Canada) to map frameworks for involuntary treatment, forensic services, CTOs (or equivalents), and community-based risk management. We also extracted procedural safeguards, duration and renewal limits, and interfaces with forensic services. Results: CTOs are available in five of the seven jurisdictions (England and Wales, France, Spain, the United States, and Canada) but are absent in Italy and Germany. We propose a three-pillar framework: (1) enforceable outpatient measures, including CTOs; (2) Forensic Psychiatry Units within Local Health Authorities; and (3) oversight boards with judicial, clinical, and social representatives. These components aim to redistribute responsibility, ensure continuity of care, and provide proportional oversight within a least restrictive, graduated system. Conclusions: When narrowly targeted, time limited, and paired with robust safeguards and service-quality standards, CTOs can support adherence and continuity for patients who repeatedly disengage from care. For Italy, integrating this instrument within the three-pillar framework and under independent oversight could strengthen patient rights and public safety, reduce revolving-door admissions, and improve outcomes. Full article

(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)

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14 pages, 560 KB

Open AccessStudy Protocol

Using Participatory Action Research to Enhance Physical Education Interventions for Promoting Active Lifestyles in Schools: A Study Design and Protocol

by Jorge Lizandra, Alexandra Valencia-Peris, Roberto Ferriz and Carmen Peiró-Velert

Healthcare 2025, 13(18), 2362; https://doi.org/10.3390/healthcare13182362 - 19 Sep 2025

Viewed by 519

Abstract

Promoting active lifestyles among adolescents is essential due to their short-, medium-, and long-term contributions to young people’s holistic development and overall health. Beyond physical well-being, Physical Education foster physical activity, autonomy, social connectedness, motivation and emotional well-being, thus constituting a key dimension [...] Read more.

Promoting active lifestyles among adolescents is essential due to their short-, medium-, and long-term contributions to young people’s holistic development and overall health. Beyond physical well-being, Physical Education foster physical activity, autonomy, social connectedness, motivation and emotional well-being, thus constituting a key dimension of quality education. Background/Objectives: The “Estilos de Vida Activos (EVA)” project is a school-based intervention designed to foster adolescent agency and motivation in adopting active habits. Grounded in the salutogenic model, self-determination theory, and the health-based Physical Education pedagogical model, this protocol describes the design and implementation strategies of a participatory intervention in secondary schools. Methods: A variety of research methods will be used to collect quantitative and qualitative data before, during, and after the intervention. Validated questionnaires will assess active commuting, socioeconomic status, satisfaction of basic psychological needs, motivation, levels and intention to engage in physical activity. Qualitative data include interviews with teachers, Photovoice sessions with students, observation notes, and programme materials. Intervention: The EVA intervention is collaboratively developed by students, teachers, and researchers using participatory action research. It includes needs analysis, participatory activities, and co-design of tailored physical activity programmes. The intervention is described using the Template for Intervention Description and Replication checklist (TIDieR) to enhance transparency and replicability. Conclusions: This protocol presents a theoretically grounded and participatory approach to school-based health promotion. By integrating educational and collaborative strategies, it offers a replicable model that promotes adolescent active lifestyles, from contextual relevance, and pedagogical coherence, serving as a guide for inclusive and sustainable interventions in school settings. Full article

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

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29 pages, 1452 KB

Open AccessArticle

Down the Digital Delta: Health Information Inequities Among Rural Mississippi Caregivers

by Danielle K. Nadorff, Sujan Anreddy, Katerina Sergi, Zaccheus J. Ahonle, Colleen Stouffer, Tockie Hemphill and David R. Buys

Healthcare 2025, 13(18), 2361; https://doi.org/10.3390/healthcare13182361 - 19 Sep 2025

Viewed by 404

Abstract

Background/Objectives: As healthcare increasingly utilizes digital delivery systems, equitable access and engagement are critical, particularly for caregivers of older adults in rural regions. This study examines how education levels and geographic rurality influence health information-seeking in Mississippi, a state with persistent structural [...] Read more.

