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Volume 13
Issue 22
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Healthcare, Volume 13, Issue 22 (November-2 2025) – 173 articles

Cover Story (view full-size image): Cognitive impairment is common in stroke survivors. Current clinical services are under significant pressure and automated tools to assess cognitive and mood impairment in stroke survivors have the potential to reduce assessment burden. CognoStroke uses automatic speech recognition and large language models to predict standard clinical scores MoCA, GAD-7, PHQ-9 used in stroke services. Automated tools like CognoStroke can help identify cognitive and mood impairments early, which is crucial for intervention and rehabilitation. Despite challenges, automated assessment in acute stroke settings is feasible and can achieve accuracy comparable to traditional tests. Some practical barriers and technical limitations must be addressed to maximize its clinical utility; however this study shows promise in using this novel tool in clinical pathways. View this paper
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16 pages, 940 KB  
Article
Nationwide Trends in Healthcare Utilization and Expenditures Among Patients with Cervical Dystonia in Korea: A 7-Year Analysis Using Health Insurance Data
by Ching-Wen Huang and Bo-Hyoung Jang
Healthcare 2025, 13(22), 2995; https://doi.org/10.3390/healthcare13222995 - 20 Nov 2025
Viewed by 956
Abstract
Background/Objectives: Cervical dystonia (CD) is the most common focal dystonia, but nationwide evidence on healthcare use is limited. This study assessed trends in utilization and expenditures in Korea. Methods: Using National Health Insurance Service claims (2017–2023), we identified CD patients (ICD-10 G24.3) and [...] Read more.
Background/Objectives: Cervical dystonia (CD) is the most common focal dystonia, but nationwide evidence on healthcare use is limited. This study assessed trends in utilization and expenditures in Korea. Methods: Using National Health Insurance Service claims (2017–2023), we identified CD patients (ICD-10 G24.3) and analyzed annual patients, visits, and expenditures by demographics, medical system, service type, and specialty. Results: A total of 6614 patients (33,896 claims) were included. Patient numbers declined until 2021 then slightly rebounded, and total expenditures fluctuated. Women were more prevalent, but men incurred higher costs. Western Medicine (WM) expenditures tended to increase while Korean Medicine (KM) tended to decline. Core botulinum toxin costs remained broadly stable; physiotherapy and diagnostic testing increased, particularly WM outpatient testing. Outpatient injection-related and anesthesia expenditures showed decreasing tendencies, while hospitalization and radiology exhibited modest or minimal changes. Neurology managed the most patients, while neurosurgery generated the highest costs. Conclusions: CD care in Korea showed declining patient numbers alongside overall stable total expenditures, with increasing use of rehabilitation and diagnostic services and continued stable use of botulinum toxin as a core therapy. Full article
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15 pages, 738 KB  
Article
Health Perception and Anxiety Among Internally Displaced and Non-Displaced Israeli Adults: The Mediating Role of Emotional Well-Being and Functioning
by Orly Toren, Tziporah Novoseller, Dahlya Selig, Mayan Bar On and Galit Madar
Healthcare 2025, 13(22), 2994; https://doi.org/10.3390/healthcare13222994 - 20 Nov 2025
Viewed by 444
Abstract
Background: Forced displacement is a significant public health challenge associated with deteriorated mental and physical health outcomes. Following the outbreak of Israel’s ‘Iron Swords’ war on 7 October 2023, more than 250,000 citizens were evacuated from their homes. Previous research has consistently [...] Read more.
Background: Forced displacement is a significant public health challenge associated with deteriorated mental and physical health outcomes. Following the outbreak of Israel’s ‘Iron Swords’ war on 7 October 2023, more than 250,000 citizens were evacuated from their homes. Previous research has consistently documented elevated anxiety and poor health perception among displaced populations; however, the extent to which displacement itself contributes to anxiety has not been directly examined or established. Objective: The objective was to compare levels of anxiety and health perception between internally displaced and non-displaced Israeli adults and examine the mediating roles of emotional well-being and emotional functioning within the framework of Hobfoll’s Conservation of Resources (COR) theory. Methods: A cross-sectional, comparative quantitative study was conducted using validated self-report questionnaires to assess health perception (SF-36) and anxiety (GAD-7). The study sample comprised 98 adults, including 46 displaced individuals and 52 participants from the general population. Differences in health dimensions and anxiety levels were analyzed using t-tests, correlation analyses, and regression models. To advance understanding beyond previous research, mediation analysis based on the Conservation of Resources (COR) theory was employed, enabling identification of the psychological mechanisms through which displacement influences anxiety. Results: Displaced participants reported significantly lower scores across all SF-36 dimensions and significantly higher anxiety levels compared to the general population. Regression analyses indicated that emotional well-being and emotional functioning were significant predictors of anxiety, whereas displacement status alone was not a direct predictor once mediators were included. Mediation analysis further demonstrated that both emotional well-being and emotional functioning fully mediated the relationship between displacement and anxiety Conclusions: Forced displacement has lasting negative effects on mental health, primarily through the erosion of emotional and functional resources. These findings highlight the importance of interventions aimed at strengthening psychological resilience and continuity of care. Study limitations include a cross-sectional design, reliance on self-reported data, and relatively small sample, which may limit generalizability. Full article
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22 pages, 583 KB  
Article
Development and Initial Validation of a Measure of Body Image in the Postpartum Period: The Postpartum Body Image Scale
by Cristian Di Gesto, Marta Spinoni and Caterina Grano
Healthcare 2025, 13(22), 2993; https://doi.org/10.3390/healthcare13222993 - 20 Nov 2025
Viewed by 866
Abstract
Background: Despite the importance of body image in the puerperium, tools specifically assessing postpartum body image are lacking. To address this gap, we developed the Postpartum Body Image Scale (PPBI-S), a measure encompassing both negative and positive key aspects of postpartum body [...] Read more.
Background: Despite the importance of body image in the puerperium, tools specifically assessing postpartum body image are lacking. To address this gap, we developed the Postpartum Body Image Scale (PPBI-S), a measure encompassing both negative and positive key aspects of postpartum body image. Methods: The reliability and validity of the PPBI-S were evaluated across three studies. In Study 1, item formulation and content validity were established through expert evaluation and cognitive interviews (n = 20). Study 2 involved 250 postpartum women and employed exploratory factor analysis (EFA), revealing a trifactorial structure: Postpartum Body Image Concerns, Postpartum Positive Body Image, and Postpartum Dieting, accounting for 25.1%, 21.7%, and 17.1% of the variance, respectively. In Study 3, confirmatory factor analysis (CFA) was conducted on a sample of 258 postpartum women to examine internal consistency and convergent validity. Results: The CFA confirmed the three-factor model, showing good internal consistency across subscales. Convergent validity was demonstrated through significant correlations with established measures of body image and psychological well-being. Predictive validity was also supported, with PPBI-S scores significantly associated with breastfeeding intentions three months later. Conclusions: The PPBI-S is a reliable and valid instrument for assessing postpartum body image, capturing both its positive and negative dimensions. This tool provides researchers and clinicians with a comprehensive measure to evaluate body image experiences during the postpartum period. Full article
(This article belongs to the Special Issue Healthy Lifestyle for Pregnant and Postpartum Women)
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12 pages, 363 KB  
Article
Influence of Hypnosis and Acupuncture on Perioperative Complications
by Jasmina Markovič-Božič, Meta Gradišar, Mihela Petovar, Polona Mušič, Nina Pirc, Joseph Meyerson, Maks Tušak, Andrej Lapoša, Matej Tušak and Alenka Spindler-Vesel
Healthcare 2025, 13(22), 2992; https://doi.org/10.3390/healthcare13222992 - 20 Nov 2025
Viewed by 882
Abstract
Background: This randomised, single-centre study and original research manuscript aimed to evaluate whether perioperative hypnosis and acupuncture can reduce postoperative nausea and vomiting (PONV), opioid use, and other complications in spinal surgery compared to standard pharmacological management. Methods: In total, 60 [...] Read more.
