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Volume 13
Issue 24
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Healthcare, Volume 13, Issue 24 (December-2 2025) – 146 articles

Cover Story (view full-size image): Medical and social care professionals (MSCPs) are a high-risk population for chronic occupational stress and autonomic dysregulation. We investigated the effects of the Somatic Psychoeducational Intervention (SPI) on autonomic reactivity (AR), psychological distress symptoms, and salivary oxytocin levels. Participants engaged in a three- to four-week intervention integrating psychoeducation, interoceptive training, breathwork, and somatic movement. Increases in salivary oxytocin and reductions in AR and psychological distress symptoms were found, with benefits sustained at one-month follow-up. Preliminary findings support the SPI as a potentially scalable intervention with neurophysiological and psychological benefits. By addressing both mind and body, the SPI may be effective in mitigating psychological stress and AR in MSCPs. View this paper
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21 pages, 893 KB  
Article
Enhancing Diagnostic Infrastructure Through Innovation-Driven Technological Capacity in Healthcare
by Nicoleta Mihaela Doran
Healthcare 2025, 13(24), 3328; https://doi.org/10.3390/healthcare13243328 - 18 Dec 2025
Viewed by 335
Abstract
Background: This study examines how national innovation performance shapes the diffusion of advanced diagnostic technologies across European healthcare systems. Strengthening technological capacity through innovation is increasingly essential for resilient and efficient health services. The analysis quantifies the influence of innovation capacity on the [...] Read more.
Background: This study examines how national innovation performance shapes the diffusion of advanced diagnostic technologies across European healthcare systems. Strengthening technological capacity through innovation is increasingly essential for resilient and efficient health services. The analysis quantifies the influence of innovation capacity on the availability of medical imaging technologies in 26 EU Member States between 2018 and 2024. Methods: A balanced panel dataset was assembled from Eurostat, the European Innovation Scoreboard, and World Bank indicators. Dynamic relationships between innovation performance and the adoption of CT, MRI, gamma cameras, and PET scanners were estimated using a two-step approach combining General-to-Specific (GETS) outlier detection with Robust Least Squares regression to address heterogeneity and specification uncertainty. Results: Higher innovation scores significantly increase the diffusion of R&D-intensive technologies such as MRI and PET, while CT availability shows limited responsiveness due to market maturity. Public health expenditure supports frontier technologies when strategically targeted, whereas GDP growth has no significant effect. Population size consistently enhances technological capacity through scale and system-integration effects. Conclusions: The findings show that innovation ecosystems, rather than economic growth alone, drive the modernization of diagnostic infrastructure in the EU. Integrating innovation metrics into health-technology assessments offers a more accurate basis for designing innovation-oriented investment policies in European healthcare. Full article
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11 pages, 914 KB  
Review
Artificial Intelligence and Innovation in Oral Health Care Sciences: A Conceptual Review
by Marco Dettori, Demetrio Lamloum, Peter Lingström and Guglielmo Campus
Healthcare 2025, 13(24), 3327; https://doi.org/10.3390/healthcare13243327 - 18 Dec 2025
Viewed by 625
Abstract
Background/Objectives: Artificial intelligence (AI) has rapidly evolved from experimental algorithms to transformative tools in clinical dentistry. Between 2020 and 2025, advances in machine learning (ML) and deep learning (DL) have reshaped diagnostic imaging, caries detection, prosthodontic design, and teledentistry, while raising new [...] Read more.
Background/Objectives: Artificial intelligence (AI) has rapidly evolved from experimental algorithms to transformative tools in clinical dentistry. Between 2020 and 2025, advances in machine learning (ML) and deep learning (DL) have reshaped diagnostic imaging, caries detection, prosthodontic design, and teledentistry, while raising new ethical and regulatory challenges. This study aimed to provide a comprehensive bibliometric and conceptual review of AI applications in dental care, highlighting research trends, thematic clusters, and future directions for equitable and responsible integration of AI technologies. In addition, the review further considers the implications of AI adoption for patient-centered care, including its potential role in supporting shared decision-making processes in oral healthcare. Methods: A comprehensive search was conducted in PubMed, Scopus and Embase for articles published between January 2020 and October 2025 using AI-related keywords in dentistry. Eligible records were analyzed using VOSviewer (v.1.6.20) to map co-occurrence networks of keywords, authors, and citations. A narrative synthesis complemented the bibliometric mapping, emphasizing conceptual and ethical dimensions of AI adoption in oral health care. Results: A total of 50 documents met the inclusion criteria. Bibliometric network visualization identified that the largest and most interconnected clusters were centered around the keywords “artificial intelligence,” “machine learning,” and “deep learning,” reflecting the technological backbone of AI-based applications in dentistry. Thematic evolution analysis indicated increasing interest in generative and multimodal AI models, explainability, and fairness in clinical deployment. Conclusions: AI has become a core driver of innovation in dentistry, enabling precision diagnostics and personalized care. However, responsible translation requires robust validation, transparency, and ethical oversight. Future research should integrate interdisciplinary approaches linking AI performance, patient outcomes, and equity in oral health. Full article
(This article belongs to the Special Issue The Future of Patient-Centered Care: Digital Tools and Strategies for Shared Decision-Making)
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17 pages, 1120 KB  
Article
Cross-Cultural Adaptation and Validation of the Beck Depression Inventory (BDI-II) in the Community Otomi of the Mezquital Valley, Mexico
by Irene López-Hernández, Claudia Lerma, Rebeca María Elena Guzmán-Saldaña, Itzel Moreno Vite, María Luisa Escamilla Gutiérrez, Cristina J. González-Flores and Abel Lerma
Healthcare 2025, 13(24), 3326; https://doi.org/10.3390/healthcare13243326 - 18 Dec 2025
Viewed by 506
Abstract
Background: The Beck Depression Inventory Second Edition (BDI-II) is used to assess depression worldwide. In Mexico, the BDI-II Spanish translation is widely used. Despite more than 23 million people being identified as indigenous, there is no empirical evidence on the BDI-II psychometric properties [...] Read more.
