Healthcare

15 pages, 614 KB

Open AccessArticle

Telomere Length and COVID-19 Severity: A Comparative Cross-Sectional Study Across the Clinical Spectrum

by Flora Bacopoulou, Anastasios Tentolouris, Eleni Koniari, Dimitrios Kalogirou, Dimitrios Basoulis, Ioanna Eleftheriadou, Pinelopi Grigoropoulou, Vasiliki Efthymiou, Konstantina K. Georgoulia, Ioanna A. Anastasiou, Stavroula Papadodima, George Chrousos and Nikolaos Tentolouris

Healthcare 2025, 13(20), 2656; https://doi.org/10.3390/healthcare13202656 - 21 Oct 2025

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Abstract

Background: Telomere attrition has been implicated in immune function and vulnerability to infectious diseases. However, the relation between telomere length and COVID-19 severity remains unclear. Methods: In this cross-sectional study, patients aged 30–75 years, with confirmed SARS-CoV-2 infection, as well as [...] Read more.

Background: Telomere attrition has been implicated in immune function and vulnerability to infectious diseases. However, the relation between telomere length and COVID-19 severity remains unclear. Methods: In this cross-sectional study, patients aged 30–75 years, with confirmed SARS-CoV-2 infection, as well as age- and BMI-matched controls without COVID-19, were recruited over a period of 1 year (2021–2022) from the outpatient clinics and wards of the General Hospitals “Laiko” and “Elpis” in Athens, Greece. Telomere length, expressed as a telomere to single-copy gene (T/S) ratio, was measured in all participants using a quantitative PCR-based method. Participants’ clinical, biochemical, demographic, and respiratory parameters were assessed in relation to their telomere length. Results: Study participants included a total of 139 individuals divided into three groups: controls (n = 34), patients with non-severe COVID-19 (n = 50), and patients with severe COVID-19 (n = 55). Patients with severe COVID-19 had significantly shorter telomeres when compared to both the non-severe COVID-19 group and controls (p < 0.001). Logistic regression analysis confirmed that telomere length was independently associated with disease severity (p < 0.001). Females demonstrated longer telomeres than males (p = 0.039), but no significant correlation was found between telomere length and age. When patients with non-severe and severe COVID-19 were analyzed together, no significant difference in telomere length was observed compared to controls (p = 0.727). Conclusions: Shortened telomeres may be linked to more severe forms of COVID-19, suggesting a potential role for telomere biology in disease progression. Results highlight the need for further research into telomere dynamics as a biomarker for disease susceptibility and outcome in viral infections. Full article

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19 pages, 959 KB

Open AccessArticle

Tracing How the Emergence of Chronic Pain Affects Military Identity: A Narrative Inquiry of Pain Trajectories Among Canadian Veterans

by Umair Majid, Tom Hoppe, Phoebe Priest, Leane Lacroix, Nicholas Held, David Pedlar and Kerry Kuluski

Healthcare 2025, 13(20), 2655; https://doi.org/10.3390/healthcare13202655 - 21 Oct 2025

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Abstract

Background/Objectives: Military identity serves as a foundational lens through which service members navigate the events of everyday military and civilian life. However, the very process that cultivates a sense of unity and purpose can be a double-edged sword in civilian life. Although the [...] Read more.

Background/Objectives: Military identity serves as a foundational lens through which service members navigate the events of everyday military and civilian life. However, the very process that cultivates a sense of unity and purpose can be a double-edged sword in civilian life. Although the prevalence and transition needs are known, few studies have explored how chronic pain specifically disrupts military identity in depth. This qualitative study explores three distinct trajectories through which Veterans with chronic pain experience identity change. Methods: This study used narrative inquiry involving two sets of in-depth interviews with 20 Veterans. Reflexive thematic analysis was employed to describe and differentiate three distinct trajectories of chronic pain. Results: Veterans with chronic pain experience identity change through three overlapping pain trajectories: (1) traumatic injury -> immediate discharge; (2) misdiagnosed/non-traumatic injury -> delayed discharge; and (3) cumulative wear and tear -> gradual discharge. Regardless of trajectory, chronic pain consistently disrupted military identity and forced Veterans to confront tensions between institutional expectations of stoicism and combat readiness and the physical realities of chronic pain during military service. Those interviewed described experiencing fragmented institutional support, uneven access to care, and the systemic invalidation of pain that did not conform to military ideals. Conclusions: These findings underscore the need for Veteran-centred approaches, including responsive services, comprehensive pain science education throughout military careers, early detection of conditions that can lead to chronic pain, and flexible care pathways tailored to the nuances of each pain trajectory and grounded in military culture and lifestyle. Full article

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

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16 pages, 460 KB

Open AccessArticle

Factors Associated with Health Service Use for Self-Reported Balance Problems in Community-Dwelling Adults: A Secondary Analysis of Nationally Representative NHANES 2001–2004 Data

by Shweta Kapur, Kwame S. Sakyi, Joshua L. Haworth, Prateek Lohia and Daniel J. Goble

Healthcare 2025, 13(20), 2654; https://doi.org/10.3390/healthcare13202654 - 21 Oct 2025

Viewed by 210

Abstract

Background: Balance problems are one of the major risk factors for falls. Despite the availability of effective fall prevention interventions, falls and related injuries are rising. This study explored the factors associated with healthcare utilization for balance problems in community-dwelling adults in the [...] Read more.

Background: Balance problems are one of the major risk factors for falls. Despite the availability of effective fall prevention interventions, falls and related injuries are rising. This study explored the factors associated with healthcare utilization for balance problems in community-dwelling adults in the United States. Methods: Study involved secondary analysis of nationally representative National Health and Nutrition Examination Survey 2001–2004 data (latest data with variables of interest at the time of study). All adults (≥40 years) who reported balance problems in the past 12 months were included. Dependent variable was whether the individual ever saw a healthcare professional for balance problems. All analyses were adjusted for probability sampling weights. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated using multivariable logistic regression. Results: Study included 1834 adults with self-reported balance problems (mean age 60.1 years (0.5 SE), 62.3% females). Of these, only 32.13% ever saw a healthcare professional for their balance problems. Having encounter(s) with a healthcare provider for any reason in the past year (AOR 2.45; 95% CI,1.19–5.06; p = 0.017), lack of health insurance (AOR 0.52; 95% CI,0.32–0.84; p = 0.009), falls in the past year (AOR, 1.29; 95% CI,1.03–1.61; p = 0.028) and age (AOR, 0.98; 95% CI,0.97–0.996; p = 0.011) had significant association with healthcare utilization for balance problems. The predicted probability of healthcare use for balance problems decreased from 0.39 for 40-year-olds to 0.26 for 80-year-olds. Conclusions: This study reports the association between factors such as age, health insurance, encounter with a healthcare provider, and falls in the past year with healthcare utilization for balance problems among community-dwelling adults with self-reported balance problems and identifies populations at increased risk of underutilization. Despite the use of older data, it provides useful information for guiding future research in this novel domain of healthcare research. Full article

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69 pages, 3340 KB

Open AccessSystematic Review

Neurodevelopmental Pathways from Maternal Obesity to Offspring Outcomes: An Umbrella Review of Cognitive and Behavioral Consequences Across Development

by Evgenia Gkintoni, Eleni Papachatzi, Erifili Efthymiadou, Emmanuella Magriplis and Apostolos Vantarakis

Healthcare 2025, 13(20), 2653; https://doi.org/10.3390/healthcare13202653 - 21 Oct 2025

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Abstract

Background: Maternal obesity affects 20–25% of pregnancies globally and has been associated with adverse offspring neurodevelopmental outcomes. This umbrella review synthesized evidence on neurodevelopmental pathways linking maternal obesity to offspring cognitive, executive, and behavioral outcomes. Methods: Following PRISMA 2020 guidelines, we [...] Read more.