Background: This randomised, single-centre study and original research manuscript aimed to evaluate whether perioperative hypnosis and acupuncture can reduce postoperative nausea and vomiting (PONV), opioid use, and other complications in spinal surgery compared to standard pharmacological management. Methods: In total, 60 patients undergoing spinal surgery were divided into three groups regarding antiemetic prevention: Hypnosis and acupuncture (HG), hypnosis, acupuncture, and antiemetic (HAG), and standard control with antiemetic (CG). Hypnosis was performed one day before surgery, or patients received premedication with midazolam on the day of surgery. Anaesthesia was induced and maintained with propofol and remifentanil. Acupuncture was performed bilaterally at points LI4 and PC6 after induction of anaesthesia. Postoperatively, the consumption of opioids and antiemetics, satisfaction and well-being, length of stay and complications were recorded. Results: In all groups, additional opioids were administered in the first hour after surgery (p = 0.4). In the ICU, only one patient in the HAG and two patients in the CG and HG required additional analgesics (p = 0.8). Overall satisfaction (9/9/0 vs. 10/6/4 vs. 9/7/3; p = 0.4) and well-being scores (10/8/0 vs. 13/5/2 vs. 13/5/1; p = 0.5) were high across all groups, with no significant differences. Two patients in CG experienced mild complications. The length of hospitalisation was similar (3 days in CG vs. 4 days in HAG and HG (p = 0.7). Only one patient in the HG required antiemetics; none were needed in CG or HAG (p = 0.4). Conclusions: Within the constraints of this exploratory single-centre trial, hypnosis appeared to provide anxiolytic benefits comparable to benzodiazepines, and intraoperative acupuncture did not increase PONV despite reduced pharmacological prophylaxis. No significant differences were detected in opioid and antiemetic consumption. Larger, adequately powered studies are needed to confirm these findings and optimise the timing and modality of non-pharmacological interventions. Full article
(This article belongs to the Special Issue Clinical Hypnosis: Advancing Integrative Approaches in Modern Healthcare)
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13 pages, 568 KB  
Article
Cross-Cultural Adaptation and Validation of the “Brief Scale of Perceived Barriers to Physical Activity for Children”: Analysis of Psychometric Properties
by Raquel Pastor-Cisneros, María Mendoza-Muñoz, Amparo Rodríguez-Gutiérrez and Jorge Carlos-Vivas
Healthcare 2025, 13(22), 2991; https://doi.org/10.3390/healthcare13222991 - 20 Nov 2025
Viewed by 513
Abstract
Background: Physical activity (PA) provides significant health benefits, yet inactivity remains high in Spain, especially among adolescents and increasingly in children. Identifying barriers to PA is essential, but available tools are mainly designed for adolescents. This study aimed to adapt the “Brief [...] Read more.
Background: Physical activity (PA) provides significant health benefits, yet inactivity remains high in Spain, especially among adolescents and increasingly in children. Identifying barriers to PA is essential, but available tools are mainly designed for adolescents. This study aimed to adapt the “Brief Scale of Perceived Barriers to Physical Activity” for Spanish schoolchildren aged 6–12 and examine its validity and reliability. Methods: The “Brief Scale of Perceived Barriers to Physical Activity for Children” was linguistically and culturally adapted. Comprehension was assessed through cognitive interviews, and reliability was examined via a test–retest procedure with 137 Spanish schoolchildren. Several analyses were conducted, including confirmatory factor analysis (CFA) to assess the factor structure, along with reliability metrics: Cronbach’s alpha (α) for internal consistency and the intraclass correlation coefficient (ICC) for test–retest reliability. Results: CFA confirmed a four-factor structure (self-concept, motivation–interest, social support, and task incompatibility) in a sample of 137 with excellent fit indices (χ2/df = 1.394, RMSEA = 0.054, CFI = 0.976, TLI = 0.966). Internal consistency ranged from good to excellent (α = 0.831–0.979). Temporal stability was substantial to near perfect (ICC = 0.708–0.979). Measurement error was low for all items and the total score (SEM% = 6.1–37.2; MDC% = 17.0–103.0), demonstrating accuracy. Conclusions: The “Brief Scale of Perceived Barriers to Physical Activity for Children” was proven to be a reliable and valid tool for assessing perceived barriers to PA in Spanish children. It offers developmentally appropriate insights that can guide strategies to enhance supportive environments and promote long-term active behaviours. As part of the social domain, it contributes to the Spanish Physical Literacy Assessment for Children (SPLA-C) model, the first physical literacy (PL) assessment instrument developed in Spain. Full article
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19 pages, 744 KB  
Article
Accuracy of Budget Impact Projections in Bulgarian Health Technology Assessment: A Five-Year Validation Study (2020–2025)
by Kostadin Kostadinov, Ralitsa Raycheva, Iva Zdravkova-Aneva, Margarita Shopova, Evgeni Ovchinnikov and Plamen Petkov
Healthcare 2025, 13(22), 2990; https://doi.org/10.3390/healthcare13222990 - 20 Nov 2025
Viewed by 594
Abstract
Background: Budget Impact Analysis is an integral part of the Health Technology Assessment in Bulgaria, informing reimbursement decisions of the National Health Insurance Fund. Inaccurate projections risk both fiscal unsustainability and restricted patient access to innovation. Yet projection accuracy methods remains uncertain, particularly [...] Read more.
Background: Budget Impact Analysis is an integral part of the Health Technology Assessment in Bulgaria, informing reimbursement decisions of the National Health Insurance Fund. Inaccurate projections risk both fiscal unsustainability and restricted patient access to innovation. Yet projection accuracy methods remains uncertain, particularly given limited epidemiologic data and evolving clinical use. Objectives: This study aimed to assess the empirical validity of Health Technology Assessment budget-impact projections for medicines approved in 2019 by comparing projected patient volumes and expenditures with real-world National Health Insurance Fund reimbursements through 2025, and to identify drivers of divergence across therapeutic areas and reimbursement channels. Methods: We conducted a retrospective cohort analysis linking 2019 Health Technology Assessment submissions with monthly National Health Insurance Fund claims for both hospital and outpatient reimbursement channels. Actual utilization was calculated as the annualized median number of treated patients per month. Projected costs were derived by multiplying HTA-projected patient volumes by the observed unit cost per patient-month. We quantified deviations using observed-to-projected ratios and absolute gaps and assessed the relationship between projected and actual expenditures using a log–log regression model. Results: By September 2025, realized volumes typically exceeded projections (median ratio 1.6; range 0.02–21.3). Large overshoots were observed for Avelumab, Risankizumab, and Guselkumab; Cobimetinib and Abemaciclib remained below forecast. Expenditure deviations were driven predominantly by volume: immunology (+€17.4 million) and oncology (+€5.0 million) accounted for the largest absolute gaps. Elasticity was near proportional overall (β = 1.002; standard error = 0.24; R2 = 0.50), lower in hospitals (β = 0.79; p = 0.055) and higher in outpatient care (β = 1.30; p = 0.003). Conclusions: Health Technology Assessment Budget Impact Analyses captured broad cost scaling but systematically missed product-specific uptake, with deviations largely volume-driven. Strengthening national registries and real-world data pipelines, and adopting dynamic, indication-responsive contracting and forecasting, could materially improve budget predictability while preserving access to innovation. Full article
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13 pages, 245 KB  
Case Report
Noncontact Gesture-Based Switch Improves Communication Speed and Social Function in Advanced Duchenne Muscular Dystrophy: A Case Report
by Daisuke Nishida, Takafumi Kinoshita, Tatsuo Hayakawa, Takashi Nakajima, Yoko Kobayashi, Takatoshi Hara, Ikushi Yoda and Katsuhiro Mizuno
Healthcare 2025, 13(22), 2989; https://doi.org/10.3390/healthcare13222989 - 20 Nov 2025
Viewed by 571
Abstract
Augmentative and alternative communication (AAC) enables digital access for individuals with severe motor impairment. Conventional contact-based switches rely on residual voluntary movement, limiting efficiency. We report the clinical application of a novel, researcher-developed noncontact assistive switch, the Augmentative Alternative Gesture Interface (AAGI), in [...] Read more.
Augmentative and alternative communication (AAC) enables digital access for individuals with severe motor impairment. Conventional contact-based switches rely on residual voluntary movement, limiting efficiency. We report the clinical application of a novel, researcher-developed noncontact assistive switch, the Augmentative Alternative Gesture Interface (AAGI), in a 39-year-old male with late-stage Duchenne Muscular Dystrophy (DMD) retaining minimal motion. The AAGI converts subtle, noncontact gestures into digital inputs, enabling efficient computer operations. Before intervention, the participant used a conventional mechanical switch, achieving 12 characters per minute (CPM) in a 2 min text entry task and was unable to perform high-speed ICT tasks such as gaming or video editing. After 3 months of AAGI use, the input speed increased to 30 CPM (+2.5-fold), and previously inaccessible tasks became feasible. The System Usability Scale (SUS) improved from 82.5 to 90.0, indicating enhanced usability, whereas the Short Form 36 (SF-36) Social Functioning (+13) and Mental Health (+4) demonstrated meaningful gains. Daily living activities remained stable. This case demonstrates that the AAGI system, developed by our group can substantially enhance communication efficiency, usability, and social engagement in advanced DMD, highlighting its potential as a practical, patient-centered AAC solution that extends digital accessibility to individuals with severe motor disabilities. Full article
(This article belongs to the Special Issue Applications of Assistive Technologies in Health Care Practices)
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14 pages, 293 KB  
Article
Are FoMO, Experiential Avoidance, and Emotional Distress Related to Problematic Social Network Use in Young Adults?
by Isabel C. Salazar, Raquel Santamaría-Perales and Ana M. Cuevas-Toro
Healthcare 2025, 13(22), 2988; https://doi.org/10.3390/healthcare13222988 - 20 Nov 2025
Viewed by 798
Abstract
Background/Objectives: Social networks have brought exciting possibilities for interacting with others in real time, anywhere in the world. However, problematic social network use (PSNU) causes distress and dysfunction in daily life. Young people may be vulnerable due to their high degree of [...] Read more.