Background: The Beck Depression Inventory Second Edition (BDI-II) is used to assess depression worldwide. In Mexico, the BDI-II Spanish translation is widely used. Despite more than 23 million people being identified as indigenous, there is no empirical evidence on the BDI-II psychometric properties among indigenous languages, including Otomi. Therefore, this study aimed to cross-culturally adapt the BDI-II for the Otomi population and evaluate its psychometric properties. Methods: This cross-sectional instrumental study with non-probability sampling was conducted with 228 participants from the Otomi community. The cross-cultural adaptation of the BDI-II followed Beaton’s guidelines for self-report measures: (i) translation, (ii) synthesis, (iii) back translation, (iv) expert committee review, (v) pretesting, and (vi) submission of documentation to the developers. Reliability was assessed using Cronbach’s alpha. Exploratory and confirmatory factor analyses were used to determine structural and construct validity. Results: The cross-culturally adapted instrument showed adequate reliability, with a total Cronbach’s α of 0.756, comprising 14 items and four factors (with alpha coefficients ranging from 0.505 to 0.633). These factors included three cognitive–affective dimensions and one somatic dimension, which conceptually align with Beck’s original model. Confirmatory factor analysis (CFA) presented adequate indices: Comparative Fit Index (CFI) = 0.901, Root Mean Square Error of Approximation (RMSEA) = 0.056, IC90% [0.028–0.079], and Goodness-of-Fit Index = 0.908, which indicate a balanced and parsimonious fit of the model. Conclusions: The BDI-II is a reliable and culturally valid instrument for measuring depressive symptoms among the Otomi people of the Mezquital Valley. Full article
(This article belongs to the Special Issue Depression: Recognizing and Addressing Mental Health Challenges)
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15 pages, 273 KB  
Article
Comparative Assessment of Out-of-Pocket Health Expenditure in Haemodialysis and Peritoneal Dialysis Patients
by Suhaila Saad, Nurulhuda Mohd Satar and Roza Hazli Zakaria
Healthcare 2025, 13(24), 3325; https://doi.org/10.3390/healthcare13243325 - 18 Dec 2025
Viewed by 505
Abstract
Background: Dialysis is a life-sustaining treatment for patients with end-stage renal disease (ESRD), but it requires high financial costs due to the need for continuous treatment and the associated expenses of medical supplies, equipment, and related care. Objective: This study aims to compare [...] Read more.
Background: Dialysis is a life-sustaining treatment for patients with end-stage renal disease (ESRD), but it requires high financial costs due to the need for continuous treatment and the associated expenses of medical supplies, equipment, and related care. Objective: This study aims to compare the out-of-pocket (OOP) health expenditure incurred by patients undergoing haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Methods: The data for this observational cross-sectional study were obtained through a survey at two public hospitals, comprising a sample of 220 ESRD patients. In order to compare the OOP health expenditure between two modalities, the Mann–Whitney U test and the chi-square test were employed. Multiple linear-regression analysis was then used to identify the contributing factors associated with the aforementioned OOP expenses. Results: The estimated median monthly OOP health expenditure for HD patients was MYR 388 (interquartile range [IQR: 224–519]), significantly higher than CAPD (MYR 160 [IQR: 100–231]; p < 0.001). Our findings confirm that the choice of dialysis modality significantly affects the OOP health expenditures for dialysis patients MYR 145.73; 95% CI: 75.51–218.15; p < 0.05; 0.001. Additional determinants of OOP health expenditure identified in this study include the interaction between the modality choice and the distance from home to the dialysis centre (MYR 3.39; 95% CI: 0.27–6.66; p < 0.05; 0.022), comorbidity status (MYR 49.51; 95% CI: 9.09–90.77; p < 0.05; 0.031), duration of illness (MYR 4.01; 95% CI: 0.71–7.63; p < 0.05; 0.041), and household income MYR 67.43 (95% CI: 1.71–134.81; p < 0.05; 0.021). Conclusions: This study emphasises the need to improve the training and awareness of CAPD to increase its use, as it requires less travel and lowers OOP expenses. In addition, introducing a travel reimbursement scheme is also recommended to reduce the transportation costs for HD patients. Full article
21 pages, 1686 KB  
Systematic Review
Nutritional Interventions in Head and Neck Cancer Patients Undergoing Chemoradiotherapy: A Systematic Review and Meta-Analysis
by Sneha Patnaik, Jiun-Yi Wang, Fawziyyah Usman Sadiq and Khemraj Sharma
Healthcare 2025, 13(24), 3324; https://doi.org/10.3390/healthcare13243324 - 18 Dec 2025
Viewed by 426
Abstract
Background: Head and neck cancer patients frequently encounter nutritional deterioration, culminating in poor clinical and treatment-related outcomes and reduced quality of life. This systematic review and meta-analysis aim to examine the effects of non-invasive nutritional interventions on nutritional status and clinical, biochemical, and [...] Read more.
Background: Head and neck cancer patients frequently encounter nutritional deterioration, culminating in poor clinical and treatment-related outcomes and reduced quality of life. This systematic review and meta-analysis aim to examine the effects of non-invasive nutritional interventions on nutritional status and clinical, biochemical, and patient-reported outcomes. Methods: A comprehensive literature search across five databases (PubMed, CINAHL, ProQuest, Medline, and Scopus) was carried out to identify potentially relevant randomized control trials published in English between 2019 and 2024. Screening, extraction of data, and quality check were carried out separately by two reviewers. The Joanna Briggs Critical Appraisal tools assessed the quality of the included studies and evidence certainty was appraised using the GRADE framework. Depending on the amount of heterogeneity present, a random or fixed-effects model was used to conduct the meta-analysis. Results: Eleven studies were included, involving 1000 participants. Pooled estimates showed significant effects on weight (SMD = 0.171, 95%CI: 0.008, 0.335, p = 0.04), serum albumin (SMD = 0.539, 95%CI: 0.150, 0.927, p= 0.007), and patient-generated subjective global assessment score (SMD = −0.518, 95%CI: −0.931, −0.106, p = 0.014) in the intervention group compared to controls. Bias concerns were observed in some studies, largely stemming from inadequate blinding and deviations from intention-to-treat analysis. Evidence certainty ranged from moderate to very low. Conclusions: Non-invasive, patient-directed nutritional interventions may lead to clinically meaningful benefits in patients with head and neck cancer receiving chemoradiotherapy, particularly for the maintenance of body weight and nutritional status. However, robust, adequately powered trials with standardized reporting of intervention components and outcome measures are needed in the future to strengthen the evidence base for clinical application. Full article
(This article belongs to the Special Issue Nutrition in Patient Care: Second Edition)
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16 pages, 363 KB  
Systematic Review
Training Nurses for Disasters: A Systematic Review on Self-Efficacy and Preparedness
by Monica Nikitara, Amarachi Kalu, Evangelos Latzourakis, Costas S. Constantinou and Venetia Sofia Velonaki
Healthcare 2025, 13(24), 3323; https://doi.org/10.3390/healthcare13243323 - 18 Dec 2025
Viewed by 740
Abstract
Background: The rising frequency and complexity of disasters underscores the urgent need for robust preparedness in healthcare. Nurses and nursing students, as key frontline responders, often lack sufficient training to respond effectively to emergencies and recovery efforts. Aim: This review evaluates the effectiveness [...] Read more.
