Healthcare

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Open AccessReview

Effectiveness of Wearable Technologies in Supporting Physical Activity and Metabolic Health in Adults with Type 2 Diabetes: A Systematic–Narrative Hybrid Review

by Alessandra Laffi, Michela Persiani, Alessandro Piras, Andrea Meoni and Milena Raffi

Healthcare 2025, 13(19), 2422; https://doi.org/10.3390/healthcare13192422 (registering DOI) - 24 Sep 2025

Abstract

Background: Physical activity is essential in the prevention and management of type 2 diabetes mellitus (T2D), yet adherence to recommended activity levels remains insufficient. Wearable electronic devices have emerged as tools to support physical activity through self-monitoring and enhanced user engagement. This [...] Read more.

Background: Physical activity is essential in the prevention and management of type 2 diabetes mellitus (T2D), yet adherence to recommended activity levels remains insufficient. Wearable electronic devices have emerged as tools to support physical activity through self-monitoring and enhanced user engagement. This review synthesizes current evidence on the effectiveness of wearable technologies in improving adherence to physical activity and promoting clinical and metabolic health in adults with T2D. Methods: The review was conducted using systematic search strategies in PubMed and Scopus. We included studies that involved the use of wearable devices to monitor physical activity for at least seven consecutive days. The reported outcomes were related to physical activity adherence or clinical–metabolic health. Thirty-two studies met the inclusion criteria and were analyzed in terms of study design, device type, intervention characteristics, and outcomes. Results: Wearable devices were used either for monitoring daily activity in free-living conditions or within structured, often supervised, interventions. Most studies reported increased physical activity, particularly in step count. Several studies showed improvements in blood pressure and lipid profile, while results for HbA1c and BMI were mixed. Structured interventions with behavioural support produced more consistent and clinically relevant outcomes than passive monitoring alone. Conclusions: Wearable technologies can support physical activity in adults with T2D, especially when integrated into structured behavioural programmes. From a clinical standpoint, they may serve as useful tools to enhance lifestyle adherence, particularly when combined with professional support. Their inclusion in care pathways could help personalize interventions and improve long-term self-management. Full article

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Open AccessArticle

by Lina Marcela Bernal Sandoval, Mónica Burgos García and Robinson Pacheco López

Healthcare 2025, 13(19), 2421; https://doi.org/10.3390/healthcare13192421 (registering DOI) - 24 Sep 2025

Abstract

Objectives: We aimed to determine the frequency and factors related to oropharyngeal dysphagia in adults in a health center in Colombia evaluated by videofluroscopy of swallowing. Methods: We reviewed the records of 144 patients evaluated through videofluroscopy of swallowing. In order [...] Read more.

Objectives: We aimed to determine the frequency and factors related to oropharyngeal dysphagia in adults in a health center in Colombia evaluated by videofluroscopy of swallowing. Methods: We reviewed the records of 144 patients evaluated through videofluroscopy of swallowing. In order to analyze the results, descriptive, bivariate statistical analysis, and multivariate regression were used. Results: This investigation revealed that 23.6% of adults had oropharyngeal dysphagia. Older adults had a higher percentage of occurrence, and the factors associated with this symptom were having a history of cerebral stroke and being medicated with anticholinergic drugs. Conclusions: These findings strongly suggest that older adults with other comorbidities have a high percentage of presenting oropharyngeal dysphagia. Further research is needed to characterize the entity in other populations. Full article

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Open AccessArticle

Neonatal Factors Associated with Mortality Among Preterm Infants Admitted to Neonatal Intensive Care in a Peruvian National Hospital

by Rosana S. Haro-Norabuena, Javier J. Gonzales-Carrillo and Miguel A. Arce-Huamani

Healthcare 2025, 13(19), 2420; https://doi.org/10.3390/healthcare13192420 (registering DOI) - 24 Sep 2025

Abstract

Background/Objectives: Preterm birth is a leading cause of neonatal mortality, especially in low- and middle-income countries. Despite advances in neonatal care, mortality among preterm infants in intensive care units remains high, and specific risk factors are not fully understood. This study aimed [...] Read more.

Background/Objectives: Preterm birth is a leading cause of neonatal mortality, especially in low- and middle-income countries. Despite advances in neonatal care, mortality among preterm infants in intensive care units remains high, and specific risk factors are not fully understood. This study aimed to identify neonatal factors associated with mortality among preterm infants admitted to the neonatal intensive care unit (NICU) of a Peruvian national hospital. Methods: An analytical cross-sectional study was conducted at Guillermo Almenara National Hospital in Lima, Peru, including all preterm neonates (<37 weeks gestational age) admitted to the NICU in 2022. Clinical and demographic data were extracted from medical records. Bivariate and multivariate logistic regression analyses identified independent associations with in-hospital mortality. Results: A total of 300 preterm neonates were included, with an in-hospital mortality rate of 15%. In adjusted analysis, extremely low birth weight (<1000 g) was the strongest predictor of mortality. Mild and severe depression in Apgar score at 1 min were associated with increased risk of death (adjusted OR: 12.08 and 6.18, respectively). Hypoglycemia was also independently associated with higher mortality (adjusted OR: 5.65). Conversely, perinatal asphyxia was linked to a lower risk of death in the multivariate model. Sex, mode of delivery, and other neonatal complications were not significant predictors after adjustment. Conclusions: Extremely low birth weight, abnormal Apgar scores at 1 min, and hypoglycemia are key determinants of mortality in preterm infants in intensive care. Early risk identification and focused management are essential to reducing preventable deaths in similar resource-limited settings. Full article

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Open AccessArticle

Evaluation of the Effectiveness of Basic Palliative Care Training for Primary Care Nurses in a Health Area in Spain: A Quasi-Experimental Study

by Isidro García-Salvador, Encarna Chisbert-Alapont, Amparo Antonaya Campos, Clara Hurtado Navarro, Silvia Fernández Peris, Luis Alberto Gómez Royuela, Paz Rodríguez Castellano and Jorge Casaña Mohedo

Healthcare 2025, 13(19), 2419; https://doi.org/10.3390/healthcare13192419 (registering DOI) - 24 Sep 2025

Abstract

Background/Objectives: The general training in palliative care (PC) offered does not meet the needs of nurses and does not usually impact their clinical practice. The aim of the present study is to analyze the efficacy of a Palliative Care training plan, created [...] Read more.

Background/Objectives: The general training in palliative care (PC) offered does not meet the needs of nurses and does not usually impact their clinical practice. The aim of the present study is to analyze the efficacy of a Palliative Care training plan, created and adapted to the specific needs of primary care nurses from the Department of Health Valencia, Doctor Peset. Methods: We executed the designed training plan offered by all the nurses in the department in five sessions lasting a total of 15 h through an active teaching methodology. A quasi-experimental pre-test/post-test study was conducted. The efficiency of the training provided was assessed through a self-administered, validated, anonymous questionnaire (INCUE instrument). Focus groups were conducted with the coordinators of the center to qualitatively assess the results and to propose lines of improvement. Results: The specific training provided to 85 nurses increased the application of PC in all areas of clinical practice (beginning of PC, communication skills, management of symptoms and care plans, legislation, bioethics at the end of life, and coping and loss). After the training, 88.8% passed the practical portion compared to 53.2% who did so previously. The area of lower impact was coping and loss or grief care. The coordinators perceived an improvement in palliative care, indicating the creation of a care protocol as a line of improvement. The percentage of nurses who felt sufficiently or very prepared to work with palliative patients practically doubled (from 23,5% to 42,4%). Conclusions: The directed training, based on the specific needs detected, was efficient and cost-effective. The methodology used had an impact on clinical practice. Full article

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

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Open AccessArticle

Adolescent Idiopathic Scoliosis in the Adult Patient: New Classification with a Treatment-Oriented Guideline

by Giovanni Viroli, Alberto Ruffilli, Matteo Traversari, Antonio Mazzotti, Marco Manzetti, Simone Ottavio Zielli, Alberto Arceri and Cesare Faldini

Healthcare 2025, 13(19), 2418; https://doi.org/10.3390/healthcare13192418 - 24 Sep 2025

Abstract

Background/Objectives: Adolescent Idiopathic Scoliosis persisting into adulthood (AAIS) presents progressive stiffening and degenerative changes that are not fully captured by existing classifications. This heterogeneity complicates clinical decision-making and surgical planning. The aim of this study was to propose a novel, treatment-oriented classification [...] Read more.