Background: Maternal obesity affects 20–25% of pregnancies globally and has been associated with adverse offspring neurodevelopmental outcomes. This umbrella review synthesized evidence on neurodevelopmental pathways linking maternal obesity to offspring cognitive, executive, and behavioral outcomes. Methods: Following PRISMA 2020 guidelines, we systematically searched six databases (PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, EMBASE, CINAHL) for studies published 2008–2024. We included original peer-reviewed studies examining maternal pre-pregnancy obesity (BMI ≥ 30 kg/m²) and offspring neurodevelopmental outcomes using prospective cohort, experimental, neuroimaging, or systematic review designs with validated assessments. Risk of bias was assessed using Newcastle–Ottawa Scale, Cochrane RoB 2.0, and SYRCLE guidelines. Results: Analysis of 78 studies encompassing 650,000+ mother–child pairs from 17 countries revealed significant associations. Study designs included prospective cohorts (59%), animal experiments (22%), systematic reviews/meta-analyses (13%), neuroimaging studies (4%), and randomized trials (3%). Maternal obesity (BMI ≥ 30 kg/m²) was associated with reduced cognitive abilities (IQ differences: −2.5 to −5.8 points), impaired executive function (OR 1.4–2.3), and increased ADHD symptoms (OR 1.4–2.8) and emotional dysregulation (OR 1.5–2.2). Dose–response relationships revealed threshold effects at BMI ≥ 30 kg/m², accelerating at BMI ≥ 35 kg/m². Four primary mechanistic pathways were identified: inflammatory, metabolic, epigenetic, and neurotransmitter alterations. Only 57.7% of studies used prospectively measured pre-pregnancy BMI. Conclusions: Observational and experimental evidence indicates maternal obesity represents a modifiable risk factor for offspring neurodevelopmental impairment. The primarily observational human evidence, supported by mechanistic animal studies, suggests multimodal interventions targeting identified pathways during critical windows (pre-conception through early postnatal period) warrant investigation. Full article

(This article belongs to the Special Issue Neurodiagnostics in Public Health: Cognitive Decline, Mental Health, and Emerging Technologies)

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20 pages, 1041 KB

Open AccessArticle

Comparative Evaluation and Performance of Large Language Models in Clinical Infection Control Scenarios: A Benchmark Study

by Shuk-Ching Wong, Edwin Kwan-Yeung Chiu, Kelvin Hei-Yeung Chiu, Anthony Raymond Tam, Pui-Hing Chau, Ming-Hong Choi, Wing-Yan Ng, Monica Oi-Tung Kwok, Benny Yu Chau, Michael Yuey-Zhun Ng, Germaine Kit-Ming Lam, Peter Wai-Ching Wong, Tom Wai-Hin Chung, Siddharth Sridhar, Edmond Siu-Keung Ma, Kwok-Yung Yuen and Vincent Chi-Chung Cheng

Healthcare 2025, 13(20), 2652; https://doi.org/10.3390/healthcare13202652 - 21 Oct 2025

Viewed by 319

Abstract

Background: Infection prevention and control (IPC) in hospitals relies heavily on infection control nurses (ICNs) who manage complex consultations to prevent and control infections. This study evaluated large language models (LLMs) as artificial intelligence (AI) tools to support ICNs in IPC decision-making [...] Read more.

Background: Infection prevention and control (IPC) in hospitals relies heavily on infection control nurses (ICNs) who manage complex consultations to prevent and control infections. This study evaluated large language models (LLMs) as artificial intelligence (AI) tools to support ICNs in IPC decision-making processes. Our goal is to enhance the efficiency of IPC practices while maintaining the highest standards of safety and accuracy. Methods: A cross-sectional benchmarking study at Queen Mary Hospital, Hong Kong assessed three LLMs—GPT-4.1, DeepSeek V3, and Gemini 2.5 Pro Exp—using 30 clinical infection control scenarios. Each model generated clarifying questions to understand the scenarios before providing IPC recommendations through two prompting methods: an open-ended inquiry and a structured template. Sixteen experts, including senior and junior ICNs and physicians, rated these responses on coherence, conciseness, usefulness and relevance, evidence quality, and actionability (1–10 scale). Quantitative and qualitative analyses assessed AI performance, reliability, and clinical applicability. Results: GPT-4.1 and DeepSeek V3 scored significantly higher on the composite quality scale, with adjusted means (95% CI) of 36.77 (33.98–39.57) and 36.25 (33.45–39.04), respectively, compared with Gemini 2.5 Pro Exp at 33.19 (30.39–35.99) (p < 0.001). GPT-4.1 led in evidence quality, usefulness, and relevance. Gemini 2.5 Pro Exp failed to generate responses in 50% of scenarios under structured prompt conditions. Structured prompting yielded significant improvements, primarily by enhancing evidence quality (p < 0.001). Evaluator background influenced scoring, with doctors rating outputs higher than nurses (38.83 vs. 32.06, p < 0.001). However, a qualitative review revealed critical deficiencies across all models, for example, tuberculosis treatment solely based on a positive acid-fast bacilli (AFB) smear without considering nontuberculous mycobacteria in DeepSeek V3 and providing an impractical and noncommittal response regarding the de-escalation of precautions for Candida auris in Gemini 2.5 Pro Exp. These errors highlight potential safety risks and limited real-world applicability, despite generally positive scores. Conclusions: While GPT-4.1 and DeepSeek V3 deliver useful IPC advice, they are not yet reliable for autonomous use. Critical errors in clinical judgment and practical applicability highlight that LLMs cannot replace the expertise of ICNs. These technologies should serve as adjunct tools to support, rather than automate, clinical decision-making. Full article

(This article belongs to the Section Artificial Intelligence in Healthcare)

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16 pages, 869 KB

Open AccessArticle

Characteristics and Distribution of Radiologists in Saudi Arabia: A Cross-Sectional Study Based on National Data

by Jaber Hussain Alsalah

Healthcare 2025, 13(20), 2651; https://doi.org/10.3390/healthcare13202651 - 21 Oct 2025

Viewed by 294

Abstract

Background: In healthcare institutions, radiologists play an essential role in patients’ care, enabling them to begin treatment and start their recoveries. However, data on the characteristics and distribution of the radiology workforce in Saudi Arabia are limited. Therefore, this study aimed to conduct [...] Read more.

Background: In healthcare institutions, radiologists play an essential role in patients’ care, enabling them to begin treatment and start their recoveries. However, data on the characteristics and distribution of the radiology workforce in Saudi Arabia are limited. Therefore, this study aimed to conduct a comprehensive analysis of the radiology workforce in SA based on national data and identify key distributional and specialty trends relevant to workforce planning and radiology service delivery. Methods: The following data were obtained from the Saudi Commission for Health Specialties (SCFHS) Registry: total number of registered radiologists, age, subspecialty, professional classification, place of qualification, and geographical location. Descriptive statistics were used for data analysis. Additionally, the findings were compared with those of published international benchmarks. Results: There were 5150 radiologists registered with SCFHS in SA, which corresponded to 147 radiologists per 1,000,000 inhabitants. The mean age was 40.8 years (standard deviation [SD] 9.8), with 60% of them being aged 30–44 years. Most of the radiologists specialised in general diagnostic radiology (83.7%), with few of them specialising in interventional radiology (1.8%), paediatric radiology (1.1%), and breast imaging (0.9%). The workforce mainly comprised consultants (35.0%), followed by registrars (29.7%) and senior registrars (22.7%). Two-thirds (65.0%) of the radiologists had obtained their qualifications abroad. More than half of the radiologists resided in three provinces: Riyadh (29%), Mecca (23%), and the Eastern Region (15%), while several provinces had fewer than 2% of the available workforce. Conclusions: The radiology workforce in SA is relatively young and has a higher density than the average in the European Union. Further, most of the radiologists are professionally classified as consultants or registrars. However, there is a clear imbalance in their geographic distribution, which is consistent with the population sizes of the respective cities. Targeted training expansion and reduced reliance on foreign-trained professionals are warranted to meet future service demands in line with the Vision 2030 objectives. Full article

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13 pages, 230 KB

Open AccessArticle

Hostility in the ICU Waiting Room: Extrapunitive and Intropunitive Reactions Among Family Members

by Zoe Konstanti, Fotios Tatsis, Konstantinos Stamatis, Foteini Veroniki, Georgios Papathanakos, Vasilios Koulouras and Mary Gouva

Healthcare 2025, 13(20), 2650; https://doi.org/10.3390/healthcare13202650 - 21 Oct 2025

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Abstract

Background/Objectives: Families of ICU patients endure intense psychological strain. While anxiety and depression are well documented, less attention has been given to hostility—expressed both outwardly as anger and inwardly as guilt or self-criticism. Hostility, however, often shapes the climate of the ICU waiting [...] Read more.