Background: The rising frequency and complexity of disasters underscores the urgent need for robust preparedness in healthcare. Nurses and nursing students, as key frontline responders, often lack sufficient training to respond effectively to emergencies and recovery efforts. Aim: This review evaluates the effectiveness of disaster preparedness training in terms of nurses’ and nursing students’ self-efficacy in providing disaster care and determines which training approaches are most effective. Method: A systematic review was conducted of peer-reviewed articles published in English between 2014 and 2025 across Medline, PubMed, ProQuest, and Health & Medical Col. Search terms included nurses, nursing students, self-efficacy, disaster training, emergency preparedness, training, simulation and scenario-based learning. Results: Nineteen peer-reviewed studies met the inclusion criteria. Overall, disaster preparedness training was found to enhance nurses’ and nursing students’ self-efficacy, knowledge and skills, with simulation-based and scenario-driven approaches producing the most consistent gains. These methods provided realistic and immersive experiences that fostered confidence and strengthened preparedness. Traditional lectures and workshops also improved outcomes but were generally less effective in sustaining self-efficacy over time. Reported challenges included limited faculty expertise, insufficient institutional support, and psychological barriers that may reduce engagement and impact. Conclusion: Integrating disaster preparedness into nursing curricula and professional training is vital for strengthening nurses’ and nursing students’ self-efficacy in crisis response. Evidence shows that simulation-based education, particularly when combined with traditional approaches, is especially effective in building knowledge and skills. Embedding these methods into training frameworks offers a sustainable strategy to ensure a more competent and resilient nursing workforce. Full article
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15 pages, 506 KB  
Article
Bridging the Knowledge Gap: A National Survey on MASLD Awareness and Management Barriers in the Saudi Population
by Abdulrahman Alwhaibi, Wael Mansy, Wajid Syed, Salmeen D. Babelghaith and Mohamed N-Alarifi
Healthcare 2025, 13(24), 3322; https://doi.org/10.3390/healthcare13243322 - 18 Dec 2025
Viewed by 382
Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. It greatly increases hepatic cirrhosis and cancer, cardiovascular disease, and chronic kidney disease. Despite the rising frequency of MASLD in Saudi Arabia, public understanding of its management [...] Read more.
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. It greatly increases hepatic cirrhosis and cancer, cardiovascular disease, and chronic kidney disease. Despite the rising frequency of MASLD in Saudi Arabia, public understanding of its management is lacking. Objective: This study seeks to evaluate public knowledge, attitudes, and management barriers related to MASLD, thereby informing future educational and preventive strategies. Methods: A cross-sectional study was conducted from November 2023 to October 2024, involving 502 participants across Saudi Arabia, employing a modified self-administered online questionnaire. Data was analyzed using SPSS 25. Descriptive statistics and Chi-square tests were used to investigate correlations between knowledge or attitude levels and demographics, with a significance threshold of p < 0.05. Results: Less than half of the respondents who took part (47.2%) had heard of MASLD. Of them, 24.9% had good knowledge, 38.2% had fair knowledge, and 36.9% had low understanding. There were strong links between knowledge and age, education, and job status, but not between knowledge and gender (p = 0.514). People were somewhat aware that being overweight (48.4%) and having high cholesterol (51.8%) were risk factors, but they often had wrong ideas regarding diabetes and high blood pressure. Only 7.8% of those surveyed said they had been formally diagnosed, and 74.4% of those who had been were given advice on how to change their lifestyle. Barriers to management included the idea that lifestyle change alone suffices (46.7%), the absence of medical advice (46.7%), and insufficient disease awareness (33.3%). Conclusions: The research shows that many Saudis are unaware of MASLD and have misconceptions about it. Targeted health education programs, greater provider–patient communication, and primary care MASLD knowledge are needed to close these gaps and promote disease prevention and management. Full article
(This article belongs to the Section Public Health and Preventive Medicine)
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13 pages, 304 KB  
Review
Narrative Medicine, Dementia, and Alzheimer’s Disease: A Scoping Review
by Venusia Covelli, Marina Angela Visco, Martino Feyles, Angelica Cristal Sirotich and Alessandra Marelli
Healthcare 2025, 13(24), 3321; https://doi.org/10.3390/healthcare13243321 - 18 Dec 2025
Viewed by 415
Abstract
Background/Objectives: In recent years, Narrative Medicine (NM) has gained prominence in the context of neurodegenerative diseases, such as dementia, offering tools to understand the subjective experience of illness and to improve the care relationship. Methods: This scoping review, conducted following the [...] Read more.