Background/Objectives: Social networks have brought exciting possibilities for interacting with others in real time, anywhere in the world. However, problematic social network use (PSNU) causes distress and dysfunction in daily life. Young people may be vulnerable due to their high degree of digital connectivity and the particularities of psychosocial development. The primary aim of this study was to assess the presence of PSNU and its relationship with anxiety, depression, stress, fear of missing out (FoMO), and experiential avoidance in young people, while also examining gender differences. Methods: An online survey was conducted with a non-probabilistic sample of 219 young people between the ages of 18 and 25 (M = 20.50, SD = 2.42; 74.4% women), which included self-report measures of the aforementioned variables. Results: A total of 27.4% reported PSNU, but there were no differences by gender. PSNU was positively and significantly related to all the variables analyzed, with the highest correlations being with FoMO and experiential avoidance, especially in women. Regression analysis showed that the set of variables explains 17.2% of the variance in PSNU, but only FoMO contributed positively and significantly to PSNU in the overall sample and in women, but not in men. Conclusions: This is the first study to jointly compare the predictive power of key variables (anxiety, depression, stress, experiential avoidance, and FoMO) on PSNU in young adults. Additionally, we examined gender differences and utilized validated instruments. Our results show that only FoMO plays a relevant role in accounting for PSNU variance, although more so in women than in men. Also, the scores in experiential avoidance are significantly higher in women compared with men. These results support the idea that PSNU may serve as a strategy for avoiding distress, specifically FoMO, particularly in women. In terms of clinical implications, it would be highly interesting to analyze the ways and contexts in which social media could be used in a healthier manner and in alignment with personal values. Full article
(This article belongs to the Special Issue Mental Health, Innovative Therapies and Assessment in Adolescents and Young Adults and Related Contexts)
18 pages, 1083 KB  
Article
Artificial Intelligence in Exercise Prescription in Palliative Care: Perceptions and Ethical Issues
by Daniela Oliveira, Francisca Rego and Rui Nunes
Healthcare 2025, 13(22), 2987; https://doi.org/10.3390/healthcare13222987 - 20 Nov 2025
Viewed by 513
Abstract
Background/Objectives: The integration of artificial intelligence (AI) in healthcare has been progressively expanding, with growing interest in its potential application in palliative care, particularly in exercise prescription. However, there is limited scientific evidence addressing professionals’ perceptions of this use. This study aimed [...] Read more.
Background/Objectives: The integration of artificial intelligence (AI) in healthcare has been progressively expanding, with growing interest in its potential application in palliative care, particularly in exercise prescription. However, there is limited scientific evidence addressing professionals’ perceptions of this use. This study aimed to explore Portuguese healthcare professionals’ perceptions of AI in exercise prescription for palliative care and to identify related ethical implications and training needs. Methods: A cross-sectional, descriptive, and analytical study was conducted using an online questionnaire applied to health professionals. Sociodemographic data, knowledge, and perceptions of AI in exercise prescription in palliative care were collected. Descriptive and inferential statistical analyses were performed, including Mann–Whitney and Spearman correlation tests. Results: The sample consisted mainly of young female professionals with backgrounds in physiotherapy. Most participants reported little knowledge and experience with AI in clinical practice but expressed a strong interest in learning. Perceptions regarding the usefulness of AI were neutral to slightly positive, particularly concerning quality of life and personalization of interventions. Ethical aspects were viewed positively, especially the complementarity of AI to human clinical judgement, transparency, and explicability. Spearman correlations indicated that greater AI literacy and longer clinical experience were associated with more positive perceptions. Conclusions: The findings highlight the importance of developing structured training programmes that integrate practical, ethical, and technical components for the safe and responsible use of AI in palliative care. Ethical guidelines are proposed to ensure the humanization of care and the preservation of patient autonomy when implementing AI in exercise prescription. Full article
(This article belongs to the Special Issue Improving End-of-Life Care in the Digital Era)
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14 pages, 559 KB  
Article
Experiences of People Living with a Kidney Transplant: A Phenomenological Study
by Wichitra Kusoom, Narin Suwanboriboon, Sangnapa Siewthong, Sununta Krongyuth and Arunee Hengyotmark
Healthcare 2025, 13(22), 2986; https://doi.org/10.3390/healthcare13222986 - 20 Nov 2025
Viewed by 906
Abstract
Background/Objective: Kidney transplantation is the most successful treatment for patients with end-stage kidney disease. However, there are positive and negative impacts on physical and mental health. This study aimed to explore the life experiences of the effects of physical, psychological, and sociocultural [...] Read more.
Background/Objective: Kidney transplantation is the most successful treatment for patients with end-stage kidney disease. However, there are positive and negative impacts on physical and mental health. This study aimed to explore the life experiences of the effects of physical, psychological, and sociocultural aspects, and managing for resilience among people with KT. Methods: A descriptive phenomenological study was employed. Data were collected through in-depth interviews with 25 participants from the Bhumirajanagarindra Kidney Institute Hospital in Thailand. Thematic analysis was applied by using Braun and Clarke’s method. Results: The five themes, including (1) having new life and life satisfaction, (2) fear of kidney rejection and complications, (3) gratitude and spiritual practices, (4) concerns for the high cost of healthcare expenses, and (5) patience with self-management and resilience. Conclusions: We suggest that holistic, financial, and culturally congruent care should be implemented among people undergoing kidney transplantation to promote resilience and a longer life. Full article
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18 pages, 686 KB  
Article
From Growth Mindsets to Life Satisfaction: Examining the Role of Cognitive Reappraisal and Stressful Life Events
by Rahma F. Goran and Xu Jiang
Healthcare 2025, 13(22), 2985; https://doi.org/10.3390/healthcare13222985 - 20 Nov 2025
Viewed by 947
Abstract
Background/Objectives: Implicit theories of thoughts, emotions, and behavior (TEB) describe beliefs that these attributes are either changeable (growth mindset) or unchangeable (fixed mindset). While the impact of mindsets on negative mental health indicators, such as psychopathological symptoms, is well-documented, their relations with positive [...] Read more.
Background/Objectives: Implicit theories of thoughts, emotions, and behavior (TEB) describe beliefs that these attributes are either changeable (growth mindset) or unchangeable (fixed mindset). While the impact of mindsets on negative mental health indicators, such as psychopathological symptoms, is well-documented, their relations with positive indicators such as life satisfaction, particularly in the context of stress, remain underexplored. This study aimed to address this gap by testing whether the association between adolescents’ implicit theories of TEB and life satisfaction is mediated by cognitive reappraisal and whether stressful life events moderated two paths within the mediation model. Methods: Participants were 620 high school students (49.5% female, 43.5% male, 5.8% gender-nonconforming, 1.1% undisclosed) aged 14 to 19 years (M = 17.51, SD = 1.23), who completed an online survey in Spring 2022, while the COVID-19 pandemic still significantly affected daily life. Mediation and moderated mediation models were tested using PROCESS macro in SPSS. Results: Mediation analysis revealed that growth mindset positively influenced life satisfaction both directly and indirectly through cognitive reappraisal. Stressful life events significantly moderated the direct effect of growth mindset on life satisfaction, with the positive direct effect diminishing as stress increased. Conclusions: The positive link between growth mindset and life satisfaction was strongest under lower stress and transmitted through cognitive reappraisal across stress levels. Given the cross-sectional design, findings should be interpreted as correlational, not causal. Future longitudinal research should clarify temporal directionality and reciprocal links among mindset, coping, and well-being to inform interventions that strengthen adaptive beliefs and regulation skills. Full article
(This article belongs to the Section Mental Health and Psychosocial Well-being)
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19 pages, 1803 KB  
Article
Influence of Rehabilitation Aid Use on Obstacle Height During Gait in Patients with Foot Drop: A Case Series Study
by Joonsung Park, Himchan Shim, Changho Jang, Hanyang Yin and Jongbin Kim
Healthcare 2025, 13(22), 2984; https://doi.org/10.3390/healthcare13222984 - 20 Nov 2025
Viewed by 528
Abstract
Background/Objectives: The study explored differences in gait characteristics and biomechanics according to rehabilitation aid use (normal gait (NG) vs. assisted gait (AG) groups) and obstacle height (0, 5, and 15 cm conditions) in patients with stroke-induced foot drop. Methods: A longitudinal study, within-subjects, [...] Read more.