Background/Objectives: As healthcare increasingly utilizes digital delivery systems, equitable access and engagement are critical, particularly for caregivers of older adults in rural regions. This study examines how education levels and geographic rurality influence health information-seeking in Mississippi, a state with persistent structural inequities, through the theoretical lenses of Digital Divide Theory and Theory of Planned Behavior. Methods: A statewide survey was conducted among caregivers in Mississippi (N = 452) who support adults aged 50+. The survey assessed rurality level, educational attainment, attitudes toward various health information sources, perceived digital accessibility, and reported challenges in obtaining necessary health guidance. Results: Findings challenged conventional assumptions regarding rural digital engagement. Rural caregivers reported higher trust in both internet and interpersonal health information sources. Rurality did not significantly predict internet use or reported difficulty finding information. However, a significant interaction between education and rurality revealed an “Outcome Divide”: while higher education correlated with more positive attitudes toward online health information in urban areas, this association weakened and reversed in highly rural contexts. Conclusions: These results underscore the need for strategies beyond merely improving access to bridge digital health equity gaps. Policy and interventions must address contextual barriers, such as digital health literacy and relevance, limiting the effectiveness of digital tools, even when internet access is available. Promoting digital health literacy, integrating trusted local interpersonal networks, and adapting educational initiatives to rural realities are essential for advancing equitable and effective digital health engagement. Full article

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14 pages, 397 KB

Open AccessArticle

Antibiotic Prescribing Patterns of Family Medicine Pediatric Visits: A Pharmacoepidemiological Study

by Reem S. AlOmar, Nouf A. AlShamlan, Ahmed M. Al-Turki, Ahmed A. Al Yateem, Abdulrahman A. Al-Abdulazeem, Najla A. Alhamed, Sameerah Motabgani, Assim M. AlAbdulkader, Abdulelah H. Almansour and Malak A. Al Shammari

Healthcare 2025, 13(18), 2360; https://doi.org/10.3390/healthcare13182360 - 19 Sep 2025

Viewed by 430

Abstract

Background/Objectives: Understanding the medication prescribing patterns in pediatric primary care is essential for informing policy and clinical practice. In the Kingdom of Saudi Arabia (KSA), and following the 2018 antibiotic restriction policy, limited data exist on the patterns, types, and regimens of [...] Read more.

Background/Objectives: Understanding the medication prescribing patterns in pediatric primary care is essential for informing policy and clinical practice. In the Kingdom of Saudi Arabia (KSA), and following the 2018 antibiotic restriction policy, limited data exist on the patterns, types, and regimens of antibiotics prescribed during routine family medicine visits for children. This pharmacoepidemiological study aimed to describe the antibiotic prescribing patterns in a university-affiliated model primary healthcare center. Methods: A retrospective chart review was conducted for all the pediatric visits (<14 years) to general family medicine clinics between January and December 2024. Demographic characteristics, visit type, diagnosis, and antibiotic prescription details such as medication class, route, frequency, and duration were extracted from electronic medical records and analyzed descriptively. Results: Among the 2036 pediatric visits, 705 (34.63%) resulted in at least one prescription. Of these, 87 visits (12.34%) included an antibiotic. The most frequently prescribed antibiotic classes were nitroimidazoles (39.29%), penicillins (36.90%), and macrolides (10.71%). Penicillins were typically prescribed for 7 days twice daily as suspensions. Among the non-antibiotic prescriptions, vaccines, nutritional supplements, and analgesics were the most common. Follow-up consultations accounted for 34.09% of all the visits. Conclusions: A lower proportion of antibiotic prescriptions was found when compared to regional and international reports, which may reflect the impact of the antibiotic restriction policy in the country. The findings suggest a shift toward more cautious prescribing in primary care and align with the national efforts to regulate antimicrobial use. Ongoing surveillance of the prescribing trends is essential to evaluate the long-term effectiveness of these measures. Full article