Background/Objectives: In recent years, Narrative Medicine (NM) has gained prominence in the context of neurodegenerative diseases, such as dementia, offering tools to understand the subjective experience of illness and to improve the care relationship. Methods: This scoping review, conducted following the PRISMA guidelines, analyzed the scientific literature from PubMed, PsycInfo, Web of Science, and Medline, encompassing 10 contributions focused on NM and patients with dementia or Alzheimer’s disease. Results: The analysis identified three main themes: 1) narrative, memory, and personal identity, highlighting the role of narrative in preserving a sense of self; 2) personalization of care, oriented towards person-centeredness; 3) the use of narrative in a formative and reflective function as a tool to promote empathy, clinical awareness, and observation skills in the training of health professionals. Conclusions: NM confirms itself as a relational and reflexive paradigm, capable of humanizing care and promoting therapeutic pathways that are more inclusive and sensitive to the patient’s subjectivity. Full article
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11 pages, 560 KB  
Article
When Sound Fades: Depression and Anxiety in Adults with Hearing Loss—A Cross-Sectional Study
by Serkan Dedeoglu, Serdar Ferit Toprak, Enes Sırma and Süleyman Dönmezdil
Healthcare 2025, 13(24), 3320; https://doi.org/10.3390/healthcare13243320 - 18 Dec 2025
Viewed by 475
Abstract
Background: Hearing loss is a prevalent sensory impairment with substantial psychosocial consequences. This cross-sectional study investigated the relationship between audiometric hearing loss and mood disturbances in adults aged 18–65 years who reported hearing difficulties for at least six months. Methods: Objective hearing level [...] Read more.
Background: Hearing loss is a prevalent sensory impairment with substantial psychosocial consequences. This cross-sectional study investigated the relationship between audiometric hearing loss and mood disturbances in adults aged 18–65 years who reported hearing difficulties for at least six months. Methods: Objective hearing level was assessed using the better-ear pure-tone average (PTA), and subjective hearing handicap was measured with the Hearing Handicap Inventory for Adults (HHIA). Standardized mood assessments included the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Results: The study found that higher HHIA scores, indicating greater perceived hearing handicap, were strongly correlated with more severe depression and anxiety (ρ ≈ 0.45 and 0.38, respectively; p < 0.001). In contrast, objective PTA showed weaker associations with mood scores. Regression analyses, adjusted for age and gender, confirmed that perceived hearing handicap (HHIA) was the strongest independent predictor of both depression (standardized β ≈ 0.37, p < 0.001) and anxiety (β ≈ 0.33, p < 0.01), accounting for about 30% of the variance in mood scores. Nearly one-third of participants had clinically significant depression (BDI-II ≥ 20), which is substantially higher than community norms. The cross-sectional design and potential selection bias are limitations. Conclusions: Even mild-to-moderate hearing loss can result in significant depressive and anxious symptoms when individuals perceive themselves as handicapped. Early identification of hearing problems, routine psychosocial screening (e.g., a simple two-question survey), and integrated care are essential for improving quality of life. Full article
(This article belongs to the Section Mental Health and Psychosocial Well-being)
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16 pages, 1650 KB  
Systematic Review
A Systematic Review and Meta-Analysis of the Effects of Various Physical Activity Interventions in Pregnant Women with Overweight or Obesity
by Mingmao Li, Hongli Yu, Guoping Qian, Anna Szumilewicz and Zbigniew Ossowski
Healthcare 2025, 13(24), 3319; https://doi.org/10.3390/healthcare13243319 - 18 Dec 2025
Viewed by 658
Abstract
Background: Obesity during pregnancy increases the risk of adverse maternal and neonatal outcomes, and excessive gestational weight gain (GWG) remains highly prevalent worldwide. Although physical activity (PA) interventions have shown potential benefits, evidence on the optimal type, intensity, and duration of exercise [...] Read more.
Background: Obesity during pregnancy increases the risk of adverse maternal and neonatal outcomes, and excessive gestational weight gain (GWG) remains highly prevalent worldwide. Although physical activity (PA) interventions have shown potential benefits, evidence on the optimal type, intensity, and duration of exercise for overweight or obese pregnant women remains limited. Methods: Electronic searches of EBSCOhost, Embase, PubMed and Web of Science were performed through August 2025 to identify randomized controlled trials comparing PA interventions versus usual prenatal care in overweight or obese pregnant women. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane ROB domains. Continuous outcomes were pooled using inverse-variance meta-analytic methods and heterogeneity was quantified by I2. Results: Ten randomized trials (twelve intervention arms) comprising 1150 participants met the inclusion criteria. In the domain of blinding of participants and personnel, three studies (30%) were judged as low risk, while seven (70%) were unclear. PA interventions varied in modality (aerobic, resistance, endurance, walking), setting (clinic, community, home/mHealth), and the intervention period ranges from 10 to 34 weeks. Most interventions (80%) employed moderate intensity, and 30% combined aerobic and resistance training. Results of the meta-analysis showed that the pooled mean GWG was 9.93 ± 5.48 kg in the treatment group and 10.65 ± 5.70 kg in the control group. Overall, PA interventions produced a modest but statistically significant reduction in GWG compared with controls, with negligible between-study heterogeneity (I2 = 0%). Conclusions: Tailored, moderate-intensity PA may have the potential to modestly reduce GWG. Although 30% included trials employed combined aerobic and resistance training, current evidence is insufficient to establish whether combined modalities are more effective than aerobic-only or resistance-only interventions. However, the current evidence is limited by small trial sizes, methodological variability and geographic concentration in higher-income settings. Larger, rigorously designed RCTs, including evaluations of digital delivery platforms and carefully supervised higher-intensity protocols, are needed to refine exercise prescriptions and inform clinical guidelines. Full article
(This article belongs to the Special Issue Obesity and Overweight: Prevention, Causes and Treatment)
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22 pages, 404 KB  
Article
Community-for-Care: An Integrated Response to Informal Post-Caregivers
by Catarina Inês Costa Afonso, Ana Spínola Madeira, Alcinda Reis and Susana Magalhães
Healthcare 2025, 13(24), 3318; https://doi.org/10.3390/healthcare13243318 - 18 Dec 2025
Viewed by 363
Abstract
Background/Objectives: Informal caregivers play a crucial role in healthcare, but when caregiving ends the “post-caregivers” often remain invisible and unsupported. Post-caregivers face needs such as reconstructing their identity and finding space and time to grieve. This study aimed to design a support network [...] Read more.