Background/Objectives: Families of ICU patients endure intense psychological strain. While anxiety and depression are well documented, less attention has been given to hostility—expressed both outwardly as anger and inwardly as guilt or self-criticism. Hostility, however, often shapes the climate of the ICU waiting room and the collaboration between families and staff. This study examined the levels and forms of hostility among ICU relatives, focusing on demographic predictors that may influence extrapunitive and intropunitive reactions. Methods: A cross-sectional study was conducted between June 2018 and December 2019 with 215 family members of ICU patients. Hostility was assessed using the Hostility and Direction of Hostility Questionnaire (HDHQ). Descriptive statistics, t-tests, ANOVAs, and multivariate regression analyses were performed to examine the effects of age, gender, and education on hostility subscales. Results: Male relatives exhibited higher acting-out hostility (M = 4.80, SD = 2.63) compared with female relatives (M = 4.12, SD = 2.21; t(216) = 1.96, p = 0.05, Cohen’s d = 0.28). Relatives with lower educational attainment showed significantly higher total hostility (β = −1.23, 95% CI [−1.78, −0.67], p < 0.001) and greater self-criticism (β = −0.44, 95% CI [−0.84, −0.03], p = 0.037). Younger age was associated with increased acting-out hostility (β = −0.029, 95% CI [−0.055, −0.002], p = 0.035). The regression models explained 12–26% of the variance across subscales (R² range = 0.12–0.26). These findings suggest two vulnerability trajectories: an externalized (extrapunitive) pattern in younger men and a broad internalized (intropunitive) pattern in relatives with lower education. Conclusions: Hostility in ICU families emerges in two distinct trajectories: externalized anger among young men and broad hostility in relatives with lower education. Recognizing these patterns is vital for preventing conflict, addressing hidden guilt and self-blame, and developing subgroup-sensitive interventions. The ICU waiting room is a space not only of fear and uncertainty but also of anger, guilt, and fragile attempts at psychological survival—dimensions that deserve systematic attention in both clinical practice and research. Full article

(This article belongs to the Special Issue Innovative Approaches to Chronic Disease Patient Care)

14 pages, 264 KB

Open AccessArticle

Impact of Chemotherapy on Motor–Cognitive Dual-Task Performance in Strength and Mobility Tests

by Almudena Martínez-Sánchez, Candela Guerrero-Torrico, Francisco Javier Dominguez-Muñoz, Narcis Gusi and Santos Villafaina

Healthcare 2025, 13(20), 2649; https://doi.org/10.3390/healthcare13202649 - 21 Oct 2025

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Abstract

Background/Objectives: Chemotherapy often leads to persistent physical and cognitive impairments, and while the dual-task paradigm is a sensitive tool for detecting such deficits, its application to functional strength in oncology remains largely unexplored. Methods: This cross-sectional study, while not designed to [...] Read more.

Background/Objectives: Chemotherapy often leads to persistent physical and cognitive impairments, and while the dual-task paradigm is a sensitive tool for detecting such deficits, its application to functional strength in oncology remains largely unexplored. Methods: This cross-sectional study, while not designed to establish causality, included 44 participants including cancer patients (11 undergoing chemotherapy and 15 post-treatment survivors) and healthy controls. Functional fitness was assessed with the Senior Fitness Test battery under single- and dual-task conditions. The dual-task condition incorporated a cognitive subtraction task, and the dual-task cost was calculated. Group comparisons were analyzed using t-tests and ANOVA with effect sizes reported (p < 0.05). Results: Within-group comparisons showed that the cancer group exhibited reduced performance from the single- to the dual-task condition, with significant declines in strength and mobility (Chair Stand Test, p = 0.011; Timed Up and Go, p < 0.001). Greater dual-task costs were observed in the Arm Curl Test for cognitive (p = 0.005) and success (p = 0.004) outcomes. Conclusions: Dual-task testing revealed greater impairments in cancer patients and survivors, supporting the impact of chemotherapy-related cognitive impairment and highlighting the need for integrated motor–cognitive rehabilitation strategies. Further research is warranted in this field, employing larger sample sizes and stratified analyses by specific cancer types, and including a spectrum of complexity in the cognitive task to characterize the effects of cancer and its treatment on motor–cognitive integration. Full article

(This article belongs to the Special Issue Impact of Physical Activity on Chronic Diseases)

11 pages, 1576 KB

Open AccessArticle

Inter-Finger Variability of SpO₂ During Hypoxemia and Step Resaturation

by Simon Walzel, Veronika Rafl-Huttova, Martin Rozanek, Petr Kudrna, Marian Rybar and Jakub Rafl

Healthcare 2025, 13(20), 2648; https://doi.org/10.3390/healthcare13202648 - 21 Oct 2025

Viewed by 247

Abstract

Background: Pulse oximetry is a non-invasive method for continuous monitoring of peripheral blood oxygen saturation (SpO₂) to estimate arterial oxygen saturation. Previous studies suggested that SpO₂ measurements show variability depending on the particular finger that is used for measurement. To [...] Read more.

Background: Pulse oximetry is a non-invasive method for continuous monitoring of peripheral blood oxygen saturation (SpO₂) to estimate arterial oxygen saturation. Previous studies suggested that SpO₂ measurements show variability depending on the particular finger that is used for measurement. To date, no study has compared all fingers for SpO₂ under hypoxemia and during continuous simultaneous monitoring with randomization of finger sensor placement. Objectives: The aim of this study was to assess the inter-finger variability of SpO₂ values during sequential desaturation and step resaturation. Methods: Forty-three out of forty-five healthy participants (age 23.0 ± 1.8 years, BMI 24.0 ± 4.4 kg·m^–2) completed the experimental assessment with short-term induced hypoxemia by consecutive inhalation of three prepared gas mixtures with reduced oxygen concentrations (14%, 12%, and 10%). SpO₂ was measured continuously with the Masimo Radical-97 (Masimo Corp., Irvine, CA, USA) pulse oximeters. Results: The SpO₂ measured on the thumb was lower than all other fingers by 0.6% to 0.7% SpO₂, a systematic difference that is less than the clinically accepted accuracy of oximeters. No difference in SpO₂ dynamics was found between any of the fingers during step resaturation. Conclusions: A systematic difference in measured SpO₂ exists between the thumb and the other fingers during desaturation, which should be considered at least as well as the impact of the performance of a particular oximeter, sensor placement or anatomical variability. Full article

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14 pages, 266 KB

Open AccessArticle

Lifestyle in Nursing Students: Physical Activity Level, Diet Quality, Body Composition, and Cardiovascular Risk (ABSI)

by Carmen María Guerrero-Agenjo, Sergio Rodríguez-Cañamero, Ángel López-González, Cristina Rivera-Picón, Samantha Díaz-González, Carlos Durantez-Fernandez, Jose Alberto Laredo-Aguilera, Juan Manuel Carmona-Torres, Jesús López-Torres Hidalgo and Joseba Rabanales-Sotos

Healthcare 2025, 13(20), 2647; https://doi.org/10.3390/healthcare13202647 - 21 Oct 2025

Viewed by 275

Abstract

Background/Objective: One of the life stages that affects the consolidation of habits and health is the university stage. This transition to adulthood is associated with a decrease in physical activity, increasing the risk of cardiovascular disease. This study describes lifestyle habits related [...] Read more.

Background/Objective: One of the life stages that affects the consolidation of habits and health is the university stage. This transition to adulthood is associated with a decrease in physical activity, increasing the risk of cardiovascular disease. This study describes lifestyle habits related to physical activity level, diet quality, and body composition in nursing students and analyzes cardiovascular risk using the ABSI-z index. Methods: We conducted a cross-sectional study with 296 students from the Faculty of Nursing of Albacete (Spain). Physical activity was assessed via the IPAQ-SF. Body composition was measured by bioimpedance, from which BMI and ABSI-z scores were obtained as indicators of cardiovascular risk. The eating patterns of the participants were analyzed. Results/Discussion: The active students had significantly better body composition, with greater fat-free mass and muscle mass than the sedentary students, both in men (p = 0.037 and p = 0.046, respectively) and in women (p = 0.002 and p = 0.007). These findings corroborate evidence of the protective role of physical activity in maintaining metabolic health. The analysis of the ABSI-z score revealed different patterns in the distribution of body fat. High ABSI values were associated with greater abdominal girth (p < 0.001) and visceral fat (p < 0.001) in women, confirming its usefulness as an early marker of cardiovascular risk in university students. In contrast, the fulfillment of healthy dietary criteria was low, especially in the consumption of legumes (19%) and fish (25.9%). Conclusions: Regular physical activity is a determining factor in the body composition of university students, and ABSI is a good indicator of cardiovascular risk. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches to Chronic Disease Management)

11 pages, 213 KB

Open AccessArticle

A Study on the Equity Dilemma and Reform Strategies of Drug Reimbursement in China’s Medical Insurance System

by Minghao Yang, Yumeng Zhang, Qiang Su, Yuanhao Sui and Lihua Sun

Healthcare 2025, 13(20), 2646; https://doi.org/10.3390/healthcare13202646 - 21 Oct 2025

Viewed by 265

Abstract

Background: The continuous expansion of the National Reimbursement Drug List has led to an increasing cost disparity among alternative drugs for the same indications. Under the current proportional reimbursement mechanism, choosing higher-cost treatments often results in higher compensation. Given the lack of empirical [...] Read more.