Background/Objectives: Adolescent Idiopathic Scoliosis persisting into adulthood (AAIS) presents progressive stiffening and degenerative changes that are not fully captured by existing classifications. This heterogeneity complicates clinical decision-making and surgical planning. The aim of this study was to propose a novel, treatment-oriented classification system for AAIS. Methods: A retrospective review was performed on patients with AAIS who underwent surgical correction between 2018 and 2022. Pre- and postoperative radiographs, CT scans, and MRI were analyzed to define curve characteristics and evaluate surgical outcomes. Subgroups were identified according to age and deformity features, and corresponding surgical strategies were outlined. Results: AAIS was stratified into Young Adult Idiopathic Scoliosis (YAdIS, 19–30 years) and Adult Idiopathic Scoliosis (AdIS, >30 years). YAdIS was divided into mild, flexible curves (YAdIS 1) and severe/stiff curves (YAdIS 2). AdIS was classified into three categories: AdIS 1 (isolated coronal deformity), AdIS 2 (combined coronal and sagittal deformity), and AdIS 3 (revision cases). Within AdIS 1, additional refinement by age (30–45, 45–60, >60 years) reflected increasing stiffness and degenerative changes. Tailored surgical strategies included selective fusions, posterior releases, high-density constructs, three-column osteotomies, and combined anterior–posterior approaches, depending on curve type and age group. Conclusions: This classification provides a comprehensive, treatment-oriented framework to support surgical decision-making in AAIS, enabling optimized planning and improved outcomes for adult patients with scoliosis of adolescent onset. Full article

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

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Open AccessReview

Field Tests for Assessing Functional Capacity in Children with Chronic Lung Diseases Other than Asthma: A Scoping Review

by Panagiotis Dalamarinis, Eleni A. Kortianou, Aspasia Mavronasou, Vaia Sapouna, Dafni Moriki and Konstantinos Douros

Healthcare 2025, 13(19), 2417; https://doi.org/10.3390/healthcare13192417 - 24 Sep 2025

Abstract

Objective: To synthesize the available evidence on field tests used to assess functional capacity in children with CLDs other than asthma, such as cystic fibrosis (CF), and non-CF bronchiectasis (NCFB). Still, the application and reliability of the field tests in non-asthmatic pediatric CLDs [...] Read more.

Objective: To synthesize the available evidence on field tests used to assess functional capacity in children with CLDs other than asthma, such as cystic fibrosis (CF), and non-CF bronchiectasis (NCFB). Still, the application and reliability of the field tests in non-asthmatic pediatric CLDs populations is scarce. Methods: Three databases (PubMed, Medline via EBSCOhost, and Web of Science) were searched from inception to 20 May 2025. Two researchers independently screened the retrieved articles and rated the methodological quality using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Information was extracted about study design, field test used, outcomes measured, and methodological quality. Results: Out of 784 records, 8 studies met the inclusion criteria. Most studies focused on CF. Five different field tests were identified: six-minute walk test (6MWT), modified shuttle walk test (mSWT), one-minute sit-to-stand test (1mSTS), three-minute step test (3mST), and TGlittre-P test. The 6MWT (n = 3) and mSWT (n = 2) were the most frequently used and demonstrated good reliability and clinical applicability. Reported outcomes included distance walked, total steps, task’ repetitions, and cardiopulmonary parameters, such as heart rate and perceived exertion of dyspnea/leg fatigue. Conclusions: Field exercise tests appear to be feasible in children with CLDs other than asthma, with most data available in CF. They can be used to monitor functional capacity over time, to assess the effectiveness of rehabilitation programs, and to complement symptom assessment with tools such as the Borg scale. Evidence in NCFB and PCD is still limited, and additional pediatric studies are needed. Full article

(This article belongs to the Special Issue Prevention and Treatment: Focus More on People with Chronic Illness)

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Open AccessArticle

The Development and Validation of a Satisfaction and Emotional Perception Scale for Women Undergoing Fertility Treatment

by Laura de la Torre García, Andrés Arias Astray, Iria Osa Subtil, Concepción del Pino Ortega, Reyes Velázquez Barbado, Carlos González Duque and María José Dios-Duarte

Healthcare 2025, 13(19), 2416; https://doi.org/10.3390/healthcare13192416 - 24 Sep 2025

Abstract

Background/Objectives: It is known that assisted human reproduction in infertility causes psychological and mental instability in those undergoing this treatment. Patient satisfaction, personal experiences with assisted reproduction treatment (IVF) and self-perception of emotional distress require a comprehensive study using complete and scientifically [...] Read more.

Background/Objectives: It is known that assisted human reproduction in infertility causes psychological and mental instability in those undergoing this treatment. Patient satisfaction, personal experiences with assisted reproduction treatment (IVF) and self-perception of emotional distress require a comprehensive study using complete and scientifically validated instruments. The aim of this study was to develop and validate a scale enabling nurses to assess patient satisfaction with the care they receive, personal satisfaction with the assisted reproduction treatment process, and self-perceptions of emotional discomfort. Methods: This study employed a mixed research strategy. Initially, a systematic literature review informed the qualitative phase, which involved expert focus groups in formulating the questionnaire items. Subsequently, the developed scale underwent psychometric analysis in the quantitative phase and was given to women undergoing fertility treatment. Results: The scale was found to have an acceptable level of factorial validity and reliability. The items were consistent and homogeneous, with high saturation in their respective factors (3). A negative covariance was observed between factors 1 and 2, and between factors 2 and 3, along with a positive covariance between factors 1 and 3. Furthermore, it was found that satisfaction with nursing care (F1) was associated with a lower need for professional psychological help and that a greater perception of emotional well-being (F2) was associated with a greater need for this type of help (F1: β = −0.07, p = 0.002; F2: β = 0.10, p = 0.004). Conclusions: This scale is a robust and dependable instrument, demonstrating its validity and reliability. Most notable are its user-friendly nature, ease of administration, and minimal time needed. Moreover, the scale proves effective in identifying women who require professional psychological support, which is a critical distinction with significant implications for patient care. In practical terms, the scale equips nurses with a powerful tool for conducting a thorough and efficient assessment of women undergoing fertility treatment. Full article

(This article belongs to the Special Issue Reproductive and Sexual Health: Addressing Understudied Areas in Public Health and Primary Care)

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Open AccessSystematic Review

Effects of Physical Activity on Executive Function and Emotional Regulation in Children and Adolescents with Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis

by María del Carmen Carcelén-Fraile, Fidel Hita-Contreras, María Aurora Mesas-Aróstegui and Agustín Aibar-Almazán

Healthcare 2025, 13(19), 2415; https://doi.org/10.3390/healthcare13192415 - 24 Sep 2025

Abstract

Background/Objectives: Children and adolescents with neurodevelopmental disorders (NDDs) often experience deficits in executive functioning and emotional regulation, which impact their academic, social, and behavioral development. While physical activity is increasingly recognized as a promising non-pharmacological intervention, the specific effects on cognitive and emotional [...] Read more.