Background/Objectives: Informal caregivers play a crucial role in healthcare, but when caregiving ends the “post-caregivers” often remain invisible and unsupported. Post-caregivers face needs such as reconstructing their identity and finding space and time to grieve. This study aimed to design a support network for informal post-caregivers by exploring perceptions of diverse stakeholders. Methods: A qualitative inductive study was conducted using three focus groups (n = 15; ages 35–70; 12 women, 3 men) held online between June and July 2023. Participants included palliative care team members, home support professionals, general practitioners, informal caregivers, post-caregivers, and members of civil society. A semi-structured guide was used, and narratives were analyzed with a Narrative Medicine-informed approach and thematic analysis. Results: Community-For-Care emerged as an overarching and distinctive concept that, while aligned with the ethos of Compassionate Communities, specifically addresses the transition after caregiving ends, a phase largely absent from existing models. It symbolizes the “living forces of the community” mobilized to accompany informal post-caregivers through identity reconstruction, bereavement, and reintegration. Three interrelated thematic axes structure this concept: (1) Compassion Axis—emphasizing a compassionate community that values caregiving; (2) Coordinated Action Axis—highlighting coordinated, continuous support across healthcare and community services; and (3) Care Literacy Axis—underscoring education and training for caregivers, post-caregivers, and professionals. These axes dynamically interact to empower post-caregivers and stitch the holes in the support network. Conclusions: A community-centered, post-caregiver-focused framework such as Community-For-Care offers a novel extension of compassionate communities by directly addressing the loneliness, identity rupture, and invisibility that often characterize the transition after caregiving. Reinforcing compassion, coordinated action, and care literacy can enable communities to better acknowledge the contributions and ongoing needs of post-caregivers, supporting their emotional recovery, social reintegration, and reconstruction of daily life. By integrating these three axes into community practice, the model introduces a post-care-specific structure that can enhance well-being, reduce preventable health decline, and relieve pressure on formal services by mobilizing local, civic, and relational assets. Full article
(This article belongs to the Special Issue Mental Health and Well-Being in Informal Caregiving: Challenges, Transitions, and Support Mechanisms)
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23 pages, 2694 KB  
Systematic Review
Oral Health-Related Quality of Life (OHRQoL), Pain and Side Effects in Adults Undergoing Different Orthodontic Treatment Modalities: A Systematic Review and Meta-Analysis
by Ama Johal, Brian Dunne, Honieh Bolooki and Cara Sandler
Healthcare 2025, 13(24), 3317; https://doi.org/10.3390/healthcare13243317 - 18 Dec 2025
Viewed by 362
Abstract
Background: The present study aimed to identify the differences between experiences, in terms of oral health-related quality of life, pain, side effects and/or other complications, of adults undergoing orthodontic treatment using removable aligners and fixed labial or lingual appliances. Methods: The [...] Read more.
Background: The present study aimed to identify the differences between experiences, in terms of oral health-related quality of life, pain, side effects and/or other complications, of adults undergoing orthodontic treatment using removable aligners and fixed labial or lingual appliances. Methods: The review was registered with PROSPERO, and a comprehensive electronic search was undertaken without language or date restrictions. Randomised and non-randomised trials and prospective cohort and cross-sectional studies along with case series were included. The Cochrane Collaboration’s Risk of Bias 2 Tool, Newcastle–Ottawa Scale and The Risk Of Bias In Non-Randomized Studies—of Interventions tools were used to assess quality. Data were grouped in terms of oral health-related quality of life, pain side effects and/or other complications. Results: Data from 35 studies were included; 9 were eligible for meta-analysis. Thus 2611 participants were included related to removable aligners (n = 513), fixed labial (n = 1816) and lingual (n = 218) appliances or a combination (n = 64) of appliances. The standardised mean differences in visual analogue scale pain reports between 24 h and 7 days were −10.02 (95% CI: −11.13, −8.91) for aligners and −6.40 (95%CI: −10.42, −2.38) for labial appliances (p = 0.09). There was a significant improvement in dental self-confidence following fixed labial appliance treatment (p = 0.001). Conclusions: No difference was detected in short-term pain with aligners and labial appliances. Aligners may have less impact on oral health-related quality of life measures compared to labial appliances. Lingual appliances have a persistent impact on speech, despite some adaptability. Any deterioration in oral health-related quality of life measures during treatment appears temporary. Further randomised trials using validated assessment tools and comparing aligners and labial and lingual appliances are required. Full article
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18 pages, 311 KB  
Article
Sensory Processing in People Experiencing Homelessness in Spain: A Pilot Study
by Alicia Cal-Herrera, Berta Gándara-Gafo, Ariadna Corbella-González, Pablo A. Cantero-Garlito, Sonia Panadero-Herrero, Olga I. Fernández-Rodríguez and Begoña Polonio-López
Healthcare 2025, 13(24), 3316; https://doi.org/10.3390/healthcare13243316 - 18 Dec 2025
Viewed by 577
Abstract
Introduction: People experiencing homelessness (PEH) often live in adverse and changing environments and have high rates of mental illness and social exclusion, factors that could influence information processing. However, it is unknown whether these conditions could be related to sensory processing problems. Objectives: [...] Read more.
Introduction: People experiencing homelessness (PEH) often live in adverse and changing environments and have high rates of mental illness and social exclusion, factors that could influence information processing. However, it is unknown whether these conditions could be related to sensory processing problems. Objectives: Analyse sensory processing in PEH. Methodology: A descriptive cross-sectional study was conducted with 150 participants (mean age of 47.43 ± 10.94 years), using the Adult/Adolescent Sensory Profile and a sociodemographic questionnaire. Results. PEH aged 18–64 showed significantly higher scores in low registration (M = 36.9), sensory sensitivity (M = 41.1) and sensation avoiding (M = 45.5) compared to the control group (p < 0.001), suggesting a distinct form of sensory processing in this population. Discussion: These results may be linked to factors such as chronic exposure to unpredictable and stressful situations, as well as to the presence of diverse mental health issues. Conclusion: It is important to consider the sensory characteristics of this population when designing person-centered interventions, in order to reduce social isolation and promote self-regulation strategies, environmental adaptation and greater occupational participation. Full article
(This article belongs to the Section Mental Health and Psychosocial Well-being)
14 pages, 596 KB  
Protocol
Medical Physics Adaptive Radiotherapy (MPART) Fellowship: Bridging the Training Gap in Online Adaptive Radiotherapy
by Bin Cai, David Parsons, Mu-Han Lin, Dan Nguyen, Andrew R. Godley, Arnold Pompos, Kajal Desai, Shahed Badiyan, David Sher, Robert Timmerman and Steve Jiang
Healthcare 2025, 13(24), 3315; https://doi.org/10.3390/healthcare13243315 - 18 Dec 2025
Viewed by 265
Abstract
Online adaptive radiotherapy (ART) is rapidly transforming clinical radiation oncology by enabling adaptation of treatment plans based on patient-specific anatomical and biological changes. However, most medical physics training programs lack structured education in ART. To address this critical gap, the Medical Physics Adaptive [...] Read more.