(This article belongs to the Section Public Health and Preventive Medicine)

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17 pages, 543 KB

Open AccessReview

The Application of Biologic and Synthetic Bone Grafts in Scoliosis Surgery: A Scoping Review of Emerging Technologies

by Nikolaos Trygonis, Ioannis I. Daskalakis and Christos Tsagkaris

Healthcare 2025, 13(18), 2359; https://doi.org/10.3390/healthcare13182359 - 19 Sep 2025

Viewed by 607

Abstract

Background: Spinal deformity correction surgery, particularly in scoliosis, often necessitates long fusion constructs and complex osteotomies that create significant structural bone defects. These defects threaten the integrity of spinal fusion, potentially compromising surgical outcomes. Bone grafting remains the cornerstone of addressing these [...] Read more.

Background: Spinal deformity correction surgery, particularly in scoliosis, often necessitates long fusion constructs and complex osteotomies that create significant structural bone defects. These defects threaten the integrity of spinal fusion, potentially compromising surgical outcomes. Bone grafting remains the cornerstone of addressing these defects, traditionally relying on autologous bone. However, limitations such as donor site morbidity and insufficient graft volume have made urgent the development and adoption of biologic substitutes and synthetic alternatives. Additionally, innovations in three-dimensional (3D) printing offer emerging solutions for graft customization and improved osseointegration. Objective: This scoping review maps the evidence of the effectiveness of the use of biologic and synthetic bone grafts in scoliosis surgery. It focusses on the role of novel technologies, particularly osteobiologics in combination with 3D-printed scaffolds, in enhancing graft performance and surgical outcomes. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library to identify studies published within the last 15 years. Inclusion criteria focused on clinical and preclinical research involving biologic grafts (e.g., allografts, demineralized bone matrix-DBM, bone morphogenetic proteins-BMPs), synthetic substitutes (e.g., ceramics, polymers), and 3D-printed grafts in the context of scoliosis surgery. Data were extracted on graft type, clinical application, outcome measures, and complications. The review followed PRISMA-ScR guidelines and employed the Arksey and O’Malley methodological framework. Results: The included studies revealed diverse grafting strategies across pediatric and adult populations, with varying degrees of fusion success, incorporation rates, and complication profiles. It also included some anime studies. Emerging 3D technologies demonstrated promising preliminary results but require further validation. Conclusions: Osteobiologic and synthetic bone grafts, including those enhanced with 3D technologies, represent a growing area of interest in scoliosis surgery. Despite promising outcomes, more high-quality comparative clinical studies are needed to guide clinical decision-making and standardize practice. Full article

(This article belongs to the Special Issue Scoliosis Deformity—Etiological Aspects, Management and Rehabilitation)

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16 pages, 958 KB

Open AccessArticle

Access to Services Within the Entrusted Budgets in Primary Healthcare in Poland from 2022 to 2025

by Magdalena Mrożek-Gąsiorowska

Healthcare 2025, 13(18), 2358; https://doi.org/10.3390/healthcare13182358 - 19 Sep 2025

Viewed by 894

Abstract

Background: Entrusted budgets were introduced as part of the primary healthcare (PHC) system in Poland in July 2022. This initiative aimed to increase the role of PHC and enhance the accessibility of diagnostic services and specialist consultations/advice for patients. Methods: Data [...] Read more.