Background/Objectives: The study explored differences in gait characteristics and biomechanics according to rehabilitation aid use (normal gait (NG) vs. assisted gait (AG) groups) and obstacle height (0, 5, and 15 cm conditions) in patients with stroke-induced foot drop. Methods: A longitudinal study, within-subjects, repeated-measures study was conducted in 10 patients with mild foot drop. Participants walked at their preferred speed on a 10-m indoor track while crossing obstacles of three heights (0, 5, and 15 cm) under two gait conditions (normal walking (NG) and assisted walking (AG). The order of gait conditions and obstacle heights was randomized clinical within participants. Synchronized 3D motion capture with force plate measurements was used to calculate spatiotemporal variables, including ground reaction force (GRF), lower extremity joint angles at heel contact (HC), and toe-off (TO). A two-way repeated-measures ANOVA was used to examine the main effects and interaction effects of gait condition (NG vs. AG) and obstacle height (0, 5, and 15 cm). Results: AG showed little change in gait pattern, while there was a significant interaction between height and group. The vertical GRF (Fz) was lower in AG than NG at 5 cm, indicating reduced initial impact. There was a significant interaction for right medial–lateral (ML) GRF, with AG showing a small ML directional GRF over low obstacles (0–5 cm). At HC, AG was associated with an increase in right ankle dorsiflexion and right knee flexion. AG led to a reduction in left hip angle in the sagittal plane, and a smaller right ankle angle in the frontal plane, suppressing ML sway. At TO, AG caused an increase in right knee flexion, and bilateral ankle angles in the frontal plane at 5 cm. Conclusions: Rehabilitation aids reduced impact at initial contact, enhanced frontal plane stability, improved knee flexion and ankle alignment during the propulsion transition phase, and contributed to reduced variability and improved gait stability. The findings suggest potential utility for public health implications ambulation over curbs and thresholds, warranting larger, adequately powered clinical outcome trials. Full article
(This article belongs to the Section Public Health and Preventive Medicine)
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1 pages, 126 KB  
Correction
Correction: Theodosopoulos et al. Cultural Competence and Ethics Among Nurses in Primary Healthcare: Exploring Their Interrelationship and Implications for Care Delivery. Healthcare 2025, 13, 2117
by Lampros Theodosopoulos, Evangelos C. Fradelos, Aspasia Panagiotou and Foteini Tzavella
Healthcare 2025, 13(22), 2983; https://doi.org/10.3390/healthcare13222983 - 20 Nov 2025
Viewed by 274
Abstract
A discrepancy has been identified between the main text and the back matter of the original publication [...] Full article
(This article belongs to the Special Issue Advancing Cultural Competence in Health Care)
12 pages, 364 KB  
Brief Report
Exploring Emotional Self-Efficacy as a Mediator of Positive Leisure Experience and Subjective Well-Being Among Elementary School-Age Children in a Marginalized Community
by Mei-Ling Lin
Healthcare 2025, 13(22), 2982; https://doi.org/10.3390/healthcare13222982 - 20 Nov 2025
Viewed by 430
Abstract
Background: Prior research has established a positive relationship between emotional self-efficacy and life satisfaction in elementary school-age children. However, less is known about the direct impact of positive leisure experience on subjective well-being and the potential mediating role of emotional self-efficacy. Objectives [...] Read more.
Background: Prior research has established a positive relationship between emotional self-efficacy and life satisfaction in elementary school-age children. However, less is known about the direct impact of positive leisure experience on subjective well-being and the potential mediating role of emotional self-efficacy. Objectives: This study examined whether emotional self-efficacy mediates the association between overall leisure enjoyment and life satisfaction among elementary schoolchildren. It was hypothesized that both direct and indirect effects are statistically significant. Methods: A quantitative, cross-sectional design was used with 100 fifth- and sixth-grade students from a U.S.–Mexico border community. Participants completed the Children’s Assessment of Participation and Enjoyment (CAPE), the emotional subscale of the Self-Efficacy Questionnaire for Children (SEQ-C), and the Student Life Satisfaction Scale (SLSS). Mediation analysis was conducted in R with bootstrapping (500 simulations). Results: Overall leisure enjoyment was positively associated with life satisfaction (β = 0.54, 95% CI [0.23, 0.90], p = 0.004). The direct effect remained significant after accounting for emotional self-efficacy (β = 0.41, 95% CI [0.15, 0.73], p = 0.004). The indirect effect through emotional self-efficacy was also significant (β = 0.13, 95% CI [0.03, 0.29], p = 0.016), accounting for approximately 25% of the total effect. Conclusions: Emotional self-efficacy partially mediated the relationship between overall leisure enjoyment and life satisfaction, suggesting that positive leisure experience enhances children’s emotional coping confidence and subjective well-being. These findings underscore the importance of promoting accessible and enjoyable leisure opportunities within marginalized communities that simultaneously foster children’s emotional self-efficacy and well-being. Full article
(This article belongs to the Special Issue Advancing Mental Well-Being and Health Equity in Marginalized Communities)
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10 pages, 225 KB  
Article
A Cognitive Model of Alcohol Use Among Taiwanese Adolescents: The Influence of Alcohol Expectancies and Drinking Refusal Self-Efficacy
by Mei-Yu Yeh, Chyi-In Wu, Yen-Hua Shih and Yu-Kuei Chen
Healthcare 2025, 13(22), 2981; https://doi.org/10.3390/healthcare13222981 - 20 Nov 2025
Viewed by 440
Abstract
Background: Drinking alcohol of adolescents is an important issue in Taiwan. The purpose of the research is to determine how drinking expectancy and drinking refusal self-efficacy influence drinking behavior among Taiwanese adolescents based on a cognitive model of alcohol consumption. Methods: In this [...] Read more.
Background: Drinking alcohol of adolescents is an important issue in Taiwan. The purpose of the research is to determine how drinking expectancy and drinking refusal self-efficacy influence drinking behavior among Taiwanese adolescents based on a cognitive model of alcohol consumption. Methods: In this cross-sectional study, a total of 908 students, selected from 10th to 12th grade of six high schools in Taiwan, were stratified randomly. Pearson correlation, and multiple regression analyses were conducted to examine the relationships among drinking expectancy, refusal self-efficacy, and alcohol use, including drinking frequency and drunkenness frequency. Results: There was significant positive relationship between drinking expectancies, and drinking and drunkenness frequency; and negative correlation between drinking refusal self-efficacy, and drinking and drunkenness frequency. Multiple regression analysis revealed that (1) tension reduction, sexual enhancement, social pressure, emotional relief, and opportunity to drink significant predicted drinking frequency (Adjusted R2 = 0.352, p < 0.001) and (2) tension reduction, increased confidence, cognitive enhancement, and social pressure significant predicted drunkenness frequency (Adjusted R2 = 0.226, p < 0.001). Conclusions: Adolescents have positive outcome expectancies regarding increased drinking frequency. Under the pressure of social interaction, drinking was the most difficult to refuse. Alcohol expectancy and drinking refusal self-efficacy have both shown notable influences on Taiwanese adolescents. Full article
10 pages, 209 KB  
Article
Can Artificial Intelligence Educate Patients? Comparative Analysis of ChatGPT and DeepSeek Models in Meniscus Injuries
by Bahri Bozgeyik and Erman Öğümsöğütlü
Healthcare 2025, 13(22), 2980; https://doi.org/10.3390/healthcare13222980 - 20 Nov 2025
Viewed by 504
Abstract
Background: Meniscus injuries are among the most common traumatic and degenerative conditions of the knee joint. Patient education plays a critical role in treatment adherence, surgical preparation, and postoperative rehabilitation. The use of artificial intelligence (AI)-based large language models (LLMs) is rapidly increasing [...] Read more.