Online adaptive radiotherapy (ART) is rapidly transforming clinical radiation oncology by enabling adaptation of treatment plans based on patient-specific anatomical and biological changes. However, most medical physics training programs lack structured education in ART. To address this critical gap, the Medical Physics Adaptive Radiotherapy (MPART) Fellowship was established at our center to train post-residency or practicing physicists in advanced adaptive technologies and workflows. The MPART Fellowship is a two-year program that provides immersive, platform-specific training in CBCT-guided (Varian Ethos), MR-guided (Elekta Unity), and PET-guided (RefleXion X1) radiotherapy. Fellows undergo modular clinical rotations, hands-on training, and dedicated research projects. The curriculum incorporates competencies in imaging, contouring, online planning, quality assurance, and team-based decision-making. Evaluation is based on the Accreditation Council for Graduate Medical Education competency domains and includes milestone tracking, mentor reviews, and structured presentations. The fellowship attracted applicants from both domestic and international institutions, reflecting strong demand for formal ART training. Out of 22 applications, two fellows have been successfully recruited into the program since 2024. Fellows actively participate in all phases of adaptive workflows and are expected to function at near-attending levels by the second year of their training. Each fellow also leads at least one translational or operational research project aimed at improving ART delivery. Fellows contribute to clinical coverage and lead developmental projects, resulting in presentations and publications at the national and international levels. The MPART Fellowship addresses a vital educational need by equipping medical physicists with the advanced competencies necessary for implementing and leading ART. This program offers a replicable framework for other institutions seeking to advance precision radiation therapy through structured post-residency training in adaptive radiotherapy. As this fellowship program is still in its early phase of establishment, the primary goal of this paper is to introduce the structure, framework, and implementation model of the program. Comprehensive outcome analyses—such as quantitative assessments, fellow feedback, and longitudinal competency evaluations—will be incorporated in future work as additional cohorts complete training. Full article
(This article belongs to the Section Healthcare Quality, Patient Safety, and Self-care Management)
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12 pages, 213 KB  
Article
Patient Satisfaction with the Expanded Nurses Service in Primary Health Care: Evidence from Kazakhstan
by Indira Abdikadirova, Lyudmila Yermukhanova, Aurelija Blaževičiene, Zhanar Dostanova, Zaure Baigozhina, Maiya Taushanova, Gulnar Sultanova and Kauysheva Almagul
Healthcare 2025, 13(24), 3314; https://doi.org/10.3390/healthcare13243314 - 18 Dec 2025
Viewed by 359
Abstract
Background/Objectives: The implementation of advanced practice nursing in Kazakhstan is aimed at improving the accessibility and quality of primary healthcare. One of the key indicators of the effectiveness of this model is patient satisfaction, which reflects the perceived quality of care and directly [...] Read more.
Background/Objectives: The implementation of advanced practice nursing in Kazakhstan is aimed at improving the accessibility and quality of primary healthcare. One of the key indicators of the effectiveness of this model is patient satisfaction, which reflects the perceived quality of care and directly influences treatment adherence. The aim of the study was to assess patient satisfaction with nurse-led consultations in primary healthcare institutions in Kazakhstan. Methods: A cross-sectional study was conducted using a questionnaire developed on the basis of Karin Bergman’s instrument and adapted to the Kazakhstani context. A total of 621 patients who attended independent nursing consultations in polyclinics in Aktobe, Almaty, Astana, and the village of Merke participated in the survey. Descriptive statistics and Pearson’s χ2 test were applied, with statistical significance set at p < 0.05. Results: The majority of respondents were women, with a median age of 61 years. Awareness of independent consultations was higher among patients who regularly visited nurses (97.1% vs. 86.9%; p < 0.006). High satisfaction levels were associated with service accessibility, quality of examination, and clarity of recommendations. Among regular visitors, 99.2% reported satisfaction with the nurse’s work, and 76.6% rated the service as “excellent”. In contrast, patients with irregular visits more often reported dissatisfaction due to insufficient attention and limited knowledge of nurses. Conclusions: The findings confirm a high level of patient satisfaction with advanced practice nursing services and highlight the importance of this model in strengthening primary healthcare in Kazakhstan. Full article
(This article belongs to the Special Issue Patient Experience and the Quality of Health Care)
11 pages, 212 KB  
Study Protocol
Leadership Succession Planning for Professional Nurses in a Selected Public Hospital in Mangaung District, Free State Province: A Study Protocol
by Lebogang G. Motlhaole, Aluwani D. Mudzweda and Takalani R. Luhalima
Healthcare 2025, 13(24), 3313; https://doi.org/10.3390/healthcare13243313 - 18 Dec 2025
Viewed by 397
Abstract
Lack of leadership succession planning in South African public hospitals places nursing leadership at great risk instead of improving healthcare. There is a significant demand for nurse managers in the Free State Province; therefore, leadership succession planning is important. The re-advertising of unfilled [...] Read more.
Lack of leadership succession planning in South African public hospitals places nursing leadership at great risk instead of improving healthcare. There is a significant demand for nurse managers in the Free State Province; therefore, leadership succession planning is important. The re-advertising of unfilled leadership roles, the projected volume of nurse managers who will be retiring, and the number of professional nurses opting for better international opportunities indicate the need for effective succession planning. The study aims to determine leadership succession planning for professional nurses in a selected public hospital in the Mangaung District, Free State Province. A qualitative, explorative, and descriptive research design will be used. Non-probability purposive sampling will be adopted to explore the leadership succession planning. The research participants will consist of professional nurses who are currently permanently employed within the Mangaung district, Free State Province. The sample size will be determined by data saturation. An estimated sample size of ±20 participants will be expected. Data collection will be performed through in-depth, unstructured interviews to answer the research question. A central place for interviews will be organised, and appointments will be made with participants as per their schedule or availability. Data will be analysed using Braun and Clarke’s thematic method. The conclusion and the recommendations will be based on the findings of the study. Full article
21 pages, 304 KB  
Article
Household Tobacco Expenditure and Child Health Outcomes: Causal Evidence from a Transitional Economy
by Kim-Anh Tran, Mai-Trang Le, Yung-Fu Huang and Manh-Hoang Do
Healthcare 2025, 13(24), 3312; https://doi.org/10.3390/healthcare13243312 - 17 Dec 2025
Viewed by 275
Abstract
Background/Objectives: The relationship between household tobacco expenditure and child health has attracted considerable attention from both academic and policy communities, as tobacco expenditure can influence children’s health, nutrition, and overall well-being in multiple ways, particularly in rural and low-income settings. This study [...] Read more.