Background: Entrusted budgets were introduced as part of the primary healthcare (PHC) system in Poland in July 2022. This initiative aimed to increase the role of PHC and enhance the accessibility of diagnostic services and specialist consultations/advice for patients. Methods: Data from the National Health Fund (NHF) databases regarding contracts between the NHF and healthcare providers in the field of PHC from 2022 to 2025 were analyzed. The share of contracts with entrusted budgets in the total number of PHC physician contracts was estimated in individual voivodships, as well as in counties, using the example of the Małopolskie Voivodship. It was assessed whether there were significant differences between voivodships and counties as well as the pace of implementation of the new solution. Results: Only 43.1% of PHC physicians have signed contracts with the NHF for coordinated care services for 2025, with this percentage varying significantly between voivodships, ranging from 24.8% in Opolskie Voivodship to 66.3% in Lubelskie Voivodship (p < 0.0001). For the vast majority of voivodships, no statistically significant increase in the share of service providers was demonstrated in the period from 2022 to 2025. Access to services between counties is also highly varied (from 10.0% to 76.5%), although the differences were not statistically significant (p = 0.217). Conclusions: The results indicate regional and local inequalities in access to services. It is necessary to implement incentive mechanisms within the contracting of health services between the NHF and providers that will ensure equal access to PHC services within entrusted budgets for all patients. The range of available services should be equal regardless of at which PHC facility a patient is registered. The current regulations concerning entrusted budgets, including the voluntary involvement of service providers, are not sufficient. Full article

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18 pages, 2375 KB

Open AccessSystematic Review

Effectiveness of Arm Swing Exercise on Comprehensive Health Outcomes: A Systematic Review and Meta-Analysis

by Phatcharaphon Whaikid and Noppawan Piaseu

Healthcare 2025, 13(18), 2357; https://doi.org/10.3390/healthcare13182357 - 19 Sep 2025

Viewed by 678

Abstract

Background: Arm swing exercise (ASE) is a simple and accessible form of physical activity that has been reported to reduce disease risk and enhance overall health across various populations. In alignment with the World Health Organization’s recommendations for promoting physical activity, ASE requires [...] Read more.

Background: Arm swing exercise (ASE) is a simple and accessible form of physical activity that has been reported to reduce disease risk and enhance overall health across various populations. In alignment with the World Health Organization’s recommendations for promoting physical activity, ASE requires no specialized equipment or professional supervision. However, systematic evidence on its health benefits remains limited. Objective: This systematic review and meta-analysis aimed to assess the effects of ASE on body composition, glycemic control, cardiovascular health, and musculoskeletal outcomes. Methods: A comprehensive systematic search was conducted in four major databases, including PubMed, Embase, Scopus, and the Thai-Journal Citation Index Center, covering studies published from inception to October 2024. Articles published in both English and Thai were included. Two independent reviewers screened and selected eligible randomized controlled trials and quasi-experimental studies. Methodological quality was assessed using the JBI critical appraisal tool, and meta-analyses were performed using Stata software (version 18), presenting mean differences (MD) with 95% confidence intervals (CI). Results: Thirteen studies were included, comprising eight randomized controlled trials and five quasi-experimental studies, with intervention durations ranging from 5 to 24 weeks. The ASE significantly reduced waist circumference (MD = −4.76; 95% CI: −8.36 to −1.17; and p < 0.05), hemoglobin A1C (MD= −0.80%; 95% CI: −1.19 to −0.40; and p < 0.001), fasting blood glucose (MD = −17.62 mg/dL; 95% CI: −25.93 to −9.32; and p < 0.05), and diastolic blood pressure (MD = −9.74 mmHg; 95% CI: −17.84 to −1.65; and p < 0.05). The ASE showed a non-significant reduction in systolic blood pressure (MD = −3.65 mmHg; 95% CI: −10.37 to 3.08; and p = 0.29). Additionally, the ASE significantly increased high-density lipoprotein cholesterol (HDL-C) levels (MD = 6.96 mg/dL; 95% CI: 2.20 to 11.71; and p < 0.05). Conclusions: This study, representing the first systematic review and meta-analysis focusing on ASE, demonstrates that ASE is an effective intervention for improving body composition, glycemic control, and cardiovascular health. Given its simplicity, low cost, and broad applicability, ASE could serve as a practical public health strategy to promote health and prevent chronic diseases across diverse populations. Full article

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11 pages, 253 KB

Open AccessArticle

Suicidal Ideation, Depression, Anxiety, Impulsivity, Self-Esteem, Emotional Regulation, Child Trauma and Hopelessness in Korean Military Soldiers

by Yeon Seo Lee, Youngil Lee and Myung Ho Lim

Healthcare 2025, 13(18), 2356; https://doi.org/10.3390/healthcare13182356 - 18 Sep 2025

Viewed by 611

Abstract

Background/Objectives: Suicide is the leading cause of death among South Korean military soldiers, accounting for more than 70% of all deaths. This issue is particularly relevant in the military context due to the nature of living in groups in a controlled environment. [...] Read more.