Background/Objectives: Children and adolescents with neurodevelopmental disorders (NDDs) often experience deficits in executive functioning and emotional regulation, which impact their academic, social, and behavioral development. While physical activity is increasingly recognized as a promising non-pharmacological intervention, the specific effects on cognitive and emotional domains remain heterogeneous. This systematic review and meta-analysis aimed to assess the efficacy of physical–motor interventions in improving executive functions and emotional regulation in youths with NDDs. Methods: Following PRISMA 2020 guidelines, a comprehensive search of five databases was conducted (2010–2024) to identify randomized controlled trials (RCTs) evaluating the effects of structured physical activity programs on executive and emotional outcomes in children and adolescents diagnosed with NDDs. A total of 22 RCTs were included in the qualitative synthesis, while 16 were included in the quantitative analysis. Effect sizes were calculated using a random effects model, while heterogeneity was assessed with the Q, I², Tau², and Egger’s tests. Results: Physical activity interventions demonstrated a non-significant effect on executive functioning (g = 0.492; p = 0.215; 95% CI: −0.286 to 1.269). Although the point estimate suggested a small-to-moderate effect, the wide confidence interval and lack of statistical significance prevent firm conclusions. In contrast, a large and significant effect was observed on emotional regulation outcomes (g = −1.204; p < 0.001; 95% CI: −1.688 to −0.655), despite moderate heterogeneity (I² = 72.3%). Several studies also reported specific improvements in working memory, cognitive flexibility, and emotional control. Conclusions: Structured physical activity may be an effective complementary intervention for improving emotional regulation in youth with NDDs, with less consistent evidence for executive functioning. Future research should clarify optimal protocols and target populations to enhance intervention effectiveness. Full article

(This article belongs to the Special Issue Physical Therapy in Mental Health)

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Open AccessReview

The Role of Prenatal Care in Fetal and Infant Development in Brazil: A Narrative Review

by Amanda Maieski da Silva, Caroline Stadler, Luiz Gustavo Gusson de Camargo, Paula Rothbarth Silva, Nathalia Marçallo Peixoto Souza, Mateus Santana Lopes, Fabiane Gomes de Moraes Rego, Juliana Sartori Bonini, Roberta Fabbri, Jéssica Brandão Reolon, Luana Mota Ferreira and Marcel Henrique Marcondes Sari

Healthcare 2025, 13(19), 2414; https://doi.org/10.3390/healthcare13192414 - 24 Sep 2025

Abstract

Background/Objectives: In Brazil, nearly universal access to prenatal care coexists with ongoing negative fetal and infant outcomes. This review explores how the adequacy of prenatal care affects maternal, fetal, and child health, and highlights recurring gaps in service delivery. Methods: A narrative review [...] Read more.

Background/Objectives: In Brazil, nearly universal access to prenatal care coexists with ongoing negative fetal and infant outcomes. This review explores how the adequacy of prenatal care affects maternal, fetal, and child health, and highlights recurring gaps in service delivery. Methods: A narrative review of Brazilian studies published between 2018 and 2024 was conducted through the Virtual Health Library and PubMed. The initial search (July 2024) was updated in February 2025, and two reviewers independently screened and extracted data, synthesizing clinical outcomes from the findings. Results: A total of thirty-six studies were included in the review. Inadequate prenatal care was consistently linked to higher rates of infant and neonatal mortality, prematurity, low birth weight, congenital syphilis, and neonatal near misses. The studies indicated that counting visits alone does not adequately reflect the quality of care: when evaluated against the Prenatal and Birth Humanization Program (PHPN), most studies met only one of the eight minimum criteria. Common shortcomings included late initiation of care, incomplete diagnostic testing, fragmented follow-up, and insufficient treatment for partners regarding sexually transmitted infections. Conclusions: Adverse outcomes persist in Brazil not due to a lack of access, but rather due to deficiencies in the content and continuity of prenatal care. To improve perinatal outcomes, it is essential to strengthen care through standardized, multidimensional indicators and integrated strategies that combine clinical, educational, and psychosocial support. Full article

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

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Open AccessArticle

Prevalence of Pediatric Preventive Dental Visits Among Children in Saudi Arabia: A Cross-Sectional Study

by Mohammed H. Alshamrani, Waad E. Alsaadi, Reem A. Alajlan, Amjad M. Alabdulmohsen, Ghada Saeed Alqahtani and Mannaa K. Aldowsari

Healthcare 2025, 13(19), 2413; https://doi.org/10.3390/healthcare13192413 - 24 Sep 2025

Abstract

Background: Early preventive dental visits are critical to reducing oral diseases in children and establishing lifelong oral hygiene behaviors. The American Academy of Pediatric Dentistry (AAPD) recommends that a child’s first dental visit occur by age one. However, in Saudi Arabia, limited evidence [...] Read more.

Background: Early preventive dental visits are critical to reducing oral diseases in children and establishing lifelong oral hygiene behaviors. The American Academy of Pediatric Dentistry (AAPD) recommends that a child’s first dental visit occur by age one. However, in Saudi Arabia, limited evidence exists on parental awareness, attitudes, and barriers toward this recommendation. Objective: This study aimed to evaluate the timing of the first dental visit among Saudi children and to identify parental knowledge, barriers, and sociodemographic factors associated with compliance with AAPD guidelines. Materials and Methods: A cross-sectional survey was conducted between April and July 2025 at the Pediatric Dental Clinic, King Saud University, Riyadh. A validated, self-administered Arabic questionnaire was distributed both online and in-clinic to Saudi parents of children under 12 years. A total of 465 completed responses were analyzed using descriptive statistics, chi-square tests, logistic regression, and Spearman correlation to assess associations between parental awareness, socioeconomic variables, and compliance. Results: Of the 465 respondents, 39.6% were aware of AAPD guidelines, yet only 30.5% reported compliance with the recommendation of a dental visit by age one. The most cited barriers were lack of time (42%), difficulty accessing clinics (22%), shortage of pediatric dentists (20%), and lack of awareness (16%). Higher parental education (p = 0.003) and income (p < 0.001) were significantly associated with compliance. A moderate positive correlation was observed between early dental visits and regular annual check-ups (ρ = 0.319). Conclusions: Compliance with AAPD guidelines among Saudi parents remains low, largely due to limited awareness and access barriers. Strengthening parental education, community-based programs, and affordable pediatric dental services is essential to promote preventive care and improve oral health outcomes in children. Full article

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Open AccessArticle

Aging Unequally: Functional Age Disparities Between Developmental and Non-Developmental Disabilities

by Ji Ung Jeong

Healthcare 2025, 13(19), 2412; https://doi.org/10.3390/healthcare13192412 - 24 Sep 2025

Abstract

Background: Adults with developmental disabilities often experience accelerated aging, but the magnitude of this phenomenon is not well quantified. This study aimed to measure the disparity in functional ability and chronic illness prevalence between adults with developmental and other disabilities. Methods: [...] Read more.

Background: Adults with developmental disabilities often experience accelerated aging, but the magnitude of this phenomenon is not well quantified. This study aimed to measure the disparity in functional ability and chronic illness prevalence between adults with developmental and other disabilities. Methods: A “functional age” was calculated for adults with developmental disabilities. This metric, designed as a statistical index of disparity, was derived from normative regression models of ADL and IADL based on a reference group of adults with other disabilities. Results: A profound gap was found between chronological and functional age. On average, a 44-year-old individual with a developmental disability exhibited a level of functional limitation equivalent to a person over 100 years older in the reference population for both ADL and IADL (p < 0.001). Conclusions: Accelerated aging in this population manifests as a severe, early onset functional disadvantage rather than an elevated burden of general chronic disease. Policies should shift toward function-based, not age-based, models of care to address these lifelong support needs. Full article

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

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Open AccessArticle

Associations Between 24-Hour Movement Behaviors and Health-Related Quality of Life in East Asian Children

by Zhen Cui, Hongzhi Guo, Yue Wang, Jiameng Ma, Ho Jin Chung, Qiang Wang, Michael Yong Hwa Chia and Hyunshik Kim

Healthcare 2025, 13(19), 2411; https://doi.org/10.3390/healthcare13192411 - 24 Sep 2025

Abstract

Background: It is important to investigate the combination of 24 h movement behaviors (24 h MB)—such as physical activity, screen time, and sleep—as children’s daily habitual behaviors significantly influence their health-related quality of life (HRQoL). However, such studies remain extremely limited in [...] Read more.