Background: The continuous expansion of the National Reimbursement Drug List has led to an increasing cost disparity among alternative drugs for the same indications. Under the current proportional reimbursement mechanism, choosing higher-cost treatments often results in higher compensation. Given the lack of empirical evidence on whether income affects the medication choices of insured individuals in the Chinese context, this study aims to evaluate the impact of income levels on drug selection, providing a basis for optimizing the medical insurance reimbursement policy. Methods: This study extracts data from hospitalized patients enrolled in basic medical insurance from the China Health and Retirement Longitudinal Study (CHARLS) database and preprocesses it in Excel. Subsequently, SPSS is used to conduct descriptive statistics, difference analysis, correlation analysis, and regression analysis on the processed data to explore the impact of income levels on drug selection. Results: After controlling for length of hospitalization and hospitalization costs, the regression coefficient for urban employee basic medical insurance participants is β = 0.505 (p < 0.01), and the regression coefficient for new rural cooperative medical insurance participants is β = 0.195 (p < 0.01). This means that, regardless of whether participants are enrolled in urban employee basic medical insurance or new rural cooperative medical insurance, an increase in income will lead to higher hospitalization drug costs. Conclusions: Compared to low-income insured individuals, high-income participants in the basic medical insurance are more likely to choose higher-cost drugs among alternatives, which leads to unfair reimbursement under the current proportional reimbursement system. Full article

(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)

14 pages, 607 KB

Open AccessSystematic Review

Enhancing Patient Safety in Refractory Ventricular Fibrillation: A Systematic Review of Double Sequential and Vector Change Defibrillation Barriers

by Kyriakos Alexandrou, Elina Khattab and Evanthia Asimakopoulou

Healthcare 2025, 13(20), 2645; https://doi.org/10.3390/healthcare13202645 - 21 Oct 2025

Viewed by 351

Abstract

Background/Objectives: Ventricular fibrillation (VF) is the most common shockable rhythm in cardiac arrest, yet refractory VF (RVF), defined as persistent VF after ≥three failed defibrillation attempts, poses a significant challenge. Two alternative strategies, double sequential external defibrillation (DSED) and vector change (VC) defibrillation, [...] Read more.

Background/Objectives: Ventricular fibrillation (VF) is the most common shockable rhythm in cardiac arrest, yet refractory VF (RVF), defined as persistent VF after ≥three failed defibrillation attempts, poses a significant challenge. Two alternative strategies, double sequential external defibrillation (DSED) and vector change (VC) defibrillation, aim to enhance defibrillation success where conventional methods fail. This review evaluates the clinical feasibility, safety, and implementation barriers of DSED and VC in RVF cases. Methods: A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and CINAHL databases were searched for studies published between January 2015 and August 2025. Eligible studies included adult RVF patients treated with DSED or VC. Outcomes assessed included implementation barriers, safety concerns, and methodological limitations. Study quality was evaluated using the Newcastle–Ottawa Scale and the Cochrane RoB 2 tool. Results: Sixteen studies met the inclusion criteria. Identified barriers were grouped into practical and methodological categories. Practical barriers included the need for dual defibrillators and pads, delays in shock coordination, inconsistent protocols, equipment compatibility issues, and dependence on trained personnel. Methodological barriers included small sample sizes, retrospective designs, inconsistent RVF definitions, and incomplete reporting of neurological outcomes. Conclusions: DSED and VC defibrillation may offer potential benefits in managing RVF, but their use is hindered by significant practical and methodological barriers. Due to the limited number of randomized trials, further high-quality studies with standardized definitions and safety endpoints are needed to clarify their clinical utility and inform implementation. Full article

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12 pages, 216 KB

Open AccessStudy Protocol

Transnational Healthcare Practices Among Afghan, Syrian, and Ukrainian Refugee Older Adults in the Greater Toronto Area: A Study Protocol

by Sepali Guruge, Lu Wang, Kateryna Metersky, Areej Al-Hamad, Zhixi Zhuang, Cristina Catallo, Hasina Amanzai, Lixia Yang, Yasin M. Yasin and Vathsala Illesinghe

Healthcare 2025, 13(20), 2644; https://doi.org/10.3390/healthcare13202644 - 21 Oct 2025

Viewed by 240

Abstract

The global population of older adults is growing rapidly, and refugees are now a significant proportion of the older adult population in Canada. Transnational healthcare practices (THPs)—seeking health information or services from the country of origin—may be an essential strategy used by refugee [...] Read more.

The global population of older adults is growing rapidly, and refugees are now a significant proportion of the older adult population in Canada. Transnational healthcare practices (THPs)—seeking health information or services from the country of origin—may be an essential strategy used by refugee older adults in Canada, but few studies have explored this phenomenon. This is a protocol for a study, which is aimed at developing a comprehensive understanding of the role THPs play in the lives of older adults from three refugee groups (Afghan, Syrian and Ukrainian) (re)settled in the Greater Toronto Area (GTA), Canada. It will be informed by Constructivist Grounded Theory and will consist of three phases. Phase 1 will involve semi-structured individual interviews with Afghan, Syrian, and Ukrainian refugee older adults living in the GTA (n = 75–90) to explore their perspectives and experiences with various types of THP. Phase 2 will also involve semi-structured interviews with 75–90 refugee older adults from the three communities to examine the role of THP in stress, coping, and resilience in the context of health promotion, illness diagnosis, and disease management as well as the individual and contextual factors driving the use of THPs. Phase 3 will involve six focus groups (n = 36–48) with refugee older adults from these communities to explore what information, care, supports, technology, and services are needed to manage their health and illnesses locally. This project will advance knowledge in the areas of (re)settlement and integration, aging, local healthcare access, and THPs among refugee older adults in Canada. The findings will inform more effective integration policies and the delivery of efficient and equitable health information, care, support, technology, and services that address the healthcare needs of refugee older adults, enabling them to age well and age in place. Full article

20 pages, 683 KB

Open AccessArticle

The Digital Amplifier in Medical Insurance: How Chinese Provincial Pooling Policy Optimizes Chronic Disease Management

by Ming Zeng, Huan Cheng and Weike Zhang

Healthcare 2025, 13(20), 2643; https://doi.org/10.3390/healthcare13202643 - 21 Oct 2025

Viewed by 348

Abstract

Background: Chronic diseases have proliferated worldwide and become one of the foremost public health challenges. The provincial pooling policy of Chinese Basic Medical Insurance Program (BMIP) (hereinafter the Policy) is conducive to coordinating healthcare resources more broadly and containing medical costs more effectively, [...] Read more.

Background: Chronic diseases have proliferated worldwide and become one of the foremost public health challenges. The provincial pooling policy of Chinese Basic Medical Insurance Program (BMIP) (hereinafter the Policy) is conducive to coordinating healthcare resources more broadly and containing medical costs more effectively, which creates opportunities to improve chronic disease patients’ health outcomes. Against this backdrop, this study aims to identify how the Policy affects chronic disease patients’ health outcomes. Methodology: Utilizing data from the China Family Panel Studies (CFPS) across 31 provinces (except Hong Kong, Macao, and Taiwan) from 2010 to 2022, we constructed a panel of 26,585 observations on chronic disease patients enrolled in the BMIP. We employed a difference-in-differences (DID) design to identify the causal effects of the Policy on self-rated health (SRH) supplemented by a series of robustness checks, including event-study analysis, placebo tests, and propensity score matching DID (PSM-DID). Results: The results show that the Policy enhances Chinese chronic disease patients’ health outcomes across various robustness assessments. However, the effects exhibit heterogeneity in that the Policy can more effectively improve the health outcomes of urban patients, low-income patients, and highly educated patients. The mechanism analysis indicates that the Policy can enhance chronic disease patients’ health outcomes by reducing the out-of-pocket ratio, increasing household income, and stimulating consumer expenditure. Furthermore, digital technology can amplify the effectiveness of the Policy in Chinese chronic disease patients’ health outcomes. Conclusions: These findings provide valuable insights into the potential of provincial pooling and digital technology to optimize Chinese chronic disease management. Full article

(This article belongs to the Special Issue Digital Health and AI for Chronic Disease Control and Management)

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17 pages, 750 KB

Open AccessArticle

Challenges and Recommendations for Oral Healthcare of Older Adults in a Long-Term Care Facility

by Haslina Rani, Amalina Alya Azizan, Nurul Izzah Abdul Walad, Siti Aisya Athirah Hassan, Tuti Ningseh Mohd Dom, Daphne Shu Huey Yeoh, Joyce Wuen Cheer Tay, Muhammad Syafiq Asyraf Rosli, Nur Saadah Mohamad Aun, Aznida Firzah Abdul Aziz, Kaung Myat Thwin and In Meei Tew

Healthcare 2025, 13(20), 2642; https://doi.org/10.3390/healthcare13202642 - 20 Oct 2025

Viewed by 395

Abstract

Background/Objectives: As the aging population is growing globally, oral health has become integral to ensuring healthy aging and quality of life. This study assessed the oral health status of older adults in a Malaysian long-term care facility and explored caregiver-reported challenges in providing [...] Read more.