Background/Objectives: The relationship between household tobacco expenditure and child health has attracted considerable attention from both academic and policy communities, as tobacco expenditure can influence children’s health, nutrition, and overall well-being in multiple ways, particularly in rural and low-income settings. This study examines the causal impact of household tobacco expenditure on child health outcomes in a transitional economy. Methods: Using nationally representative microdata from the most recent Household Living Standards Survey, the authors employ Ordinary Least Squares (OLS), Random Effects (RE), and Instrumental Variable (IV) estimations to identify the effects of tobacco spending on children’s healthcare utilization and health status. Results: The results consistently show that higher household tobacco expenditure significantly increases the likelihood of hospitalization among Vietnamese children, with the effects being most pronounced for those under six years of age. Moreover, the authors uncover substantial heterogeneity across gender, maternal age at childbirth, and regional contexts, highlighting persistent socioeconomic inequalities in health outcomes. Conclusions: This study provides compelling evidence of the adverse effects of household tobacco expenditure on children’s health in Vietnam. Theoretically, the study contributes to the literature on the economics of health and intra-household resource allocation by providing micro-level causal evidence from a transitional setting. From a policy perspective, the findings underscore the need for targeted fiscal and public health interventions to mitigate tobacco-related welfare losses and to promote equitable access to healthcare among vulnerable populations. Full article
(This article belongs to the Special Issue Promoting Healthcare and Well-Being in Rural and Vulnerable Communities)
11 pages, 227 KB  
Article
The Relation Between Imposter Phenomenon and Self-Critical, Narcissistic, and Rigid Perfectionism: An Observational Study from a Women’s Medical College in Saudi Arabia
by Nasser M. AbuDujain, Rauof A. Almebki, Rakan M. Alghonaim, Mohammed A. Aldkhyyal, Norah A. Alshehri, Saud Alomar, Ahmed S. Almujil, Joud S. Almutairi, Msaad A. Altulihee and Turky H. Almigbal
Healthcare 2025, 13(24), 3311; https://doi.org/10.3390/healthcare13243311 - 17 Dec 2025
Viewed by 408
Abstract
Background/aim: Medical students often face intense pressure to excel, which can lead to imposterism, characterized by persistent self-doubt and fear of being exposed as inadequate, alongside high levels of perfectionism. This study aims to assess the prevalence of imposterism and perfectionism among medical [...] Read more.
Background/aim: Medical students often face intense pressure to excel, which can lead to imposterism, characterized by persistent self-doubt and fear of being exposed as inadequate, alongside high levels of perfectionism. This study aims to assess the prevalence of imposterism and perfectionism among medical students in Saudi Arabia and explore their potential implications for student well-being. Methods: A cross-sectional analytical study was conducted between October and December 2024 among female medical students in Saudi Arabia. Data were collected via an online survey, which included demographic questions, the validated Arabic versions of the Clance Impostor Phenomenon Scale (Ar-CIPS), the short form of the Big Three Perfectionism Scale (BTPS-SF), and the General Self-Efficacy Scale (GSES). Results: A total of 265 medical students (mean age 20.96 ± 1.44 years) participated. Most reported a monthly income of less than 2000 SR, and the majority had a GPA above 4.5. A 74.3% expressed moderate impostor experiences. The BTPS-SF revealed the highest scores in self-critical perfectionism, followed by narcissistic and rigid perfectionism. Higher impostor scores were significantly associated with greater perfectionism and lower self-efficacy (p < 0.05). In multivariable analysis, BTPS-SF scores positively predicted CIPS scores (β = 0.52, p < 0.001), whereas GSE scores predicted lower CIPS scores (β = −0.47, p = 0.001). Conclusions: This study revealed a high prevalence of impostor phenomenon and perfectionism among female medical students, with self-critical perfectionism being the most prominent. Imposterism was significantly associated with higher perfectionism and lower self-efficacy. Full article
17 pages, 976 KB  
Systematic Review
Effectiveness of the Internet of Things for Improving Health of Non-Pregnant Women Living in High-Income Countries: A Systematic Review
by Olukunmi Omobolanle Balogun, Etsuko Nishimura, Noyuri Yamaji, Kiriko Sasayama, Md. Obaidur Rahman, Katharina da Silva Lopes, Citra Gabriella Mamahit, Mika Ninohei, Phyu Phyu Tun, Rina Shoki, Daichi Suzuki, Aya Nitamizu, Windy Mariane Virenia Wariki, Daisuke Yoneoka, Eiko Saito and Erika Ota
Healthcare 2025, 13(24), 3310; https://doi.org/10.3390/healthcare13243310 - 17 Dec 2025
Viewed by 582
Abstract
Background/Objectives: There is increased advocacy for the potential for digital applications (apps) and the Internet of Things (IoT) to improve women’s health. We conducted a systematic review to assess and synthesise the role of Apps and the IoT in improving the health [...] Read more.