Background: It is important to investigate the combination of 24 h movement behaviors (24 h MB)—such as physical activity, screen time, and sleep—as children’s daily habitual behaviors significantly influence their health-related quality of life (HRQoL). However, such studies remain extremely limited in East Asia. This study aimed to examine whether adherence to the 24 h MB is associated with HRQoL among children from three East Asian countries. Methods: In this cross-sectional study, data were collected from primary school children aged 7–12 years in Japan (n = 786), China (n = 1246), and South Korea (n = 1011). HRQoL was assessed using the KIDSCREEN-27 questionnaire, while physical activity, screen time, and sleep duration were measured through a self-reported questionnaire survey. Results: Logistic regression analyses, adjusted for relevant covariates, confirmed significant associations with HRQoL subfactors including physical well-being, psychological well-being, social support, and peer relationships. Conclusions: Our findings highlight the critical relationship between adherence to 24 h MB and HRQoL in East Asian children, contributing valuable evidence to support integrated health promotion strategies in this region. Full article

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Open AccessArticle

Developing a Health System Literacy Measure for Chinese Immigrants in Canada: Adapting the HLS₁₉–NAV Scale

by Anh Thu Vo, Ying Cao, Lixia Yang, Robin Urquhart, Yanqing Yi and Peizhong Peter Wang

Healthcare 2025, 13(19), 2410; https://doi.org/10.3390/healthcare13192410 - 24 Sep 2025

Abstract

Background: Health system literacy is crucial for immigrants to navigate health care systems and access necessary services. Little is known about how well immigrants understand and use the healthcare system in Canada. This study aimed to adapt and validate a health system literacy [...] Read more.

Background: Health system literacy is crucial for immigrants to navigate health care systems and access necessary services. Little is known about how well immigrants understand and use the healthcare system in Canada. This study aimed to adapt and validate a health system literacy scale for the Canadian context (HSL-CAN). Methods: A cross-sectional online survey was conducted from March 11 to July 19, 2024, among Chinese individuals aged 30 or older who have lived in Canada for at least 6 months. The HSL-CAN was developed through a literature review, patient and provider consultation, and adaptation of the European Health Literacy Population Survey 2019–2021 for navigational health literacy measurement (HLS₁₉–NAV) and was then translated into simplified and traditional Chinese. Content validity was evaluated via stakeholders’ feedback, and structural validity was evaluated via exploratory and confirmatory analyses (EFA/CFA). Convergent and discriminant validity, as well as known-group validity, were tested using correlations with the HLS₁₉-SF12, ANOVA (or t-test), and effect size. Internal consistency was measured with Cronbach’s alpha coefficient and composite reliability. Results: Initially, HSL-CAN contained 25 items developed using a five-point Likert response scale. Some minor revisions were made according to the stakeholders’ feedback (n = 12). Five redundancy items were removed based on the EFA. CFA supported a one-factor model with good fit indices (CFI = 0.960, TLI = 0.955, SRMR = 0.033, RMSEA = 0.025),

χ^{2}

/df = 1.41). The scale showed a solid internal reliability (Cronbach’s alpha = 0.81; composite reliability = 0.812). The HSL-CAN is highly correlated with the “health care” construct but lowly with the “health prevention and promotion” construct of HLS₁₉–SF12. Known-group validity showed large mean differences by education, income, and non-cancer chronic comorbidities and small to moderate mean differences by gender, age groups, employment status, self-rated health, and assistance needed to see a healthcare provider. Conclusions: The HSL-CAN is the first validated instrument to evaluate health system literacy in the Chinese population in Canada. Given strong validity and reliability, the instrument can be useful for research and practice, although further refinement is recommended before using this scale on the general population in Canada. Full article

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

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Open AccessArticle

Determinants of Psychosocial and Mental Health Risks of Multicultural Adolescents: A Multicultural Adolescents Panel Study 2023

by Jeoungmi Kim and Vasuki Rajaguru

Healthcare 2025, 13(19), 2409; https://doi.org/10.3390/healthcare13192409 - 24 Sep 2025

Abstract

Background: Adolescence is a critical developmental period when Psychosocial and mental health risks such as depression, social withdrawal, low self-esteem, and aggression may shape lifelong mental health outcomes. In Republic of Korea, multicultural adolescents face additional vulnerabilities due to cultural identity struggles, discrimination, [...] Read more.

Background: Adolescence is a critical developmental period when Psychosocial and mental health risks such as depression, social withdrawal, low self-esteem, and aggression may shape lifelong mental health outcomes. In Republic of Korea, multicultural adolescents face additional vulnerabilities due to cultural identity struggles, discrimination, and family stressors. Objective: This study examined the determinants of Psychosocial and mental health risks among multicultural adolescents using data from the 2023 Multicultural Adolescents Panel Study (MAPS). Methods: A cross-sectional analysis was conducted with adolescents from multicultural families. Outcomes included social withdrawal, depression, self-esteem, and aggression, measured by four-point Likert scales. Covariates comprised sociodemographic factors such as sex, age, parental nationality, parental education, parental occupation, and household income. Partial correlations, F-tests, and multiple linear regression were used to identify significant predictors. Results: Female adolescents reported significantly lower self-esteem (p = 0.003). Region was associated with both self-esteem (p = 0.037) and aggression (p = 0.047), with adolescents living in metropolitan areas reporting lower self-esteem and higher aggression compared to those in capital areas. Non-Korean father nationality increased the likelihood of aggression (p = 0.036), while higher paternal education reduced aggression risk (p = 0.048). Overweight and obesity were linked to greater aggression (p = 0.007, p = 0.050, respectively). Conclusions: The findings highlight the interrelated nature of Psychosocial and mental health risks among multicultural adolescents and underscore the influence of gender, family background, and body image. Addressing these factors within culturally sensitive school and community interventions is essential to support positive Psychosocial and mental health risk outcomes. Full article

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Open AccessArticle

Barriers and Predictors of HPV Vaccine Uptake Among Female Medical Students in Saudi Arabia: A Multi-Center Cross-Sectional Study

by Hanadi Bakhsh, Sarah Ali Altamimi, Falak Nasser Aldosari, Lujain Hatim Aljohani, Sarah Abdulrahman Alali, Nujud Ibrahim Almutlaq, Norah Khalid Alrusaini, Shuruq Munif Alshammari, Yara Abdulaziz Alsuhaibani and Shatha Abdulwahab Alshehri

Healthcare 2025, 13(19), 2408; https://doi.org/10.3390/healthcare13192408 - 24 Sep 2025

Abstract

Background/Objectives: Low HPV vaccine uptake persists in Saudi Arabia despite improving awareness. This study aimed to assess the level of awareness, knowledge, and uptake of the human papillomavirus (HPV) vaccine among female medical students in Saudi Arabia, and to identify key demographic, academic, [...] Read more.

Background/Objectives: Low HPV vaccine uptake persists in Saudi Arabia despite improving awareness. This study aimed to assess the level of awareness, knowledge, and uptake of the human papillomavirus (HPV) vaccine among female medical students in Saudi Arabia, and to identify key demographic, academic, and informational factors that predict vaccination behavior. It also sought to explore perceived barriers influencing vaccine acceptance within this population. Methods: A multi-center cross-sectional survey recruited 246 female medical students from five Saudi universities using convenience sampling. An anonymous, structured, and validated questionnaire assessed HPV/vaccine knowledge, attitudes, uptake, and perceived barriers. Data were analyzed using descriptive statistics, t-tests, ANOVA, correlation, and logistic regression. Results: Overall, 82.9% of participants had heard of HPV and 78.9% knew of the vaccine, but only 10.3% demonstrated high vaccine-specific knowledge. While 69.5% expressed willingness to be vaccinated, only 22.8% had received at least one dose. The most reported barriers were perceived lack of necessity (45.3%), abstinence from sexual activity (41.3%), and safety concerns (34.7%). Logistic regression indicated that higher academic year and higher vaccine-specific knowledge significantly predicted vaccine uptake (p < 0.001). Conclusions: Despite high general awareness, low vaccine-specific knowledge and cultural framing constrain HPV vaccine uptake among future prescribers. Universities should integrate cancer-prevention framing into curricula, strengthen female-to-female counseling, and provide on-campus vaccination opportunities. Addressing knowledge gaps and sociocultural barriers is critical to improving HPV vaccine coverage in Saudi Arabia. Full article

(This article belongs to the Special Issue Gynecological Cancer: Screening, Prevention and Treatment)

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Open AccessArticle

Food Insecurity, Walkability, and Social Determinants of Health: A Cross-Sectional, County-Level Study of Associations with Maternal and Infant Mortality in the United States

by Brooklyn Stone, Azita Amiri, Shuang Zhao, Shima Hamidi, Paige Johnson and Debra Bruns

Healthcare 2025, 13(19), 2407; https://doi.org/10.3390/healthcare13192407 - 24 Sep 2025

Abstract

Background: Compared to other high-income countries, US women face higher maternal and infant mortality rates. Methods: This study used structural equation modeling (SEM) to examine cross-sectional, county-level associations between structural and intermediary social determinants of health (SDOHs) and maternal and infant mortalities, based [...] Read more.