Background: Meniscus injuries are among the most common traumatic and degenerative conditions of the knee joint. Patient education plays a critical role in treatment adherence, surgical preparation, and postoperative rehabilitation. The use of artificial intelligence (AI)-based large language models (LLMs) is rapidly increasing in healthcare. This study aimed to compare the quality and readability of responses to frequently asked patient questions about meniscus injuries generated by ChatGPT-5 and DeepSeek R1. Materials and Methods: Twelve frequently asked questions regarding the etiology, symptoms, diagnosis, imaging, and treatment of meniscus injuries were presented to both AI models. The responses were independently evaluated by two experienced orthopedic surgeons using a response rating system and a 4-point Likert scale to assess accuracy, clarity, comprehensiveness, and consistency. Readability was analyzed using the Flesch–Kincaid Reading Ease Score (FRES) and the Flesch–Kincaid Grade Level (FKGL). Interrater reliability was determined using intraclass correlation coefficients (ICCs). Results: DeepSeek performed significantly better than ChatGPT in the response rating system (p = 0.017) and achieved higher scores for comprehensiveness on the 4-point Likert scale (p = 0.005). No significant differences were observed between the two models in terms of accuracy, clarity, or consistency (p > 0.05). Both models produced comparable readability scores (p > 0.05), corresponding to a high-school reading level. Conclusions: Both ChatGPT and DeepSeek show promise as supportive tools for educating patients about meniscus injuries. While DeepSeek demonstrated higher overall content quality, both models generated understandable information suitable for general patient education. Further refinement is needed to improve clarity and accessibility, ensuring that AI-based materials are appropriate for diverse patient populations. Full article
(This article belongs to the Section Artificial Intelligence in Healthcare)
22 pages, 1385 KB  
Article
Charting Advances in Asset Management Systems: A Bibliometric Analysis Revealing Applications and Potential in Healthcare
by Dalibor Stanimirović, Lan Umek and Dejan Ravšelj
Healthcare 2025, 13(22), 2979; https://doi.org/10.3390/healthcare13222979 - 19 Nov 2025
Viewed by 716
Abstract
Background: Asset management has become crucial to organizational performance over the past three decades. Implementing an Asset Management System (AMS) can be pivotal in managing the operation, sustainability, and efficiency of both tangible and intangible organizational assets. However, many organizations still underappreciate AMSs, [...] Read more.
Background: Asset management has become crucial to organizational performance over the past three decades. Implementing an Asset Management System (AMS) can be pivotal in managing the operation, sustainability, and efficiency of both tangible and intangible organizational assets. However, many organizations still underappreciate AMSs, particularly in healthcare, where poor organization, unclear processes, and a lack of control contribute to long patient waiting times, financial losses, regulatory non-compliance, and diminished credibility. Methods: This study provides a comprehensive review of the existing body of research on AMSs, discusses AMSs in the context of healthcare, and identifies the specific healthcare areas that have most frequently been the focus of AMS research. This study applies bibliometric analysis of 16,667 documents on AMSs, complemented by a focused bibliometric analysis of a subset of 248 publications specifically addressing AMSs in healthcare. All documents, published up to the end of 2024 and indexed in the Scopus database, were analyzed to investigate the evolution of AMS research, with a particular emphasis on its applications within healthcare. The research employs several bibliometric approaches, utilizing the Python and VOSviewer software. Results: The findings highlight the rapid growth of AMS research, evolving from a niche topic into a strategic discipline that enhances predictive maintenance, efficiency, and sustainability. In healthcare, the adoption of AMSs has grown substantially, supported by the integration of artificial intelligence (AI) and the Internet of Things (IoT). Conclusions: The incorporation of these technologies has enabled more effective monitoring of medical equipment, improved oversight of critical infrastructure, and optimized the operational performance of healthcare providers. Nevertheless, significant research gaps remain concerning the direct impact of AMSs on the quality of patient care, provider coordination, and strategic decision-making. Addressing these gaps is essential not only for advancing academic knowledge but also for leveraging the full potential of AMSs to enhance healthcare delivery, improve outcomes, and support the evidence-based management of healthcare systems. Full article
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11 pages, 221 KB  
Article
Prevalence and Associated Factors of Physical Inactivity Among Malaysian Adults
by Kuang Kuay Lim, Hamizatul Akmal Abd Hamid, Muhammad Fadhli Mohd Yusof, Azli Baharudin Shaharuddin, Tuan Mohd Amin Tuan Lah, Ying Ying Chan, Khairulaizat Mahdin, Norliza Shamsudin, Halizah Mat Rifin and Vanitha Subramaniam
Healthcare 2025, 13(22), 2978; https://doi.org/10.3390/healthcare13222978 - 19 Nov 2025
Viewed by 783
Abstract
Background: Regular physical activity benefits people of all ages by enhancing both mental and physical health, whereas inactivity raises the risk of noncommunicable diseases (NCDs) like cardiovascular diseases, cancer, and diabetes, which can result in premature death. The objective of this cross-sectional [...] Read more.
Background: Regular physical activity benefits people of all ages by enhancing both mental and physical health, whereas inactivity raises the risk of noncommunicable diseases (NCDs) like cardiovascular diseases, cancer, and diabetes, which can result in premature death. The objective of this cross-sectional study was to determine the prevalence and associated factors of physical inactivity among adults in Malaysia. Methods: Data on physical inactivity were extracted from the 2023 National Health and Morbidity Survey (NHMS), conducted from July to September 2023 among adults aged 18 and above across all states of Malaysia. Physical activity was assessed using the Global Physical Activity Questionnaire, with individuals classified as inactive if they did not achieve at least 600 metabolic equivalents of task (MET) minutes per week. Logistic regression was used to identify factors associated with physical inactivity. Results: A total of 10,858 out of 13,616 respondents participated in the study, resulting in a response rate of 79.7%. The overall rate of physical inactivity was 29.9%. The multivariable logistic regression analysis showed that physical inactivity was significantly higher among urban residents (aOR 1.42; 95% CI: 1.16, 1.75), individuals who were single/divorced/widowed (aOR 1.16; 95% CI: 1.01, 1.33), those not working (aOR 1.61; 95% CI: 1.24, 2.09), and those with sedentary time exceeding four hours per day (aOR 1.46; 95% CI: 1.20, 1.76). Inactivity was also more likely among individuals with diabetes (aOR 1.17; 95% CI: 1.00, 1.37) or disabilities (aOR 1.67; 95% CI: 1.39, 2.02). Conclusions: About one-third of Malaysian adults are physically inactive, with higher rates among urban residents, single/divorced/widowed, those not working, those with extended sedentary time, diabetes, or disabilities. Targeted interventions are needed to encourage behaviour change, foster active urban design, and strengthen policies that support active lifestyles. Full article
(This article belongs to the Special Issue Health Intervention of Physical Activity and Sedentary Behaviors)
15 pages, 1226 KB  
Systematic Review
Determinants of Postpartum Sexual Dysfunction in the First Year: A Systematic Review
by Aris Boarta, Adrian Gluhovschi, Marius Lucian Craina, Carmen Ioana Marta, Bogdan Dumitriu, Ioana Denisa Socol, Madalina Ioana Sorop and Bogdan Sorop
Healthcare 2025, 13(22), 2977; https://doi.org/10.3390/healthcare13222977 - 19 Nov 2025
Viewed by 1322
Abstract
Background and Objectives: This systematic review synthesized somatic and psychosocial determinants of postpartum sexual dysfunction (PSD) during the first 12 months after childbirth. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Web of Science, and Scopus from inception to 4 August 2025 without [...] Read more.
Background and Objectives: This systematic review synthesized somatic and psychosocial determinants of postpartum sexual dysfunction (PSD) during the first 12 months after childbirth. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Web of Science, and Scopus from inception to 4 August 2025 without language limits for the indexed records. Eligible studies enrolled postpartum women (≤12 months) and reported validated sexual outcomes (FSFI/FSFI-6, PISQ-12), dyspareunia, or sexual activity, examining breastfeeding, partner support/body image, perineal trauma/instrumentation, or postpartum perineal/musculoskeletal pain. Two reviewers independently screened and extracted data; risk of bias was assessed with a modified Newcastle–Ottawa Scale. Results: Of 1127 records screened, 15 studies were included. Perineal morbidity and early pain consistently tracked with worse sexual outcomes; assisted vaginal birth increased 6-month dyspareunia odds (OR 2.5). Breastfeeding was often associated with lower early sexual function and higher dyspareunia (6-month dyspareunia OR 4.4), with attenuation by 12 months. Higher partner/family support and more positive body image correlated with better FSFI scores. Heterogeneity in timing, measures, and adjustment precluded meta-analysis; results were narratively synthesized. Conclusions: Perineal trauma and early pain are dominant risk signals; breastfeeding-related symptoms exert early and context-dependent effects; psychosocial resources are protective. Full article
(This article belongs to the Special Issue Interdisciplinary Perspectives in Maternal Health: Integrating Theoretical Frameworks and Practical Applications)
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18 pages, 1450 KB  
Article
Strengthening the Neonatal Workforce Through World Café Methodology
by Suza Trajkovski, Linda Ng, Patricia Lowe and Margaret Broom
Healthcare 2025, 13(22), 2976; https://doi.org/10.3390/healthcare13222976 - 19 Nov 2025
Viewed by 442
Abstract
Aim: This workshop aimed to facilitate in-depth discussions, promote knowledge sharing, and generate evidence-informed strategies to improve the recruitment and retention of the neonatal nursing workforce in Australia. Research Design: A qualitative participatory study was conducted using the World Café methodology to engage [...] Read more.