Background/Objectives: Suicide is the leading cause of death among South Korean military soldiers, accounting for more than 70% of all deaths. This issue is particularly relevant in the military context due to the nature of living in groups in a controlled environment. This study was conducted active-duty south Korean male soldiers aged 18 to 28 who were performing mandatory military service for one year and six months. Additionally, it compares and analyzes the differences in suicidal ideation and risk factors between military soldiers and a comparison group consisting of males in their 20s without military experience. Methods: This study included 248 Korean soldiers and 292 general controls, totaling 540 participants. The research instruments used for evaluation included the Beck Scale of Suicide Ideation (BSI), the Childhood Trauma Questionnaire (CTQ-SF), the Perceived Stress Scale (PSS), the Difficulties in Emotion Regulation Scale (DERS-16), the Barratt Impulsiveness Scale Version 11 (BIS-11), the Rosenberg Self-Esteem Scale (RSES), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item scale (GAD-7), the UCLA Loneliness Scale (UCLAS), and the State-Beck Hopelessness Scale (S-BHS). Results: The results of this study showed that suicidal ideation, depression, anxiety, impulsivity, and self-esteem were significantly higher in the military group compared to the comparison group. Conversely, emotional dysregulation was considerably lower in the soldiers than in the comparison group. No significant differences were found in childhood trauma, stress, loneliness, and hopelessness between the two groups. Multiple regression analysis within the military group revealed that childhood trauma, hopelessness, and depression were major factors influencing suicidal ideation. Conclusions: These findings will help identify risk factors for suicide among soldiers and develop effective intervention strategies to prevent it. Full article

(This article belongs to the Special Issue Social Determinants of Health/Mental Health Among Youth and Young Adults)

13 pages, 337 KB

Open AccessArticle

Exploring the Social Network Structure of Dementia-Friendly Communities in Rural Taiwan: A Qualitative Study

by Hsien-Ting Pan, Shu-Ting Chang and Shofang Chang

Healthcare 2025, 13(18), 2355; https://doi.org/10.3390/healthcare13182355 - 18 Sep 2025

Viewed by 381

Abstract

Background/Objectives: The rising prevalence of dementia presents significant emotional, psychological, and economic challenges for families. Dementia-friendly communities (DFCs) aim to alleviate these burdens by fostering social inclusion and mutual support for people with dementia (PWD) and their caregivers. This study explores the [...] Read more.

Background/Objectives: The rising prevalence of dementia presents significant emotional, psychological, and economic challenges for families. Dementia-friendly communities (DFCs) aim to alleviate these burdens by fostering social inclusion and mutual support for people with dementia (PWD) and their caregivers. This study explores the social network structures within DFCs in rural Taiwan, utilizing social network theory as its framework. Methods: A qualitative design was employed, involving semi-structured interviews with eleven participants, including eight caregivers and three case managers. Data were analyzed using grounded theory. Results: The results indicate that the DFC social network is grounded in reciprocal relationships and mutual support between families, workplaces, and neighborhoods. Durability depends on stable relationships, sustained support systems, and the preservation of local culture. Cultural alignment and engagement reduce stigma and foster understanding, while diverse activities strengthen social bonds and participation. Conclusions: The study highlights the importance of government policy, infrastructure, and public awareness in sustaining dementia-friendly environments. The results offer valuable insights for enhancing community design and policy to better support PWD and their families. Full article

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