Background: Compared to other high-income countries, US women face higher maternal and infant mortality rates. Methods: This study used structural equation modeling (SEM) to examine cross-sectional, county-level associations between structural and intermediary social determinants of health (SDOHs) and maternal and infant mortalities, based on the World Health Organization’s Commission on Social Determinants of Health framework. Results: Our findings suggest maternal mortality may be linked to increased food insecurity, food assistance, distance to obstetric care, and decreased walkability and marriage rates. Our modeling also points toward a connection between infant mortality and increased food insecurity, food assistance, Black race, mental distress, and decreased walkability, education, and income. SEM revealed significant direct and indirect effects of these SDOHs. Notably, food insecurity and walkability had direct associations with both maternal and infant mortality in both SEM models. Conclusions: The findings underscore the need for policy, practice, and research efforts to address key SDOHs and reduce mortality disparities in the US. Full article

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Open AccessCase Report

Implementation of Medicalholodeck^® for Augmented Reality Surgical Navigation in Microsurgical Mandibular Reconstruction: Enhanced Vessel Identification

by Norman Alejandro Rendón Mejía, Hansel Gómez Arámbula, José Humberto Baeza Ramos, Yidam Villa Martínez, Francisco Hernández Ávila, Mónica Quiñonez Pérez, Carolina Caraveo Aguilar, Rogelio Mariñelarena Hernández, Claudio Reyes Montero, Claudio Ramírez Espinoza and Armando Isaac Reyes Carrillo

Healthcare 2025, 13(19), 2406; https://doi.org/10.3390/healthcare13192406 - 24 Sep 2025

Abstract

Mandibular reconstruction with the fibula free flap is the gold standard for large defects, with virtual surgical planning becoming integral to the process. The localization and dissection of critical vessels, such as the recipient vessels in the neck and the perforating vessels of [...] Read more.

Mandibular reconstruction with the fibula free flap is the gold standard for large defects, with virtual surgical planning becoming integral to the process. The localization and dissection of critical vessels, such as the recipient vessels in the neck and the perforating vessels of the fibula flap, are demanding steps that directly impact surgical success. Augmented reality (AR) offers a solution by overlaying three-dimensional virtual models directly onto the surgeon’s view of the operative field. We report the first case in Latin America utilizing a low-cost, commercially available holographic navigation system for complex microsurgical mandibular reconstruction. A 26-year-old female presented with a large, destructive osteoblastoma of the left mandible, requiring wide resection and reconstruction. Preoperative surgical planning was conducted using DICOM data from the patient’s CT scans to generate 3D holographic models with the Medicalholodeck^® software. Intraoperatively, the primary surgeon used the AR system to superimpose the holographic models onto the patient. The system provided real-time, immersive guidance for identifying the facial artery, which was anatomically displaced by the tumor mass, as well as for localizing the peroneal artery perforators for donor flap harvest. A free fibula flap was harvested and transferred. During the early postoperative course and after 3-months of follow-up, the patient presented with an absence of any clinical complications. This case demonstrates the successful application and feasibility of using a low-cost, consumer-grade holographic navigation system. Full article

(This article belongs to the Special Issue Virtual Reality Technologies in Health Care)

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Open AccessSystematic Review

Motivational Interventions for Reducing Excessive Alcohol Consumption Among University Students: A Systematic Review and Meta-Analysis

by Víctor Serrano-Fernández, Esperanza Barroso-Corroto, Cristina Rivera-Picón, Brigida Molina-Gallego, Ana Quesado, Juan Manuel Carmona-Torres, Pablo Jesús López-Soto, Alba Sánchez-Gil, Juan Luis Sánchez-González and Pedro Manuel Rodríguez-Muñoz

Healthcare 2025, 13(19), 2405; https://doi.org/10.3390/healthcare13192405 - 24 Sep 2025

Abstract

Background/Objectives: University students frequently engage in risky alcohol consumption, making them a priority population for targeted interventions. Motivational interventions (MIs) have been widely implemented to address this issue, but evidence of their effectiveness remains heterogeneous. This study aimed to evaluate the efficacy of [...] Read more.

Background/Objectives: University students frequently engage in risky alcohol consumption, making them a priority population for targeted interventions. Motivational interventions (MIs) have been widely implemented to address this issue, but evidence of their effectiveness remains heterogeneous. This study aimed to evaluate the efficacy of MIs in reducing alcohol consumption and related harm among university students through a systematic review and meta-analysis. Methods: A systematic search was conducted in PubMed, Scopus, and BVS Library, including randomized controlled trials (RCTs) published up to April 2025. The PRISMA and RoB-2 tools guided reporting and risk of bias assessment. Random-effects models were applied to pool effect sizes for changes in alcohol consumption patterns and related consequences. Results: Fifteen RCTs were included. MIs significantly reduced daily alcohol intake (−0.55 drinks/day; 95% CI: −0.78 to −0.32), with additional reductions in weekly consumption and binge drinking episodes, though these were not statistically significant. Positive effects were also observed in reducing alcohol-related consequences and blood alcohol concentration levels. Short, single-session formats (45–90 min) showed consistent efficacy across studies, with effects sustained at 2–3 months and, in some cases, up to one year post-intervention. Conclusions: MIs are effective, brief, and adaptable strategies for reducing harmful alcohol use and associated negative outcomes among university students. Their simplicity, feasibility, and sustained effects make them valuable tools for university health programs. Future research should focus on optimizing intervention components and evaluating their effectiveness in diverse cultural and socioeconomic contexts. Full article

(This article belongs to the Special Issue Healthy and Harmful Habits: Impact on Nursing Practice and Patient Health)

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Open AccessArticle

Changes in Autonomic Balance, Cardiac Parasympathetic Modulation, and Cardiac Baroreflex Gain in Older Adults Under Different Orthostatic Stress Conditions

by Dihogo Gama de Matos, Jefferson Lima de Santana, Felipe J. Aidar, Stephen M. Cornish, Gordon G. Giesbrecht, Albena Nunes-Silva, Roman Romero-Ortuno, Todd A. Duhamel and Rodrigo Villar

Healthcare 2025, 13(19), 2404; https://doi.org/10.3390/healthcare13192404 - 24 Sep 2025

Abstract

Background: As we age, our autonomic function declines, resulting in altered autonomic balance during postural transitions. These changes can affect the dynamic interplay between sympathetic and parasympathetic modulation, compromising short-term compensatory responses to active standing. Objectives: This study aimed to compare [...] Read more.