Aim: This workshop aimed to facilitate in-depth discussions, promote knowledge sharing, and generate evidence-informed strategies to improve the recruitment and retention of the neonatal nursing workforce in Australia. Research Design: A qualitative participatory study was conducted using the World Café methodology to engage neonatal nurses in collaborative dialogue. Methods: Twenty-seven neonatal nurses (all female, predominantly aged 40–60 years) participated in a structured World Café workshop. An inductive thematic analysis was employed to explore participants’ perspectives on workforce challenges and solutions. Results: Four key themes were identified: (1) Leadership and Advocacy, (2) Professional Identity, (3) Future Vision and Innovation, and (4) Creating a Supportive Culture. These themes reflect the complex, interrelated factors influencing workforce sustainability and highlight the need for targeted, multi-level interventions. Conclusions: Building a resilient neonatal nursing workforce and ensuring the delivery of high-quality care requires a coordinated response from professional nursing organisations, nurse leaders and managers, and individual clinicians. This study provides a replicable model for stakeholder engagement and offers actionable recommendations to inform workforce policy, leadership development, and practice innovation. Full article
(This article belongs to the Special Issue Educating and Strengthening the Workforce for Maternal and Neonatal Health)
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20 pages, 793 KB  
Article
Essential Safety Sheet in University Hospital and Healthcare Laboratories: A Comprehensive Evaluation Study with Longitudinal Impact Analysis
by Oh-Hyun Kwon, Gyu-Jin Sim, Sun-Haeng Choi and Ki-Youn Kim
Healthcare 2025, 13(22), 2975; https://doi.org/10.3390/healthcare13222975 - 19 Nov 2025
Viewed by 521
Abstract
Background/Objectives: Safety information in hospital laboratories is often fragmented or difficult to retrieve under time pressure. We developed an Essential Safety Sheet (ESS) to present critical, task-level safety information immediately and evaluated its effectiveness on safety performance and incidents. Methods: We conducted a [...] Read more.
Background/Objectives: Safety information in hospital laboratories is often fragmented or difficult to retrieve under time pressure. We developed an Essential Safety Sheet (ESS) to present critical, task-level safety information immediately and evaluated its effectiveness on safety performance and incidents. Methods: We conducted a mixed-methods evaluation across eight university hospital laboratories from March 2023 to August 2024, including a 13-month interrupted time series with a concurrent difference-in-differences comparison between ESS and control laboratories (pre-implementation 6 months, implementation month, post-implementation 6 months). Primary outcomes were (1) emergency escalation accuracy, (2) information search time for task-critical items and (3) laboratory incident rates. Segmented regression models with robust Standard errors estimated level and slope changes; parallel trends were assessed pre-intervention. Multiple comparisons across the three primary outcomes were controlled for using the Bonferroni correction. Qualitative usability feedback was analyzed to contextualize the quantitative effects. Results: ESS implementation was associated with significant improvements in information search time and reductions in incident rates that were sustained over the post-implementation period in the ESS laboratories relative to the controls. Escalation accuracy improved in direction but did not reach statistical significance after multiple comparison correction (Bonferroni-adjusted p = 0.150). Findings were robust to the sensitivity analyses of model specification and pre-trend assumptions. Conclusions: A concise, task-level safety sheet can enhance the speed of safety-critical information retrieval and contribute to lower incident rates in hospital laboratories. While escalation accuracy showed only a favorable trend after correction, overall results support ESS as low-cost, scalable interventions to strengthen laboratory safety performance. Future studies should test generalizability across more sites and tasks to assess longer-term sustainability. Full article
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15 pages, 259 KB  
Article
Confronting Patients’ Refusal to Undergo Treatment: A Cross-Sectional Study of Ethical Attitudes and Intended Behaviour Among Lithuanian Physicians
by Asta Čekanauskaitė, Karolina Lukošienė, Jelizaveta Krotova, Džiugilė Kersnauskaitė, Benedikt Bachmetjev, Artur Airapetian and Marija Jakubauskienė
Healthcare 2025, 13(22), 2974; https://doi.org/10.3390/healthcare13222974 - 19 Nov 2025
Viewed by 792
Abstract
Introduction: Refusal to undergo treatment, including one of its manifestations, discharge against medical advice, must be informed, just as consent is, which is considered a core ethical principle in contemporary medical ethics. The aim of this study was to explore physicians’ attitudes and [...] Read more.
Introduction: Refusal to undergo treatment, including one of its manifestations, discharge against medical advice, must be informed, just as consent is, which is considered a core ethical principle in contemporary medical ethics. The aim of this study was to explore physicians’ attitudes and intended behaviour toward patients’ refusal of necessary treatment and to identify factors associated with their clinical decisions in such situations. Methods: A cross-sectional anonymous online survey of 393 physicians working in Lithuanian public hospitals was conducted between November 2020 and March 2021 using the secure national platform manoapklausa.lt. A convenience sampling strategy ensured representation of both large university and smaller regional hospitals, and all responses were complete due to mandatory fields in the questionnaire. Results: Most physicians (85%; 95% CI 81.2 to 88.5) have encountered situations of refusal to undergo treatment. Women (p < 0.05) and senior physicians (aged 51 years and over) (p < 0.05) tend to apply treatment without patients’ consent more often in all clinical cases, especially in surgical ones (VN1 and VN2). Difficulty in the decision-making process was associated with chronic conditions and the influence of individual religious beliefs. Insufficient patient information on the intervention was indicated as the main cause of refusal to undergo treatment (62.9%; 95% CI 58.0 to 67.4). Refusal to undergo treatment was associated with physicians’ concern about the patient (57.5%; 95% CI 52.7 to 62.3) and anxiety (38.9%; 95% CI 34.1 to 43.8). Physicians’ attitudes towards patients’ refusal to undergo treatment reflect paternalistic patterns and are mainly associated with the physician’s older age, gender, and duration of professional experience. Insufficient patient information on the intervention was indicated as the most important factor determining patients’ refusal to undergo treatment. Under Lithuanian law, patients have a clear legal right to refuse treatment, and physicians who proceed without consent may face criminal liability. Conclusions: Our findings show that, despite the legal restrictions, many physicians would still choose to treat against a patient’s will, reflecting a persistent paternalistic attitude even in the presence of clear legal prohibitions. Full article
(This article belongs to the Section Public Health and Preventive Medicine)
15 pages, 493 KB  
Systematic Review
Effectiveness of Exercise and Physiotherapy in Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review
by Javier Antonio Tamayo Fajardo and Francisco León Parejo
Healthcare 2025, 13(22), 2973; https://doi.org/10.3390/healthcare13222973 - 19 Nov 2025
Viewed by 2001
Abstract
Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and disabling adverse effect of cancer treatment, affecting up to 65% of patients. It reduces quality of life, increases fall risk, and often leads to chemotherapy dose reduction or discontinuation. Because pharmacological management provides limited [...] Read more.
Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and disabling adverse effect of cancer treatment, affecting up to 65% of patients. It reduces quality of life, increases fall risk, and often leads to chemotherapy dose reduction or discontinuation. Because pharmacological management provides limited relief, non-pharmacological strategies such as exercise and physiotherapy have become increasingly relevant. Methods: A systematic review following the PRISMA 2020 guidelines was conducted to identify randomised controlled trials (RCTs) evaluating exercise and physiotherapy for the prevention or treatment of CIPN. PubMed, Scopus, Web of Science, and Cochrane Library were searched up to May 2025. Methodological quality was assessed with the PEDro scale, and due to heterogeneity, a narrative synthesis was performed. Outcomes included neuropathic symptoms, pain, motor and sensory function, balance, muscle strength, and quality of life. Results: Twenty-six RCTs published between 2017 and 2025 were included. Nineteen assessed exercise-based interventions (aerobic, resistance, sensorimotor, balance, yoga, or multimodal), and seven examined physiotherapy modalities (manual therapy, photobiomodulation, Scrambler therapy, ultrasound, or electrical stimulation). Both approaches improved sensory and motor symptoms, balance, muscle strength, and quality of life. Adherence ranged from 70% to 95%, and no serious adverse events were reported. However, variability in intervention design and outcome measures precluded meta-analysis. Conclusions: Exercise and physiotherapy are safe, feasible, and effective non-pharmacological strategies for managing CIPN. However, heterogeneity in intervention design highlights the need for high-quality RCTs to establish optimal protocols and standardised clinical guidelines. Full article
(This article belongs to the Special Issue The Role of Physical Activity and Sports in Enhancing Psychological Well-Being and Quality of Life)
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12 pages, 243 KB  
Study Protocol
Digital Educational Intervention to Improve Adherence and Self-Care in Chronic Patients: A Prospective Study Protocol (PROSELF)
by Angelo Cianciulli, Giovanni Boccia, Roberta Manente, Antonietta Pacifico, Giuseppina Speziga and Emanuela Santoro
Healthcare 2025, 13(22), 2972; https://doi.org/10.3390/healthcare13222972 - 19 Nov 2025
Viewed by 815
Abstract
Background: Chronic non-communicable diseases—chiefly chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus (T2DM), and cardiovascular diseases (CVDs)—remain the leading causes of morbidity and mortality worldwide. Despite the proliferation of telehealth programs, few longitudinal studies have rigorously evaluated theory-based, nurse-led digital education across [...] Read more.