Background/Objectives: As the aging population is growing globally, oral health has become integral to ensuring healthy aging and quality of life. This study assessed the oral health status of older adults in a Malaysian long-term care facility and explored caregiver-reported challenges in providing oral care. Methods: A convergent mixed-methods design was applied, involving 115 residents aged ≥60 years and 16 caregivers in a public facility. The residents’ oral health was assessed using interviewer-assisted questionnaires (demography, dependency level, Oral Frailty Five-item Checklist), clinical examinations (dental caries status, number of remaining teeth, oral and denture hygiene), and the Decayed, Missing, and Filled Teeth (DMFT) index. Focus group discussions with caregivers were conducted, transcribed, and thematically analyzed. Quantitative data were descriptively analyzed using SPSS version 29.0. Results: Over one-third of the residents (39%) were moderately to highly dependent on caregivers. All had experienced dental caries, with most having fewer than 20 teeth (92.9%) and requiring dentures (81.7%). Overall, both oral and denture hygiene were poor. Assessment of oral frailty indicated that the majority of residents (94.8%) were at risk of impaired oral function. A thematic analysis identified four key themes influencing oral health: (1) health and oral health conditions of residents; (2) variety in oral care practices; (3) older adults’ attitudes and behaviors; and (4) system factors. These themes were mapped in a conceptual framework demonstrating multilevel influences on oral care. Conclusions: Despite the single-center design, these findings provide actionable insights for improving geriatric oral health policies in Malaysia. Practical recommendations include integrating oral health into aged-care standards, expanding mobile dental services, and establishing oral care champions within facilities. Addressing these challenges is critical to improving quality of life and aligning long-term care practices with the WHO’s healthy aging priorities. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Health Care: Third Edition)

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22 pages, 5517 KB

Open AccessArticle

Medical vs. Organizational Complaints: A Machine Learning Analysis Reveals Divergent Patterns in Patient Reviews Across Russian Cities

by Irina Evgenievna Kalabikhina, Anton Vasilyevich Kolotusha and Vadim Sergeevich Moshkin

Healthcare 2025, 13(20), 2641; https://doi.org/10.3390/healthcare13202641 - 20 Oct 2025

Viewed by 458

Abstract

Background: The growth of digital patient feedback presents a new opportunity for healthcare quality monitoring. This study addresses the need to automatically classify the content of patient reviews to identify primary sources of dissatisfaction. Objective: The purpose of this study is to develop [...] Read more.

Background: The growth of digital patient feedback presents a new opportunity for healthcare quality monitoring. This study addresses the need to automatically classify the content of patient reviews to identify primary sources of dissatisfaction. Objective: The purpose of this study is to develop a machine learning algorithm for classifying negative patient reviews into two core categories: medical content (M—pertaining to diagnosis, treatment, and outcomes) and organizational support (O—pertaining to logistics, cost, and communication). We aim to identify which type of concern prevails and to analyze variations across cities, patient gender, and medical specialties. Methods: A database of 18,680 negative patient reviews (rated 1 star) was compiled from the Russian aggregator infodoctor.ru for the period from July 2012 to August 2023. A training set was created using an independent annotation procedure with three experts. A logistic regression model was trained to classify reviews into M and O categories, demonstrating an accuracy of 88.5%. Results: The analysis revealed a significant structural shift in Moscow, where since 2021, medical (M) complaints began to prevail over organizational (O) ones. This trend was not observed in St. Petersburg or other major Russian cities. Notably, in St. Petersburg, M-type reviews were more common within the most represented medical specialties, whereas O-type reviews consistently dominated in other cities. Gender differences were most pronounced in St. Petersburg, where women were more frequently authors of M reviews and men of O reviews. Conclusions: The developed algorithm provides a valuable tool for the automated monitoring of patient feedback. It enables healthcare managers to distinguish between clinical and service-related issues, facilitating targeted improvements in medical service quality and patient satisfaction. Full article

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20 pages, 543 KB

Open AccessReview

Tools for Detecting Ageing in People with Autism Spectrum Disorder: A Scoping Review

by Maider Ugartemendia-Yerobi, Beatriz Pereda-Goikoetxea, Maria Isabel Trespaderne and Jaione Lacalle

Healthcare 2025, 13(20), 2640; https://doi.org/10.3390/healthcare13202640 - 20 Oct 2025

Viewed by 182

Abstract

Background: People with Autism Spectrum Disorder (ASD) require a customised, multidisciplinary plan throughout their lifetime to support optimal health. The purpose of this scoping review was to synthesise research on the main scales used to detect signs of ageing in people with ASD. [...] Read more.

Background: People with Autism Spectrum Disorder (ASD) require a customised, multidisciplinary plan throughout their lifetime to support optimal health. The purpose of this scoping review was to synthesise research on the main scales used to detect signs of ageing in people with ASD. Methods: Eligible papers published between January 2003 and August 2025 were identified through searches of PubMed, PsycInfo, Scopus, Web of Science, NICE and Cochrane databases. The assessment was performed using the Joanna Briggs Institute critical appraisal and extraction checklist. Of the 820 papers reviewed, 24 were found to meet the established criteria. Results: Based on the evidence collected, 57 tools focusing on specific domains within the Comprehensive Geriatric Assessment were identified: 19 addressed the functional domain, 18 the mental, 6 the biomedical, 1 the social, 2 related to frailty, 1 to fall risk, and 10 to quality of life. Conclusions: This review highlights the need to obtain a ‘multi-domain’ tool for the detection of ageing in autistic people, which would facilitate the development of a Comprehensive Geriatric Assessment that makes planning customised care possible. Full article

(This article belongs to the Special Issue Nursing Care for Patients with Autism Spectrum Disorder)

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24 pages, 2821 KB

Open AccessSystematic Review

Assessment Tools and Psychosocial Consequences of Smartphone Addiction in Nursing Students: A Systematic Review and Meta-Analysis

by María Dolores Lazo-Caparrós, José Luis Gómez-Urquiza, Ana González-Díaz, Inmaculada Pérez-Conde, Piedad Gómez-Torres and María José Membrive-Jiménez

Healthcare 2025, 13(20), 2639; https://doi.org/10.3390/healthcare13202639 - 20 Oct 2025

Viewed by 903

Abstract

Background/Objectives: Problematic smartphone use is common among nursing students and has been linked to academic and psychosocial difficulties. This PROSPERO-registered systematic review (CRD42024559668) identified the instruments used to assess smartphone addiction in nursing students and, secondarily, pooled typical addiction levels using the [...] Read more.

Background/Objectives: Problematic smartphone use is common among nursing students and has been linked to academic and psychosocial difficulties. This PROSPERO-registered systematic review (CRD42024559668) identified the instruments used to assess smartphone addiction in nursing students and, secondarily, pooled typical addiction levels using the Smartphone Addiction Scale–Short Version (SAS-SV; 10–60) and examined psychosocial correlates. Methods: Following PRISMA 2020, we searched PubMed, Scopus, Web of Science, CINAHL and ScienceDirect from 1 January 2014 to 9 May 2024. Eligible studies assessed problematic smartphone use in undergraduate nursing students with validated instruments, while development-only studies and pandemic-specific contexts were excluded. Methodological quality was appraised using the JBI checklist, and a random-effects meta-analysis was performed to estimate pooled scores and explore cross-study variability. Results: Fifty-three studies met inclusion; eleven contributed to the SAS-SV meta-analysis (N = 5586). The pooled mean score was 29.5 (95% CI 27.7–31.3), with very high heterogeneity (I² = 98%). Sensitivity analyses yielded similar results, and no publication bias was detected. Across studies, higher smartphone addiction was correlated with elevated stress and anxiety, sleep disturbance, and poorer academic and clinical performance. Conclusions: Nursing students’ SAS-SV scores cluster around ~29/60, with substantial between-study variability. Higher addiction scores were consistently associated with stress, anxiety, poor sleep, and reduced academic and clinical performance. However, interpretation is limited by the cross-sectional nature of the included studies and the very high heterogeneity observed. Standardising measurement is essential, but equally important is developing targeted educational interventions to foster healthier smartphone habits in nursing education. These results may guide nursing educators and institutions to design programs that foster healthier digital habits and support students’ academic and clinical performance. Full article

(This article belongs to the Section Mental Health and Psychosocial Well-being)

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14 pages, 535 KB

Open AccessArticle

Evaluation of Safety and Acceptability of 40 Hz Amplitude-Modulated Auditory Stimulation in Healthy Older People: A Prospective Study from Japan

by Shunsuke Sato, Kazuma Maeda, Hiroki Chinen, Shinzo Hiroi, Keita Tanaka, Eriko Ogura, Hiroki Fukuju, Kentaro Morimoto, Yoshiki Nagatani, Kazuki Takazawa, Taiki Kasai, Yumi Ohta and Manabu Ikeda

Healthcare 2025, 13(20), 2638; https://doi.org/10.3390/healthcare13202638 - 20 Oct 2025

Viewed by 313

Abstract

Background/Objectives: Dysregulated gamma oscillations are associated with cognitive dysfunction. Auditory stimulation at 40 Hz enhances neural activity in brain regions associated with learning, attention, and memory. This study assessed the safety and acceptability of 40 Hz amplitude-modulated auditory stimulation in healthy older people. [...] Read more.