Background: As we age, our autonomic function declines, resulting in altered autonomic balance during postural transitions. These changes can affect the dynamic interplay between sympathetic and parasympathetic modulation, compromising short-term compensatory responses to active standing. Objectives: This study aimed to compare heart rate variability (HRV) at baseline, cardiac parasympathetic modulation (CPM), and cardiac baroreflex gain (CRG) between younger adults (YA) and older adults (OA) following active standing orthostatic stress. A secondary objective was to analyze the incidence of orthostatic intolerance (OI) symptoms. Methods: Participants (n = 76) completed sit-to-stand and lie-to-stand maneuvers with continuous beat-to-beat blood pressure and heart rate (HR, electrocardiogram). HRV at baseline was analyzed in both time and frequency domains. CPM was measured by the HR 30:15 ratio on standing. CBG was determined as the ratio of HR and SBP changes (ΔHR/ΔSBP) at specific phase time points (30 s, 60 s, 180 s, and 420 s). Results: At baseline, OA showed reduced Standard Deviation of RR intervals (SDRR), Root Mean Square of Successive Differences (RMSSD), low-frequency (LF), and high-frequency (HF) power, and elevated LF/HF ratio (all p < 0.05), indicating a shift toward sympathetic dominance. During active standing orthostatic stress, OA demonstrated a lower HR30:15 ratio and CBG in later phases (phases 2–4) (all p < 0.05). Also, OA reported more symptoms (14%) of OI than YA (0%) (p = 0.041). Conclusions: These findings indicate that older adults have impaired autonomic function characterized by reduced HRV, CPM and CBG responses. These impairments lead to diminished autonomic regulation under active-standing orthostatic stress and a higher incidence of OI symptoms. Full article

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

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Open AccessReview

Comparison of Kaltenborn-Evjenth, McKenzie, and HVLA Manipulation Techniques in the Treatment of Lumbar Spine Pain: A Review of the Literature

by Michał Grzegorczyk, Magdalena Brodowicz-Król and Grażyna Brzuszkiewicz-Kuźmicka

Healthcare 2025, 13(19), 2403; https://doi.org/10.3390/healthcare13192403 - 24 Sep 2025

Abstract

Lumbar spine pain (LBP) is a leading cause of disability worldwide and remains a major challenge in clinical practice. Among non-invasive treatment strategies, manual therapy plays a central role, offering individualized interventions that target both biomechanical dysfunction and pain. This narrative review compares [...] Read more.

Lumbar spine pain (LBP) is a leading cause of disability worldwide and remains a major challenge in clinical practice. Among non-invasive treatment strategies, manual therapy plays a central role, offering individualized interventions that target both biomechanical dysfunction and pain. This narrative review compares three commonly used physiotherapeutic approaches—Kaltenborn-Evjenth mobilization, the McKenzie method, and high-velocity low-amplitude (HVLA) manipulation—based on current evidence regarding their effectiveness, safety, and clinical application. A total of 32 randomized controlled trials, systematic reviews, and meta-analyses published between 2003 and 2024 were analyzed. The Kaltenborn-Evjenth method demonstrated notable effectiveness in improving range of motion and reducing chronic pain, particularly in patients with segmental hypomobility. The McKenzie method showed strong outcomes in both acute and chronic LBP, especially in cases involving symptom centralization and high patient engagement. HVLA techniques offered rapid symptom relief in acute phases but required careful patient selection due to their mechanical intensity. The findings suggest that no single method is universally superior. Instead, optimal outcomes are achieved through individualized treatment plans that integrate multiple techniques based on clinical presentation, pain chronicity, and functional limitations. Multimodal strategies that combine manual therapy with exercise and patient education appear to be the most effective in managing LBP and preventing recurrence. Full article

(This article belongs to the Special Issue Advances in Manual Therapy: Diagnostics, Prevention and Treatment)

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Open AccessSystematic Review

Type 1 Diabetes Mellitus and Alexithymia: A Systematic Review

by Emanuele Maria Merlo, Liam Alexander MacKenzie Myles, Orlando Silvestro, Domenica Ruggeri, Giuseppina Tiziana Russo, Giovanni Squadrito and Gabriella Martino

Healthcare 2025, 13(19), 2402; https://doi.org/10.3390/healthcare13192402 - 24 Sep 2025

Abstract

Background: Alexithymia has been recognised as a predictor of negative outcomes in various chronic conditions, including type 2 diabetes mellitus (T2DM). However, evidence concerning its role in type 1 diabetes mellitus (T1DM) remains limited. This systematic review aims to explore the relationship between [...] Read more.

Background: Alexithymia has been recognised as a predictor of negative outcomes in various chronic conditions, including type 2 diabetes mellitus (T2DM). However, evidence concerning its role in type 1 diabetes mellitus (T1DM) remains limited. This systematic review aims to explore the relationship between alexithymia and T1DM. Methods: In June 2025, following PRISMA guidelines, a systematic review was conducted using Scopus, PubMed, and Web of Science databases. Studies specifically addressing the relationship between alexithymia and type 1 diabetes mellitus were analysed. The search strategy included the keywords “Alexithymia” AND (“Type 1 Diabetes Mellitus” OR “T1DM”). The NIH Study Quality Assessment Tool was employed to evaluate the methodological quality of the selected studies. Results: Fifteen studies met the inclusion criteria. The systematic analysis of the literature highlighted three dominant themes: alexithymia was found to be associated with patients’ health status concerning weight and obesity, glycaemic control, and psychopathological symptoms. Moreover, alexithymia emerged as a potential predictor of adverse outcomes in T1DM self-management. Conclusions: Available evidence suggests that alexithymia has a clinically relevant impact on the management of T1DM. However, further research involving larger samples and longitudinal designs is needed to bridge the gap with other chronic conditions. Promoting evidence-based research in this area is aligned with the need for targeted psychological assessment, specific interventions, and improved care strategies. Full article

(This article belongs to the Special Issue Psychodiabetology: The Psycho-Social Challenges of Diabetes)

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Open AccessArticle

A Longitudinal Study on the Impact of Preceptors’ Perceived Difficulty and Role Performance in Instructing Newly Graduated Nurses—Following Changes in Clinical Practicum Due to COVID-19—On Their Mental Health

by Takashi Ohue and Yuka Ohue

Healthcare 2025, 13(19), 2401; https://doi.org/10.3390/healthcare13192401 - 24 Sep 2025

Abstract

Objective: This longitudinal study examined how preceptors’ perceived difficulty and role performance in instructing newly graduated nurses impacted by restricted clinical practicum opportunities because of COVID-19 impact their mental health outcomes, including stressors, burnout, and turnover intention. Methods: The study surveyed 426 preceptors [...] Read more.

Objective: This longitudinal study examined how preceptors’ perceived difficulty and role performance in instructing newly graduated nurses impacted by restricted clinical practicum opportunities because of COVID-19 impact their mental health outcomes, including stressors, burnout, and turnover intention. Methods: The study surveyed 426 preceptors responsible for newly graduated nurses across 39 hospitals during fiscal year 2022. Data were collected at three time points: June, September, and December 2022. The questionnaire assessed personal attributes, perceived instructional difficulty (PID) due to limited clinical practice, self-rated preceptor role performance, nursing job stressors, burnout, and intention to resign. Two-way ANOVA was conducted to analyze the effects of perceived difficulty (high/low) and role performance (high/low) on mental health indicators. Results: Seventy-six preceptors (6 males, 70 females) completed all three surveys. In June 2022, preceptors reporting high perceived difficulty demonstrated significantly higher scores in role performance subscales, including “goal achievement and accident prevention” and “continuation of instruction with cooperation.” Significant main effects of perceived difficulty and role performance were observed on stressors such as role conflict, physician conflict, and death-related stress, as well as on burnout dimensions such as emotional exhaustion and personal accomplishment. By December, significant interaction effects emerged for outcomes related to “intention to quit nursing” and “desire to change departments.” Conclusions: Preceptors’ PID and role performance significantly influence their stress, burnout, and turnover intentions. Those experiencing both high difficulty and high role performance experience increased psychological burdens. This underscores the importance of targeted mental health support for preceptors. Full article

(This article belongs to the Section Nursing)

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Open AccessArticle

Types and Frequencies of Physical Activity Associated with Physical Fitness in Chinese Children and Adolescents: A National Cross-Sectional Study

by Linjie Wei, Zhe Li and Yuliang Sun

Healthcare 2025, 13(19), 2400; https://doi.org/10.3390/healthcare13192400 - 24 Sep 2025

Abstract

Background: Rising sedentary behavior and declining physical activity (PA) among youth are major public health concerns. Evidence on how different PA types affect fitness in Chinese children is limited. PA indicators were classified according to the Global Matrix 4.0, an international framework for [...] Read more.