Background: Chronic non-communicable diseases—chiefly chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus (T2DM), and cardiovascular diseases (CVDs)—remain the leading causes of morbidity and mortality worldwide. Despite the proliferation of telehealth programs, few longitudinal studies have rigorously evaluated theory-based, nurse-led digital education across multiple chronic conditions within a unified self-care framework. PROSELF (Promotion of Self-Care through Educational Interventions in Chronic Patients) addresses this gap. Methods: Promotion of Self-Care (PROSELF) is a prospective, longitudinal, multicenter, non-interventional study in community and primary-care settings in Southern Italy. A 12-month nurse-led digital educational intervention—grounded in the Middle-Range Theory of Self-Care of Chronic Illness—targets the three core self-care dimensions (maintenance, monitoring, and management) through individualized tele-education, asynchronous reinforcement, and structured follow-up at baseline, 3, 6, and 12 months. Validated self-care, quality-of-life, and social-support measures will be used. Data will be analyzed using repeated-measures and multivariate models to evaluate longitudinal changes in self-care, adherence, and related outcomes. Participation requires digitally informed consent. Results: The PROSELF study is expected to demonstrate the effectiveness of a 12-month, nurse-led digital educational program in improving adherence and self-care behaviors among patients with chronic diseases (COPD, diabetes, and cardiovascular disease). The intervention will leverage validated self-care assessment tools and tele-educational follow-up sessions. Conclusions: Findings from this study will inform the design of scalable, evidence-based, behaviorally informed models for digital chronic care delivery and nursing education. Full article
(This article belongs to the Special Issue Adherence and Behavior Change in Health and Rehabilitation Interventions)
17 pages, 357 KB  
Review
Components and Effectiveness of Adult Inpatient Psychiatric Rehabilitation Programs: A Scoping Review
by Panagiota Giannios, Fanie Chainey, Catherine Degré, Stéphanie Borduas Pagé and Alexandre Hudon
Healthcare 2025, 13(22), 2971; https://doi.org/10.3390/healthcare13222971 - 19 Nov 2025
Viewed by 1330
Abstract
Background/Objectives: Inpatient psychiatric rehabilitation plays a critical role in the recovery of adults with serious mental illness (SMI), offering structured, supportive care to improve functioning and community integration. Despite its clinical relevance, there is considerable heterogeneity in how these programs are structured, [...] Read more.
Background/Objectives: Inpatient psychiatric rehabilitation plays a critical role in the recovery of adults with serious mental illness (SMI), offering structured, supportive care to improve functioning and community integration. Despite its clinical relevance, there is considerable heterogeneity in how these programs are structured, delivered, and evaluated. This scoping review aimed to map the core components and reported outcomes of adult inpatient psychiatric rehabilitation programs and to identify elements associated with program effectiveness. Methods: A scoping review was conducted according to PRISMA-ScR guidelines. Four electronic databases (MEDLINE, Web of Science, PsycINFO, and Google Scholar) were systematically searched for articles published between inception and 2024. Studies were eligible if they described inpatient psychiatric rehabilitation programs for adults and reported on clinical, functional, or system-level outcomes. Data extraction included program characteristics, intervention components, effectiveness indicators, and study limitations. A qualitative thematic synthesis was conducted, and methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Results: Fifteen studies met the inclusion criteria. Core rehabilitation components included structured psychosocial interventions (e.g., CBT, psychoeducation), vocational and occupational support, recovery-oriented goal setting, and transitional care planning. Most programs demonstrated positive outcomes, including reduced readmissions, improved functional and psychosocial functioning, and enhanced quality of life. Effectiveness appeared to be influenced by the duration of rehabilitation, multidisciplinary team involvement, and continuity of care post-discharge. However, outcome measures varied considerably, and few studies used standardized assessment tools or included long-term follow-up. Conclusions: This review highlights common features of effective inpatient psychiatric rehabilitation programs and underscores the need for standardized outcome measures, implementation fidelity assessments, and longitudinal research. Findings can guide service planning, inform policy development, and support recovery-oriented inpatient care. Full article
(This article belongs to the Section Mental Health and Psychosocial Well-being)
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18 pages, 615 KB  
Article
Assessment of Oral Hygiene Practices, Adjunctive Cleaning Methods, and Their Impact on Plaque and Gingival Indices Among Young Adults in Urban and Rural Settings in Romania
by Ioana Elena Lile, Șerban Talpoș-Niculescu, Diana Marian, Otilia Stana, Andra-Alexandra Stăncioiu, Alexandru Cătălin Motofelea and George-Dumitru Constantin
Healthcare 2025, 13(22), 2970; https://doi.org/10.3390/healthcare13222970 - 19 Nov 2025
Cited by 1 | Viewed by 710
Abstract
Background/Objectives: Young adults increasingly prefer natural dentifrices; however, the short-term clinical effects and behavioural correlates of these products remain insufficiently documented. This study aimed to evaluate the associations between daily oral-hygiene practices, adjunctive cleaning methods, and plaque and gingival indices, and to compare [...] Read more.
Background/Objectives: Young adults increasingly prefer natural dentifrices; however, the short-term clinical effects and behavioural correlates of these products remain insufficiently documented. This study aimed to evaluate the associations between daily oral-hygiene practices, adjunctive cleaning methods, and plaque and gingival indices, and to compare the short-term effects of three natural toothpaste formulations—sodium bicarbonate, activated charcoal, and lemon-based. Methods: In this cross-sectional study, 101 Romanian adults (aged 20–41 years; 69.3% urban) completed a structured questionnaire assessing brushing frequency and the use of dental floss, interdental stimulators, and mouth rinses. Clinical assessments included the Silness–Löe Plaque Index and the Löe–Silness Gingival Index (modified by Lobene), recorded immediately before and after a supervised 2 min brushing session using the Bass technique with soft-bristled brushes and the participant’s self-reported natural toothpaste (baking soda: n = 42; charcoal: n = 27; lemon: n = 32). Results: Before brushing, 78.2% of participants presented with thin adherent plaque, while the gingival status was normal in 72.3%, mildly inflamed in 22.8%, and moderately inflamed in 5.0%. After brushing, the proportion with normal gingiva increased to 77.2%, and the proportion of thin, adherent plaque decreased to 22.8%. Brushing frequency was positively correlated with plaque reduction (ρ = 0.42, p < 0.001), while the use of adjunctive cleaning methods was inversely correlated with post-brushing gingival inflammation (ρ = −0.36, p = 0.002). Gingival improvement differed significantly among toothpaste types (χ2, p < 0.001), with formulations containing baking soda and lemon showing slightly more favourable short-term gingival categories than charcoal; these patterns are descriptive and do not demonstrate comparative product efficacy. Urban–rural differences were observed for brushing frequency (p < 0.001) and periodontal status with fewer lesions among urban participants (p = 0.002). Conclusions: A single supervised Bass-technique brushing session resulted in measurable short-term improvements in plaque and gingival indices among young adults. Sodium bicarbonate and lemon-based dentifrices appeared to be associated with slightly more favourable short-term gingival responses than charcoal, although these findings should be interpreted as preliminary. These findings emphasise the importance of consistent brushing and interdental cleaning behaviours and highlight the need for longitudinal randomised trials to evaluate the durability, safety, and comparative effectiveness of natural versus conventional dentifrices. Given the cross-sectional, single-session design, these findings are exploratory and do not establish causal or comparative product efficacy. Full article
(This article belongs to the Special Issue Dental Research and Innovation: Shaping the Future of Oral Health)
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15 pages, 1524 KB  
Systematic Review
The Impact of Virtual Reality on Cardiopulmonary Function and Adherence in Cardiac Rehabilitation Patients: A Systematic Review and Meta-Analysis
by Qiqi Cheng, Feng Li, Qingyuan Zhang, Huidan Yu and Suqing Wang
Healthcare 2025, 13(22), 2969; https://doi.org/10.3390/healthcare13222969 - 19 Nov 2025
Viewed by 871
Abstract
Purpose: This systematic review aimed to evaluate the effectiveness of virtual reality (VR) technology in cardiac rehabilitation (CR) patients, focusing on cardiopulmonary function, quality of life, adherence, and satisfaction. Methods: Conducted following PRISMA guidelines and registered on PROSPERO (CRD42025643632), this study systematically searched [...] Read more.