Background/Objectives: Dysregulated gamma oscillations are associated with cognitive dysfunction. Auditory stimulation at 40 Hz enhances neural activity in brain regions associated with learning, attention, and memory. This study assessed the safety and acceptability of 40 Hz amplitude-modulated auditory stimulation in healthy older people. Auditory stimuli were created using popular songs, where vocals and background music were separated and independently amplitude-modulated at 40 Hz with different modulation depths to generate periodic 40 Hz gamma waveforms. Methods: In this open-label, single-arm study, healthy participants aged ≥65 years received 40 Hz amplitude-modulated auditory stimulation daily via a smartphone for 28 days through earphones/headphones. Safety was assessed through adverse event (AE) monitoring and changes in clinical scores for depression, cognitive function, and hearing thresholds. Acceptability was evaluated by adherence rates, listening time, dropout reasons, volume levels, intent for future use, and subjective impressions of the sound source on a 7-point Likert scale. Results: Among 28 participants (mean age 69.1 years, 53.6% female), six reported 12 AEs, with six considered device-related (e.g., ear discomfort, jaw pain, musculoskeletal stiffness). The AEs observed were mild or moderate. Scores for cognitive function, depression, and hearing thresholds did not worsen during the study period. Adherence was observed in 96.4%, with 85.7% expressing interest in continuing. Most participants rated the sounds’ unnaturalness between 2 and 3 and discomfort between 1 and 3 on the 7-point Likert scale. Conclusions: The intervention was well tolerated and acceptable in study participants, with no major safety concerns identified. Auditory stimulation did not cause severe discomfort or reduce acceptability. Further studies should explore the long-term effects and broader clinical applications. Full article

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11 pages, 901 KB

Open AccessArticle

How Does Age at Diagnosis Influence Multiple Myeloma Survival? Empirical Evidence

by Michael O. Lawanson, Ernest Griffin, Daniel Berleant, Phillip Farmer, Ragen Hodge, Carolina Schinke, Cody Ashby and Michael A. Bauer

Healthcare 2025, 13(20), 2637; https://doi.org/10.3390/healthcare13202637 - 20 Oct 2025

Viewed by 673

Abstract

Background/Objectives: Disparities in multiple myeloma (MM) survival occur based on factors like genetics, age, race, income level, and access to healthcare. The impact of age at diagnosis on MM survival is not fully understood and continues to draw research attention. This study explores [...] Read more.

Background/Objectives: Disparities in multiple myeloma (MM) survival occur based on factors like genetics, age, race, income level, and access to healthcare. The impact of age at diagnosis on MM survival is not fully understood and continues to draw research attention. This study explores the link between age at diagnosis and survival outcomes using data from the University of Arkansas Medical Sciences Myeloma Center Database (MMDB). Methods: Kaplan–Meier curves and Cox models were used to analyze the data. The log-transformed age variable strongly predicted survival. Results: The analysis found survival curves showing that patients in lower age brackets tend to have better survival profiles. Thus, for example, those in the oldest category (>70) showed the steepest decline, while the youngest age category (under 40) had better survival. Spline functions identified a non-linear relationship between age and survival. The likelihood ratio test, Wald test, and log-rank score test confirmed that the overall model was statistically significant, indicating that the spline-based approach effectively captured the relationship between age and survival. Further analysis using a stratified Cox model by age group showed significant risk differences. Patients aged 50–59, 60–69, and over 70 all had higher risks of death compared to younger patients, with those over 70 having a 3.3 times greater risk. Conclusions: In conclusion, the study confirmed that age at diagnosis has a significant association with survival outcomes for MM patients. Full article

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14 pages, 4431 KB

Open AccessArticle

Heterogeneity in Responding to Clinical Vignettes Depicting Sepsis Suggests That Non-Medical Data May Drive the Decision-Making Process

by Hossam Gad, Abdelhamed Elgazar and Krzysztof Laudanski

Healthcare 2025, 13(20), 2636; https://doi.org/10.3390/healthcare13202636 - 20 Oct 2025

Viewed by 198

Abstract

Background/Objectives: Treating critically ill patients is complex and often subjective. This study investigates adherence to clinical guidelines for sepsis among different providers. Considering the strengths of the recommendations, we hypothesize that heterogeneity in the decision-making process will be low and independent of [...] Read more.

Background/Objectives: Treating critically ill patients is complex and often subjective. This study investigates adherence to clinical guidelines for sepsis among different providers. Considering the strengths of the recommendations, we hypothesize that heterogeneity in the decision-making process will be low and independent of provider background and psychological makeup. Methods: This cohort study used two clinical vignettes of sepsis. Providers were given standardized treatment plans for 7 days, and their responses were recorded. Demographical, professional, and psychological (ambiguity tolerance, defensiveness, anxiety due to uncertainty, risk-taking behavior, decision styles, and optimism) variables were acquired. Results: Crystalloids were commonly used in both vignettes. Pressor engagement, especially norepinephrine, increased significantly after the third day. Providers recommended antibiotics and no provider stopped antibiotic therapy. Cluster analysis revealed no differences in therapy implementation among provider types, but some differences existed between the two vignettes. Cluster #1 was characterized by the implementation of early light bundle therapy combined with the use of pressors and a notable enhancement in therapies by the fifth day (Early Cluster). Cluster #2 (Minimalists) involved consistent engagement only in light bundle therapy throughout the treatment period. Cluster #3 (Escalation) comprised providers who rapidly escalated treatment using multiple different modalities. Cluster #3 stood out as most providers were female, non-MD, with significant ICU duties, and enhanced rational thinking. Conclusions: Providers differ in implementation styles of the sepsis treatment standard based on types of therapies selected not studied psychological variables. Full article

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15 pages, 3647 KB

Open AccessArticle

Association Between Unmet Healthcare Needs and Depression in Older Adults: Evidence from the Korean National Health and Nutrition Examination Survey

by Ji-Woo Seok, Kahye Kim, Jaeuk U. Kim and Mi Hong Yim

Healthcare 2025, 13(20), 2635; https://doi.org/10.3390/healthcare13202635 - 20 Oct 2025

Viewed by 251

Abstract

Background: Studies on the relationship between unmet healthcare needs and depression in older adults are limited in Asia. This study aimed to investigate the relationship between unmet healthcare needs and the risk of depression in older adults aged ≥65 years in Korea. Methods: [...] Read more.

Background: Studies on the relationship between unmet healthcare needs and depression in older adults are limited in Asia. This study aimed to investigate the relationship between unmet healthcare needs and the risk of depression in older adults aged ≥65 years in Korea. Methods: This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey in 2014, 2016, and 2018. Three models were constructed using a weighted multivariate logistic regression analysis to account for the complex survey design. Model 1 is adjusted for sex and age. Model 2 was further adjusted for household income, education level, marital status, and private health insurance. Model 3 was further adjusted for alcohol use, cigarette use, weekly walking activity, hypertension, dyslipidemia, and diabetes mellitus. Subgroup analyses were performed to assess the stability and robustness of the association between unmet healthcare needs and depression. Results: In total, this study included 4062 participants aged ≥65 years, with 3749 and 313 individuals in the non-depression and depression groups, respectively. In the unadjusted models, individuals with unmet healthcare needs had a greater likelihood of depression than those without unmet needs. This association remained significant across all three sequentially adjusted models. Subgroup analyses supported these findings. Conclusions: Unmet healthcare needs are significantly associated with depressive symptoms in older adults. Therefore, a multidimensional approach is required when addressing mental health issues in this population, and addressing unmet healthcare needs may be crucial for promoting mental health. Full article

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21 pages, 468 KB

Open AccessArticle

Impact of Physical Exercise on Adult Asthma Control: A Randomized Clinical Trial

by Sarah Micozzi, Pilar Gajate Fernández, Paula Sánchez López, Jimena Laiseca García and Francisco Javier Pérez Rivas

Healthcare 2025, 13(20), 2634; https://doi.org/10.3390/healthcare13202634 - 20 Oct 2025

Viewed by 293

Abstract

Background: Most research on asthma and physical exercise is complex, costly, and often inconclusive, leading to minimal mention of exercise in international asthma management guidelines. Patients with mild asthma are frequently excluded from clinical trials, which focus on more severe cases, resulting in [...] Read more.