Background: Rising sedentary behavior and declining physical activity (PA) among youth are major public health concerns. Evidence on how different PA types affect fitness in Chinese children is limited. PA indicators were classified according to the Global Matrix 4.0, an international framework for benchmarking PA in children and adolescents. Objective: To identify which PA types and frequencies, based on the Global Matrix 4.0, are most associated with physical fitness in Chinese youth. Methods: Data from 102,942 children aged 9–18 were analyzed. Descriptive statistics summarized demographics, PA levels, and physical fitness rates. Chi-square tests assessed group differences. Binary logistic regression examined associations between PA and physical fitness, adjusting for gender, age, school level, parental education, and urban–rural residence, with cluster-robust standard errors at the school level. Results: Higher frequencies of moderate-to-vigorous physical activity (MVPA), muscle-strengthening exercise (MSE), and organized sports and physical activity (OSPA) were significantly associated with better fitness (p < 0.001). OSPA (OR = 1.23) and MSE (OR = 1.21) showed the strongest associations. Sedentary behavior was negatively associated with fitness (p < 0.001). Conclusions: Regular engagement in MVPA, MSE, and OSPA, alongside reduced sedentary time, promotes physical fitness among Chinese children and adolescents. Policies should support diverse and consistent PA participation. Full article

(This article belongs to the Special Issue Physical Activity and Fitness in the Health Promotion of Children and Adolescents)

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Open AccessArticle

Quality of Care for Hypertension in Primary Health Care in South Africa: Cross-Sectional Feasibility Study

by Enos Muisaphanda Rampamba, Stephen M. Campbell, Brian Godman and Johanna C. Meyer

Healthcare 2025, 13(19), 2398; https://doi.org/10.3390/healthcare13192398 - 24 Sep 2025

Abstract

Introduction: Little is known about the quality of care for patients with hypertension in primary health care (PHC) facilities in South Africa, where most people receive care. Objectives: To test 46 quality indicators, developed previously, to assess and improve care; to assess [...] Read more.

Introduction: Little is known about the quality of care for patients with hypertension in primary health care (PHC) facilities in South Africa, where most people receive care. Objectives: To test 46 quality indicators, developed previously, to assess and improve care; to assess the indicators’ clinimetric properties; and to recommend improvement strategies. Methods: A descriptive cross-sectional clinical audit in a purposive sample of 12 South African PHC clinics involving a retrospective review of 295 patient medical records. Results: A total of 45 of the 46 indicators were tested in the main sample (n = 295), of which 9 indicators could not be applied. Of the 36 applicable indicators, 22 could be applied and measured for ≥75% of the sample, while 14 were applicable to ≤50% of the sample. Only five indicators showed a quality of care score for ≥75% of patients. Overall, 82% and 92% of the sample had their blood pressure (BP) recorded in the last 12 months or in the previous 5 years for those aged >40, respectively, and 53.2% had a controlled BP. In the last 12 months, 30% of patients had a cholesterol record, 30% had their BMI recorded, 17% had a hypertension review with a medical practitioner, and 12% had received lifestyle advice. Only 38% received all clinically indicated antihypertensive medicines at their last visit. Conclusion: There were gaps in the quality of care for patients with hypertension, demonstrating the need for greater adherence to evidence-based guidelines, better data quality, and the use of electronic health information systems. Twenty-two indicators are recommended to address these gaps and improve the quality of care, patient outcomes, and the health care system. Full article

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

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Open AccessBrief Report

Factors Associated with Fruit and Vegetable Intake Among Women of Reproductive Age in Flint, Michigan: A Cross-Sectional Analysis

by Gayle Shipp, Diana K. Haggerty, Amy Saxe-Custack, Jenny LaChance and Nicole Jones

Healthcare 2025, 13(19), 2399; https://doi.org/10.3390/healthcare13192399 - 23 Sep 2025

Abstract

Background/Objectives: There is a paucity of research evaluating factors associated with healthy eating behaviors in reproductive-age, non-pregnant women. This study aims to examine the association between sociodemographic, perceived health, and environmental factors with fruit and vegetable (F&V) consumption and adherence to dietary recommendations [...] Read more.

Background/Objectives: There is a paucity of research evaluating factors associated with healthy eating behaviors in reproductive-age, non-pregnant women. This study aims to examine the association between sociodemographic, perceived health, and environmental factors with fruit and vegetable (F&V) consumption and adherence to dietary recommendations among women of reproductive age who lived, worked, or attended school in Flint, Michigan, during the Flint water crisis (April 2014–October 2015). Methods: This cross-sectional study used data collected from enrollment surveys completed by participants in the Flint Registry (December 2019–2021). Inclusion criteria were females aged 18–55 having complete data on sociodemographic indicator, general health perception, and dietary assessment data (n = 1239). Pearson chi-square measures of association were used to compare frequencies within groups between sociodemographic characteristics, perceived health and wellbeing (PHW), F&V quality/selection, adherence to recommendations, and total F&V intake. Results: Few participants met recommendations for fruits (22.8%) and vegetables (20.3%). Approximately 50.5% reported having access to a wide variety of F&Vs in their neighborhood and perceived F&V quality to be high. Factors significantly associated with meeting F&V recommendations included education, income, homeownership status, and PHW (p < 0.05). Conclusions: Associations between environmental and socioeconomic factors and daily F&V intake among women of reproductive age offer important considerations for designing interventions to improve this demographic’s nutritional status. Results indicate low adherence to recommended F&V intake but perceived access and quality as high in this population. Targeted interventions addressing key components of socioeconomic barriers, perceived access and quality, and perceived wellbeing are needed to improve F&V intake. Full article

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Open AccessArticle

Isotemporal Associations of Patterns and Domains of Sedentary Behavior and Physical Activity with Sleep Quality in Pregnant Women in Saudi Arabia

by Abdullah Bandar Alansare, Ghareeb Omar Alshuwaier, Nada Khojah, Saja Abdullah Alghamdi, Alawyah Alsalman, Om Kalthom Sowadi, Hadeel Saad and Bethany Barone Gibbs

Healthcare 2025, 13(19), 2397; https://doi.org/10.3390/healthcare13192397 - 23 Sep 2025

Abstract

Background: Although higher sedentary behavior (SB) and lower physical activity (PA) have been associated with poor prenatal sleep quality, the influence of specific exchanges of SB and types of PA on sleep quality during pregnancy remains unexplored. Objectives: This secondary, cross-sectional analysis examined [...] Read more.

Background: Although higher sedentary behavior (SB) and lower physical activity (PA) have been associated with poor prenatal sleep quality, the influence of specific exchanges of SB and types of PA on sleep quality during pregnancy remains unexplored. Objectives: This secondary, cross-sectional analysis examined associations between the statistical replacement of patterns (weekdays, weekends) and domains (leisure, occupational, commuting) of SB with moderate (MPA), vigorous (VPA), or moderate-to-vigorous (MVPA) PA and sleep quality among pregnant women in Saudi Arabia. Methods: Participants (n = 935; age = 30 ± 5.6 years; first trimester = 24.1%, second trimester = 33.9%, third trimester = 42.0%) self-reported their patterns and domains of SB, PA, and sleep quality using validated instruments. Adjusted isotemporal substitution models evaluated the associations of exchanging 30 min of different SB and PA with sleep quality. Results: Replacing 30 min of total or leisure SB on weekdays with 30 min of MPA was associated with improved sleep quality (β = −0.519 and −0.590, respectively; p < 0.05) only among those in their first trimester. Paradoxically, replacing 30 min of total, leisure, occupational, or commuting SB across the week, on weekdays, and weekends with 30 min of VPA was associated with poor prenatal sleep quality (β ranged between 1.258 and 7.217; p < 0.05 for all). Exchanging SB with MPVA or different domain-specific SB did not influence sleep quality (p > 0.05 for all). Conclusions: These novel findings suggest that although replacing SB with PA may help enhance sleep quality in pregnant women, particularly during the first trimester, the underlying associations are likely multifaceted. The variable relationships observed emphasize the importance of considering patterns and domains of SB and intensity of PA used as a replacement, rather than total duration solely, to improve prenatal sleep quality, especially during early pregnancy, particularly in Saudi Arabia. Full article

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

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Open AccessArticle

Why Organizational Commitment and Work Values of Veterans Home Caregivers Affect Retention Intentions: A Social Exchange Theory Perspective

by Szu-Han Yeh and Kuo-Chung Huang

Healthcare 2025, 13(19), 2396; https://doi.org/10.3390/healthcare13192396 - 23 Sep 2025

Abstract

Background/Objectives: The stability of caregiver manpower plays a crucial role in the operation of long-term care institutions. This study adopts Social Exchange Theory as the theoretical foundation to construct the psychological mechanism through which organizational commitment and work value influence retention intention via [...] Read more.