Purpose: This systematic review aimed to evaluate the effectiveness of virtual reality (VR) technology in cardiac rehabilitation (CR) patients, focusing on cardiopulmonary function, quality of life, adherence, and satisfaction. Methods: Conducted following PRISMA guidelines and registered on PROSPERO (CRD42025643632), this study systematically searched PubMed, Web of Science, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Scopus, CNKI, and Wanfang Data. Meta-analysis was performed using RevMan 5.4 to assess the impact of VR interventions on cardiopulmonary function, quality of life (QOL), adherence, and satisfaction compared to conventional CR programs. Results: Twenty studies were included. Meta-analysis revealed that VR improved the 6 min walk test distance (MD: 34.9, 95% CI: 24.43, 45.37; p < 0.00001, I2 = 67%) and QOL (SMD: 0.63, 95% CI: 0.09, 1.17; p = 0.002, I2 = 86%). However, evidence regarding adherence and satisfaction was inconclusive. Conclusions: VR technology outperforms traditional CR in enhancing cardiopulmonary function and quality of life. While it might improve patient adherence, further research is necessary to confirm these findings. Full article
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17 pages, 1066 KB  
Article
Impact of the Saudi Health Sector Transformation Program (SHSTP): A Mixed-Methods Evaluation of Patient-Centered Care and Digital Health Adoption
by Ahmed Abdullah Alshehri and Asaad Abdulrahman Abduljawad
Healthcare 2025, 13(22), 2968; https://doi.org/10.3390/healthcare13222968 - 19 Nov 2025
Cited by 1 | Viewed by 1334
Abstract
Background: As part of Vision 2030, the Saudi Health Sector Transformation Program (SHSTP) introduced hospital clustering and digital health to strengthen patient-centered care. However, limited empirical evidence exists on its real-world impact. SHSTP represents one of the first large-scale digital integration reforms in [...] Read more.
Background: As part of Vision 2030, the Saudi Health Sector Transformation Program (SHSTP) introduced hospital clustering and digital health to strengthen patient-centered care. However, limited empirical evidence exists on its real-world impact. SHSTP represents one of the first large-scale digital integration reforms in the Gulf region, aligning with international frameworks such as the WHO Integrated People-Centred Health Services (IPCHS) and the Wagner Chronic Care Model. This study therefore contributes policy-relevant evidence on how national digital health reforms translate into measurable improvements in care coordination and patient experience. Methods: A convergent mixed-methods study was conducted across two regions (Mecca and Eastern Province) and four public hospitals (two clustered, two non-clustered) from 2016 to 2024. Quantitative indicators included patient satisfaction, Patient-Centered Care Index (PCCI), follow-up compliance, digital engagement (telemedicine, Sehat app/EMR), operational efficiency, and readmissions. Analyses used t-tests, ANOVA, and multivariable regression. Qualitative data from 53 semi-structured interviews (patients and physicians) were thematically analyzed and integrated with quantitative results through triangulation. Results: Clustered hospitals showed higher patient satisfaction (87.6% vs. 75.0%), stronger care coordination (PCCI: 89.4 vs. 69.7; p < 0.001), and better follow-up compliance (83.6% vs. 71.2%; p = 0.006). Digital engagement was greater (telemedicine 0.53 vs. 0.30; Sehat app 0.55 vs. 0.26; both p < 0.05). Regression identified hospital clustering (β = 12.49; p = 0.022), physician role (β = 19.92; p < 0.001), and digital literacy (β = 4.03; p = 0.047) as significant predictors of care coordination. Qualitative findings supported these results but highlighted challenges with digital literacy and workforce stability. Conclusions: SHSTP clustering improves patient experiences, digital engagement, and operational performance in chronic care. Sustained progress requires investment in digital literacy, workforce development, and change management. Broader longitudinal evaluation is warranted to confirm scalability and system-wide effects. These results extend the global evidence base on health system transformation by illustrating how digital and structural integration can operationalize patient-centered care in emerging-economy settings. Full article
(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)
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14 pages, 237 KB  
Article
Invisible Barriers: Institutional Discrimination Against Asylum-Seeking Women in Portugal
by Gabriela Mesquita Borges
Healthcare 2025, 13(22), 2967; https://doi.org/10.3390/healthcare13222967 - 19 Nov 2025
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Abstract
Introduction: Building a life in an asylum country poses specific challenges for women, who often face compounded barriers in healthcare, language acquisition, economic independence, childcare, education, cultural adaptation, and legal processes. This study examines the experiences of asylum-seeking women in Portugal, focusing on [...] Read more.
Introduction: Building a life in an asylum country poses specific challenges for women, who often face compounded barriers in healthcare, language acquisition, economic independence, childcare, education, cultural adaptation, and legal processes. This study examines the experiences of asylum-seeking women in Portugal, focusing on discrimination perpetrated by professionals within reception and integration institutions. Methods: Drawing on 24 semi-structured interviews with women from the Middle East (n = 14) and Africa (n = 10), this research adopts a criminological and gender lens and employs a narrative paradigm informed by constructivist Grounded Theory and an abductive approach. Results: The analysis reveals that institutional discrimination, manifested through neglect, hostility, and cultural insensitivity, reinforces feelings of abandonment and fear, obstructs integration, and perpetuates cycles of marginalization and vulnerability. These dynamics are intensified by gender-based and structural violence embedded in asylum procedures and professional practices. The findings highlight the emotional and relational dimensions of institutional encounters, showing how empathy, trust, and intercultural awareness among professionals are crucial for effective inclusion. Conclusions: This study concludes that addressing institutional discrimination requires systemic change, professional training in gender-sensitive and intercultural competencies, and the promotion of equitable, inclusive, and human rights-based reception practices in Portugal. Full article
(This article belongs to the Special Issue Healthcare for Immigrants and Refugees)
19 pages, 1183 KB  
Article
Burnout Syndrome Among Primary Care Physicians in Romania: A National Overview
by Nina Ciuciuc, Eugenia-Maria Lupan-Mureșan, Alexandra-Ioana Roșioară, Monica Popa, Dana Manuela Sîrbu, Daniela Curșeu, Codruța Alina Popescu and Bogdana-Adriana Năsui
Healthcare 2025, 13(22), 2966; https://doi.org/10.3390/healthcare13222966 - 19 Nov 2025
Viewed by 651
Abstract
Background/Objectives: This study provides the first national-level assessment of burnout among family physicians (FPs) and emergency physicians (EPs) in Romania. Burnout syndrome is a growing concern in medical settings, particularly among primary care physicians. The aim of this study was to compare the [...] Read more.
Background/Objectives: This study provides the first national-level assessment of burnout among family physicians (FPs) and emergency physicians (EPs) in Romania. Burnout syndrome is a growing concern in medical settings, particularly among primary care physicians. The aim of this study was to compare the levels of frustration and emotional exhaustion (EE) among the Romanian EPs and FPs. Methods: A cross-sectional observational online study was conducted using validated psychometric questionnaires. Statistical analyses included correlation, regression, and between-group comparisons. Results: A total of 307 participants were included (222 FP and 85 EP). EPs reported significantly higher levels of frustration (Mean ± SD = 1.94 ± 1.22) and EE (2.52 ± 0.86) than FPs (2.01 ± 1.24 and 2.51 ± 0.84, respectively; p < 0.001). Regression analysis identified ‘feeling at the end of one’s strength’ (M = 1.26, p < 0.001) and ‘evening exhaustion’ (M = 1.20, p = 0.0112) as significant predictors of EE. Conclusions: The findings highlight the need for differentiated intervention strategies adapted to the specific work conditions of each medical specialty. Organizational support and mental health promotion are recommended to reduce burnout, alongside encouraging professionals to practice individual strategies to ensure well-being. Full article
(This article belongs to the Section Public Health and Preventive Medicine)
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