Background: Most research on asthma and physical exercise is complex, costly, and often inconclusive, leading to minimal mention of exercise in international asthma management guidelines. Patients with mild asthma are frequently excluded from clinical trials, which focus on more severe cases, resulting in a lack of scientific evidence for this population. Objective: This study aimed to evaluate the effectiveness of a 3-month health intervention program promoting unstructured physical activity to improve asthma control, defined as a decrease of 0.5 points in the Asthma Control Questionnaire (ACQ-5). Methods: the study was designed as an open-label, two-arm randomized clinical trial involving sedentary asthmatic patients with intermittent to moderate persistent asthma. Participants were divided into an intervention group that attended three workshops based on World Health Organization recommendations for physical activity and a control group that continued their usual activities. All participants underwent three medical visits to assess variables such as asthma control, quality of life, rescue medication use, exacerbations, average steps taken, and respiratory function. Results: A total of 52 patients were recruited and randomized (26 patients per group), (73.1% women), with 48 completing the study (24 patients per group). The intervention group showed significant improvements in ACQ-5 scores (p = 0.035), mini-AQLQ score (p = 0.017), and average daily steps (p < 0.001). Significant differences were also observed between groups regarding respiratory function (p = 0.04) and average daily steps (p = 0.01). Conclusions: in sedentary asthmatic patients, including those with milder profiles, implementing low-resource physical exercise interventions significantly improved the average steps taken and respiratory function, while asthma control and rescue medication use showed a positive trend. Full article

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17 pages, 262 KB

Open AccessArticle

Caregiver Burden and Psychological Distress Among Informal Caregivers for Individuals with Dementia in the Republic of Kazakhstan: A Cross-Sectional Study

by Yelaman Toleuov, Ken Inoue, Kamila Akkuzinova, Timur Moldagaliyev, Nursultan Seksenbayev, Ulzhan Jamedinova, Haruo Takeshita, Yasuyuki Fujita, Nargul Ospanova and Altay Dyussupov

Healthcare 2025, 13(20), 2633; https://doi.org/10.3390/healthcare13202633 - 20 Oct 2025

Viewed by 337

Abstract

Background: In the Republic of Kazakhstan, informal caregivers remain the main source of patient support. Caregivers of individuals with dementia experience an increased caregiver burden and significantly higher levels of stress. We investigated the levels of caregiver burden, depression, anxiety, and stress among [...] Read more.

Background: In the Republic of Kazakhstan, informal caregivers remain the main source of patient support. Caregivers of individuals with dementia experience an increased caregiver burden and significantly higher levels of stress. We investigated the levels of caregiver burden, depression, anxiety, and stress among informal dementia caregivers and assessed the relationships between these indicators and the caregivers’ socio-demographic characteristics. Methods: With the cooperation of two regional mental health centers and three polyclinics in Kazakhstan, we conducted a cross-sectional study of 174 informal caregivers of dementia patients. The caregiver burden was assessed using the Zarit Burden Interview, and psychological distress was measured with the Depression Anxiety Stress Scale-21. The caregivers’ sociodemographic data were collected and analyzed. The adjusted odds ratios and 95%CIs were calculated using logistic and ordinal regressions. Results: Overall, 75.9% of the caregivers reported experiencing at least a mild burden, and the levels of depression, anxiety, and stress among the caregivers were higher than expected. Spousal caregivers had higher odds of abnormal depression (p = 0.022) and anxiety (p = 0.020); in severity models, spouses more often had a severe burden (p = 0.042) and anxiety (p = 0.006). Conclusions: Caregiver burden and psychological distress are highly prevalent among informal dementia caregivers in Kazakhstan, particularly among spouses. It is especially important to provide support for spouse caregivers. Culturally tailored psychoeducation, support groups, and respite services are urgently needed to mitigate the mental health risks faced by dementia caregivers in Kazakhstan. Full article

20 pages, 2946 KB

Open AccessArticle

Predicting High Urinary Tract Infection Rates in Skilled Nursing Facilities: A Machine Learning Approach

by Diane Dolezel, Tiankai Wang and Denise Gobert

Healthcare 2025, 13(20), 2632; https://doi.org/10.3390/healthcare13202632 - 20 Oct 2025

Viewed by 275

Abstract

Objectives: Urinary tract infections (UTIs) are the most common healthcare-associated infections in Skilled Nursing Facilities (SNFs); they are associated with longer lengths of stay, higher levels of care, increased treatment costs, and higher mortality rates. This study aimed to develop a machine [...] Read more.

Objectives: Urinary tract infections (UTIs) are the most common healthcare-associated infections in Skilled Nursing Facilities (SNFs); they are associated with longer lengths of stay, higher levels of care, increased treatment costs, and higher mortality rates. This study aimed to develop a machine learning classification model to predict the risk of high catheter-associated urinary tract infection rates based on SNF characteristics. Methods: We analyzed 94,877 total SNF-year observations from 2019 to 2024, not unique facilities; thus, individual SNFs may appear in multiple years. The factor variables were average length of stay in days, number of staffed beds, total nurse and total physical therapy staffing hours per resident per day, facility ownership, geographic classification, facility accreditation, Accountable Care Organization affiliations, Centers for Medicare and Medicaid Services SNF Overall Star Rating, and the SNF-year of the observations. We utilized three machine learning models for this analysis: Random Forest, XGBoost, and LightGBM. We used Shapley Additive exPlanations to interpret the best-performing machine learning model by visualizing feature importance and examining the relationship between key predictors and the outcome. Results: We found that machine learning models outperformed traditional logistic regression in predicting UTIs in skilled nursing facilities. Using the best-performing model, Random Forest, we identified rural SNFs, and the number of staffed beds as the most influential predictors of high UTI rates, followed by average length of stay, and geographic location. Conclusions: This study demonstrates the value of using facility-level characteristics to predict the risk of UTIs in SNFs with machine learning models. Results from this study can inform infection prevention efforts in post-acute care settings. Full article

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14 pages, 740 KB

Open AccessReview

The Effects of the Schroth Method on the Cobb Angle, Angle of Trunk Rotation, Pulmonary Function, and Health-Related Quality of Life in Adolescent Idiopathic Scoliosis: A Narrative Review

by Ana Belén Jiménez-Jiménez, Elena Gámez-Centeno, Javier Muñoz-Paz, María Nieves Muñoz-Alcaraz and Fernando Jesús Mayordomo-Riera

Healthcare 2025, 13(20), 2631; https://doi.org/10.3390/healthcare13202631 - 20 Oct 2025

Viewed by 537

Abstract

Background/Objectives: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that can negatively impact on quality of life, pulmonary function, and body image. Its conservative management includes various interventions, among which the Schroth method stands out. This approach is based [...] Read more.

Background/Objectives: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that can negatively impact on quality of life, pulmonary function, and body image. Its conservative management includes various interventions, among which the Schroth method stands out. This approach is based on three-dimensional corrective exercises and rotational breathing. This review aimed to analyze the effectiveness of the Schroth method, applied either alone or in combination with other conservative therapies, on variables such as Cobb angle, angle of trunk rotation (ATR), pulmonary function, and health-related quality of life in patients with AIS. Methods: A scientific literature search was conducted using the PubMed database. We searched for randomized controlling trials (RCTs), systematic reviews, and meta-analyses reported in English from 2020 to 2025. Different combinations of the terms and MeSH terms “adolescent”, “idiopathic”, “scoliosis”, and “Schroth” connected with various Boolean operators. Results: Overall, 82 articles were reviewed from the selected database. After removing duplicated papers and title/abstract screening, 13 studies were included in our review. The results showed that the Schroth method proved effective in reducing the Cobb angle and ATR, particularly in patients with mild curves and in early stages of skeletal growth. Improvements were also observed in health-related quality of life and aesthetic perception, and to a lesser extent, in pulmonary function. Moreover, therapeutic adherence and treatment continuity were important to maintaining long-term benefits. Conclusions: The Schroth method could be an effective treatment associated with orthopedic treatment, yielding satisfactory results. Its implementation requires structured programs, professional supervision, and strategies to enhance therapeutic adherence. Nevertheless, to validate its long-term effectiveness, we need more homogeneous studies with longer follow-up durations. Full article

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

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17 pages, 5496 KB

Open AccessArticle

Quantitative MRCP as Part of Primary Sclerosing Cholangitis Standard of Care in the National Health Service in England: A Feasibility Assessment Among Hepatologists

by Elizabeth Shumbayawonda, Mamta Bajre, Daniel Eadle, Carlos Ferreira, Michele Pansini and Rajarshi Banerjee

Healthcare 2025, 13(20), 2630; https://doi.org/10.3390/healthcare13202630 - 20 Oct 2025

Viewed by 288

Abstract

Background: Primary sclerosing cholangitis (PSC) is a rare chronic liver disease characterised by bile duct strictures. Magnetic resonance cholangiopancreatography (MRCP) is the principal imaging modality for diagnosis; however, its interpretation is subjective. Quantitative MRCP (MRCP+) provides quantitative assessment of the biliary anatomy and [...] Read more.