Background/Objectives: The stability of caregiver manpower plays a crucial role in the operation of long-term care institutions. This study adopts Social Exchange Theory as the theoretical foundation to construct the psychological mechanism through which organizational commitment and work value influence retention intention via job involvement. Against the backdrop of Taiwan’s intensifying aging society and the increasing service demands of the veterans’ support system, Veterans Homes have gradually become indispensable within the long-term care system. Therefore, the primary objective of this study is to explore the formation mechanism of retention intention among caregivers in Veterans Homes. Methods: Data analysis was conducted using structural equation modeling, with 447 valid samples collected from caregivers across 16 Veterans Homes in Taiwan. Results: The results indicate that, in the process of forming retention intention, job involvement serves as a mediator between organizational commitment and work value on retention intention and demonstrates significant mediating effects. Conclusions: These findings suggest that when caregivers perceive value realization and organizational identification in their work, they are more likely to exhibit active engagement, thereby strengthening their tendency to remain employed. Furthermore, the study reveals that the effect of organizational commitment on job involvement is stronger than that of work value, indicating that exchange motives triggered by emotional bonds carry greater implications for retention. In conclusion, organizational support and personal value perceptions stimulate emotional engagement, which further influences caregivers’ decisions to remain in long-term service and ultimately shape their retention behavior. Full article

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Open AccessArticle

Anger and Post-Traumatic Stress Symptoms in Firefighters After a Firefighting Operation with Two Team Member Fatalities

by Tabea Görlich, Vanessa Borck, Nils Hüttermann, Francesco Pahnke, Tristan Wellendorff and Ulrich Wesemann

Healthcare 2025, 13(19), 2395; https://doi.org/10.3390/healthcare13192395 - 23 Sep 2025

Abstract

Due to the burdens of critical operations, firefighters are at occupational risk of developing mental health problems such as post-traumatic stress symptoms (PTSS) or anger. In this study, we assessed the impact of a firefighting operation with two fatalities and eleven injuries among [...] Read more.

Due to the burdens of critical operations, firefighters are at occupational risk of developing mental health problems such as post-traumatic stress symptoms (PTSS) or anger. In this study, we assessed the impact of a firefighting operation with two fatalities and eleven injuries among colleagues on the mental health of those involved. Aims: The study hypothesizes that firefighters who were acquainted with the wounded or deceased show more PTSS and score higher on the STAXI-2 State Anger, Anger Expression-In/Out, and Anger Control-In/Out compared to those who were not. The second hypothesis assumes that the deployed group shows more PTSS and scores higher on the STAXI-2 State Anger, Anger Expression-In/Out, and Anger Control-In/Out compared to the grouping of non-deployed colleagues. Methods: A total of N = 138 firefighters were included, of which n = 32 were deployed and n = 106 were not (n = 26 acquainted with wounded or injured; n = 107 not acquainted with wounded or injured; n = 5 not specified). Both groups completed a standardized questionnaire voluntarily and after providing written informed consent ten months after the incident. The questionnaire consisted of the Posttraumatic Stress Checklist for DSM-5 (PCL-5) and the State-Trait Anger Inventory (STAXI-2) questionnaire. Results: Firefighters who knew the injured or deceased colleagues had significantly higher PTSS [T(23.7) = −2.5; p = 0.019; d = 0.67; 95% CI = (−10.8, −1.0)], state anger [T(74.2) = 2.4; p = 0.021; d = 0.41; 95% CI = (0.2, 2.0)], and anger control scores [T(124) = −2.7; p = 0.008; d = 0.71; 95% CI = (−5.9, −0.9)]. In addition, the deployed group showed higher anger control [T(134) = 2.0; p = 0.046; d = 0.42; 95% CI = (0.0, 4.2)] and outward anger expression [T(73.5) = −2.2; p = 0.032; d = 0.40; 95% CI = (−2.3, −0.1)] scores compared to their non-deployed colleagues. Discussion: Future psychological pre- and post-deployment interventions should place more focus on the increased vulnerability of those acquainted with wounded or deceased colleagues. Full article

(This article belongs to the Special Issue Health Promotion, Disease Prevention, and Chronic Illness Experience: A Health Psychology Perspective)

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Open AccessArticle

Addressing Health Inequalities in Greece: A Comprehensive Framework for Socioeconomic Determinants of Health

by Christos Triantafyllou, Dimitra Latsou, Vion Psiakis, George Pierrakos and Joao Breda

Healthcare 2025, 13(19), 2394; https://doi.org/10.3390/healthcare13192394 - 23 Sep 2025

Abstract

Background/Objectives: The study proposes an indicator-based framework for monitoring health inequalities in Greece by examining key socioeconomic and health-related determinants. Methods: The framework draws on the World Health Organization’s Social Determinants of Health model and the Dahlgren–Whitehead model, using Eurostat data [...] Read more.

Background/Objectives: The study proposes an indicator-based framework for monitoring health inequalities in Greece by examining key socioeconomic and health-related determinants. Methods: The framework draws on the World Health Organization’s Social Determinants of Health model and the Dahlgren–Whitehead model, using Eurostat data (2008–2023). Results: Life expectancy at birth showed a moderate negative correlation with public health expenditures (r = −0.716), while healthy life years were positively linked with GDP (r = 0.765) and public health expenditures (r = 0.743). Self-perceived health was strongly negatively correlated with poverty risk (r = −0.864). Chronic conditions and functional limitations were inversely associated with GDP and health spending. Social factors also mattered: healthy life years correlated negatively with unemployment (r = −0.814) and positively with employment (r = 0.810). Educational attainment influenced both self-perceived health and reported health problems. Conclusions: This framework goes beyond existing WHO/EU models by systematically integrating economic, social, and health outcome indicators tailored to the Greek context. It provides a comprehensive view of the determinants impacting health in Greece, enabling policymakers to tackle the underlying causes of health inequalities and enhance both the fairness and efficiency of healthcare services. Strengthening primary healthcare is crucial to reducing unmet medical needs, minimizing private health expenditures, and improving overall public health. Full article

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Open AccessArticle

Visualization of Medical Record with 3D Human Body Models

by Tz-Jie Liu, Chia-Yi Lai and Yi-Cheng Chiang

Healthcare 2025, 13(19), 2393; https://doi.org/10.3390/healthcare13192393 - 23 Sep 2025

Abstract

Background/Objectives: With the rapid development of smart healthcare, medical records have shifted from a disease-centered to a patient-centered approach. However, traditional formats, such as narratives and tables, often make it challenging for physicians to quickly grasp a patient’s condition within a limited timeframe, [...] Read more.

Background/Objectives: With the rapid development of smart healthcare, medical records have shifted from a disease-centered to a patient-centered approach. However, traditional formats, such as narratives and tables, often make it challenging for physicians to quickly grasp a patient’s condition within a limited timeframe, potentially leading to diagnostic errors and a decline in the quality of care. Recently, advances in information visualization and 3D technology have led many medical institutions to employ charts and graphs or use 3D simulations of organs to support clinical practice and education. However, few have integrated 3D models into medical records for use during physician consultations. Methods: This study presents the development and evaluation of a novel web-based 3D EMR system that integrates real-time ICD-10 diagnostic code mapping with interactive 3D human body models, enabling physicians to visualize patient-specific anatomical and diagnostic information in a dynamic and context-aware manner. Results: We employed the System Usability Scale (SUS) to evaluate the system’s usability, conducting a satisfaction survey. Results from the survey indicate that participants rated the system highly in terms of ease of use, satisfaction, and efficiency, with an average SUS score of 70.42, reflecting usability between moderate and good. Comparative evaluations and future expansion plans are also discussed. Conclusions: These findings demonstrate that integrating a 3D human model into the medical record retrieval process significantly improves visualization and interactivity, meeting the needs of healthcare professionals and enhancing both their efficiency and patient satisfaction. Full article

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Healthcare, Volume 13, Issue 19 (October-1 2025) – 38 articles

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