Background: Primary sclerosing cholangitis (PSC) is a rare chronic liver disease characterised by bile duct strictures. Magnetic resonance cholangiopancreatography (MRCP) is the principal imaging modality for diagnosis; however, its interpretation is subjective. Quantitative MRCP (MRCP+) provides quantitative assessment of the biliary anatomy and can support objective disease assessment. We evaluated the potential impact, feasibility, and perceived usefulness that MRCP+ would have on PSC patient management. Methods: Alongside systematic evaluation of UK and European clinical guidelines on PSC management, semi-structured interviews with 16 stakeholders were conducted. The Lean Assessment Process methodology was used to assess potential impact and feasibility of adopting MRCP+ for the PSC care pathway within the NHS. Price as a barrier to adoption was investigated to evaluate perceptions between technology cost and adoption. Perceived ease of use and perceived trust were calculated and used to evaluate perceived usefulness (PU). Results: For PSC management, MRCP (81%) scored higher than liver biopsy (68%) and ERCP (50%) due to its non-invasive nature. There was good internal consistency between responders on the relationship between price point and the use of MRCP+ to support diagnosis (CA:0.836) and monitoring (CA:0.904). A price point of up to GBP 500 was unlikely to be a barrier for adoption. The overall perceived usefulness for MRCP+ for patient management was 74%. Conclusions: There is strong interest in using MRCP+ to support PSC management. MRCP+ has the potential to address unmet needs including reducing subjectivity, measurement of the whole biliary tree and objectively measuring biliary disease progression. Full article

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11 pages, 207 KB

Open AccessArticle

Perception of Generic Drugs Among Pharmacists in Poland: The Role of Sociodemographic Factors in Shaping Professional Attitudes and Practices

by Marcin Lewandowski, Urszula Religioni, Dariusz Świetlik, Adam Kobayashi, Marcin Czech, Piotr Wierzbiński, Daniel Śliż, Waldemar Wierzba, Katarzyna Plagens-Rotman and Piotr Merks

Healthcare 2025, 13(20), 2629; https://doi.org/10.3390/healthcare13202629 - 20 Oct 2025

Viewed by 449

Abstract

Background: Pharmacists’ perceptions and practices shape the real-world uptake of generic medicines. From a health-economics perspective, wider generic substitution reduces patient out-of-pocket spending and creates headroom in payer budgets for high-value interventions. We assessed attitudes toward the efficacy, safety, and use of generics [...] Read more.

Background: Pharmacists’ perceptions and practices shape the real-world uptake of generic medicines. From a health-economics perspective, wider generic substitution reduces patient out-of-pocket spending and creates headroom in payer budgets for high-value interventions. We assessed attitudes toward the efficacy, safety, and use of generics and examined sociodemographic correlates among Polish pharmacists. Methods: Analytical cross-sectional survey of licensed pharmacists in Poland was used (June–August 2025). The questionnaire covered reasons for recommending generics in long-term and single-use therapy; doubts about efficacy; views on bioequivalence testing; patient-reported experiences; and Likert-scale opinions on innovation, safety, efficacy, access, and payer savings. Associations were tested with χ² and Mann–Whitney U (α = 0.05). Results: Of 342 respondents (67.5% women; 74.9% community pharmacists), cost was the leading reason to recommend generics in long-term therapy (91.0%), followed by efficacy (53.0%) and safety (51.5%); for single-use prescriptions, cost remained central (76.2%), with lower emphasis on efficacy (47.5%) and safety (45.0%). Pharmacists who never recommend generics were older and more experienced (p = 0.006; p = 0.012). Doubts about generic efficacy were reported by 36.2% overall and more often among women, hospital pharmacists, and those with a specialization; 53.5% of those with doubts would advise switching even to a costlier option. Nearly half supported conducting bioequivalence studies between generics (49.6%). Positive perceptions predominated: 82.9% agreed generics are as effective and 84.6% as safe as originators. Most endorsed system benefits, including payer savings enabling list expansion (73.6%) and improved patient access (92.5%); agreement on access was higher among community pharmacists (p = 0.004). Conclusions: Polish pharmacists largely view generics as clinically equivalent and system-enhancing, with cost the dominant driver of recommendation. Targeted education—especially for hospital settings and specialized pharmacists—and attention to patient-reported experiences may further strengthen confidence and appropriate use of generics. Full article

(This article belongs to the Special Issue Collaborative Practice: The Role of Research and Education in Shaping Modern Pharmacy Practice)

22 pages, 418 KB

Open AccessReview

The Relationship Between Diet and the Neuropathological Hallmarks of Alzheimer’s Disease in Cognitively Normal Adults: A Systematic Narrative Review

by Amanda A. Harb, Kelly A. Brock-Spano, Jill R. Silverman, Jack R. Thomas and Ashley S. Pothen

Healthcare 2025, 13(20), 2628; https://doi.org/10.3390/healthcare13202628 - 20 Oct 2025

Viewed by 681

Abstract

Background/Objectives: Alzheimer’s disease (AD) remains a leading cause of mortality with millions suffering worldwide. The number of annual cases is sharply increasing primarily due to growing older adult populations. To date, there is neither an effective prevention nor cure for AD. Recently, [...] Read more.

Background/Objectives: Alzheimer’s disease (AD) remains a leading cause of mortality with millions suffering worldwide. The number of annual cases is sharply increasing primarily due to growing older adult populations. To date, there is neither an effective prevention nor cure for AD. Recently, AD was specified using biomarkers, facilitating research into primary and secondary prevention strategies, including dietary interventions. This systematic narrative review maps the literature on dietary prevention of AD by synthesizing the evidence on diet and AD biomarkers in cognitively normal adults. Additionally, it explores limitations in the current evidence base and identifies areas for future research. Methods: Search terms and inclusion/exclusion criteria were set, and PubMed and EBSCOhost were searched for articles up through September 2025. Out of 331 results, 14 articles passed the inclusion/exclusion criteria and were included in this review. Results: Most studies were cross-sectional (n = 8), followed by cohort (n = 4), with one study including both cross-sectional and longitudinal analyses (n = 1). Only one intervention study was published. Various dietary exposures were tested, with most studies (n = 5) supporting a protective relationship between the Mediterranean diet and prevention of the neuropathological hallmarks of AD. However, the evidence base varies in methodology. Future research would benefit from greater consensus in methodology and should prioritize prospective cohort and randomized trial designs. Conclusions: Evidence from this review suggests existence of a potential role for dietary interventions, especially the Mediterranean diet, in AD prevention. However, further research is needed to address existing gaps. (248 words) Full article

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22 pages, 766 KB

Open AccessArticle

Perceived Causes of Illness Among Infants and Young Children in Bangladesh: An Exploratory Qualitative Study

by Md. Fakhar Uddin, Asma-Ul-Husna Sumi, Akash Saha, Mubassira Binte Latif, Shariffah Suraya Syed Jamaludin, Nur Haque Alam and Mohammod Jobayer Chisti

Healthcare 2025, 13(20), 2627; https://doi.org/10.3390/healthcare13202627 - 20 Oct 2025

Viewed by 490

Abstract

Background and objective: Child illness remains a significant public health challenge in low- and middle-income countries, including Bangladesh, with complex multifactorial causes extending beyond biomedical factors. This qualitative study explored perceived causes of child illness from the perspectives of caregivers and healthcare providers [...] Read more.

Background and objective: Child illness remains a significant public health challenge in low- and middle-income countries, including Bangladesh, with complex multifactorial causes extending beyond biomedical factors. This qualitative study explored perceived causes of child illness from the perspectives of caregivers and healthcare providers in rural and urban Bangladesh. Methods: Twenty-three in-depth interviews with primary caregivers, grandmothers, healthcare providers, and a group discussion with four community representatives revealed four primary categories of perceived illness causes. Results: Individual causes included maternal illness, forgetfulness, and knowledge gaps that affected caregiving practices, leading to missed vaccinations, poor hygiene and feeding practices. Socio-cultural causes included supernatural beliefs, intra-household power dynamics, domestic violence, maternal work burdens, early marriage, adolescent motherhood, and dowry practices. Economic causes included irregular income, rising food prices, and marketing of unhealthy products. Environmental causes included poor housing ventilation, inadequate waste management, heat wave exposure, urban air pollution, and water contamination, causing respiratory and waterborne diseases. Conclusions: These findings illustrate that child illness results from complex interactions between individual, socio-cultural, economic, and environmental causes. Potential interventions can address these multifaceted causes through comprehensive approaches including caregiver education, maternal empowerment strategies, economic support programs, and household environment improvements. Full article

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Healthcare, Volume 13, Issue 20 (October-2 2025) – 109 articles

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