Background/Objectives: There is increased advocacy for the potential for digital applications (apps) and the Internet of Things (IoT) to improve women’s health. We conducted a systematic review to assess and synthesise the role of Apps and the IoT in improving the health of non-pregnant women. Methods: Six databases were searched from inception to 13 February 2023. We included randomised controlled trials that assessed the effects of various Apps and the IoT with regard to improving the health of non-pregnant women in high-income countries. Our primary outcomes were health status and well-being or quality of life, and we assessed behaviour change as the secondary outcome. Screening, data extraction, and quality assessment were performed in duplicate. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. Narrative methods were used to synthesise study outcomes. Results: The search retrieved 18,433 publications and seven publications from six studies met the inclusion criteria. Participants included overweight or obese women, postmenopausal women, or women with stage I–III breast cancer. Intervention types varied across included studies but broadly included wearable or sensor-based personal health tracking digital technologies. The most commonly assessed intervention effect was on behaviour change outcomes related to promoting physical activity. Interventions administered yielded positive effects on health outcomes and well-being or quality of life in one study each, while three of the four studies that assessed behaviour change reported significant positive effects. Most included studies had methodological concerns, while study designs and methodologies lacked comparability. Conclusions: Based on our findings, the use of apps and the IoT may be promising for facilitating behaviour change to promote physical activity. However, more evidence is needed to assess the effectiveness of the IoT for improving health status, well-being and quality of life among non-pregnant women. Full article
(This article belongs to the Special Issue Digital Health Innovations for Sustainable and Equitable Care Delivery)
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18 pages, 325 KB  
Article
Breast Milk Donation After Perinatal Loss: A Qualitative Exploration of Maternal Grief and Healing Among Israeli Arab Women and the Islamic Legal-Ethical Perspectives: A Qualitative Research Study
by Mahdi Tarabeih, Orsan Yahya, Mohammad Sabbah and Khaled Awawdi
Healthcare 2025, 13(24), 3309; https://doi.org/10.3390/healthcare13243309 - 17 Dec 2025
Viewed by 383
Abstract
Background/Objectives: After perinatal loss, namely stillbirth and neonatal death, many bereaved mothers continue to produce breast milk, facing the decision as to whether to suppress lactation or donate their milk. Our aims were to explore the experiences and views of Muslim mothers [...] Read more.
Background/Objectives: After perinatal loss, namely stillbirth and neonatal death, many bereaved mothers continue to produce breast milk, facing the decision as to whether to suppress lactation or donate their milk. Our aims were to explore the experiences and views of Muslim mothers who had donated their breast milk following perinatal loss and examine the Islamic legal-ethical perspectives relating to milk donation. This research explores how milk donation serves as a coping mechanism and how Islamic teachings frame its permissibility and ethical considerations. Methods: A qualitative research methodology was employed, using a Interpretative Phenomenological Analysis (IPA). Nine bereaved Muslim mothers who had donated their breast milk and three Islamic religious scholars (an Imam, a Mufti, and a Muslim jurist) participated in in-depth interviews. Thematic analysis identified recurring patterns and insights. Results: Our findings revealed that mothers experienced milk donation as a coping mechanism, allowing them to maintain a symbolic connection with their lost child while contributing to other infants’ survival. Religious scholars who we interviewed agreed that milk donation is permissible in Islam, provided that milk kinship (rida’a) regulations are observed. Mothers reported a strong need for structured support from healthcare providers and religious leaders in order to assist in the informed decision-making process. Conclusions: Breast milk donation after perinatal loss aids in grief management for bereaved mothers while benefiting vulnerable infants. Healthcare providers should offer comprehensive lactation counseling for bereaved mothers, including milk donation options. Milk banks should implement processes in alignment with rida’a guidelines. Improving support systems for bereaved mothers can alleviate their grieving process while ensuring alignment with cultural and religious norms. Full article
17 pages, 538 KB  
Article
The Experience of Goals and Rewards in Young People Who Self-Harm: A Qualitative Exploration
by Martina Di Simplicio, Ruksana Begum-Meades, Emily Gaardner-Bougard, Charis Eleftheriou, Oyinlola Akinsanya, Rachel Rodrigues, Lavanya Thana and Lindsay H. Dewa
Healthcare 2025, 13(24), 3308; https://doi.org/10.3390/healthcare13243308 - 17 Dec 2025
Viewed by 509
Abstract
Background/Objectives. Self-harm is a heterogeneous behaviour with a lifetime prevalence of around 20% in young people aged 16–25 years old. Recent neurocognitive evidence suggests that, for some individuals, self-harm is associated with motivational processes similar to addiction, including maladaptive mental imagery, reward anticipation, [...] Read more.
Background/Objectives. Self-harm is a heterogeneous behaviour with a lifetime prevalence of around 20% in young people aged 16–25 years old. Recent neurocognitive evidence suggests that, for some individuals, self-harm is associated with motivational processes similar to addiction, including maladaptive mental imagery, reward anticipation, and goal pursuit. However, our knowledge of young people’s subjective experiences of rewards and goals in relation to self-harm behaviour remains limited. Our study aimed to investigate how young people who self-harm experience enjoying and wanting rewards and pursuing goals in daily life and whether this experience changes during periods of self-harm. We also explored their use of mental imagery as a key cognitive process to support motivation. Methods. We conducted two parallel focus groups online (total of N = 12) with young people (mean age = 12.2, SD = 3; nine women, two men, and one non-binary) with a past-year history of self-harm behaviour. Qualitative data was analysed using inductive thematic analysis. Two young people with lived experience of self-harm informed the topic guide and data interpretation. Examples of questions were “Do you think your experiences of enjoying and/or looking forward to pleasant things are related in any way to self-harm, or not?” and “Do you visualise things you enjoy or may look forward to? If you do, how is that experience?”. Results. There were six themes: rewards need deserving, high self-standards, keeping control, trapped into long-term goals, unhelpful mental imagery, and self-harm alters the experience and anticipation of rewards and goal attainment. Most young people reported enjoying conditional rewards and working towards long-term goals that tend to be unattainable and beyond their control. Imagining these goals was experienced as unhelpful by most. For all young people, periods of self-harm thwarted enjoyment and goal achievement, shifted the preference to short-term immediate gratification, including from self-harm behaviour, and devalued long-term goals. However, our data cannot determine if these experiences are specific to young people who self-harm. Conclusions. Our findings indicate that the reciprocal relationship between motivational processes and self-harm behaviour in young people warrants further investigation. Helping individuals develop more adaptive rewards and goals, including appreciation of short-term goals and use of motivational mental imagery, could represent valued support for young people with self-harm. Full article
(This article belongs to the Special Issue Health Risk Behaviours: Self-Injury and Suicide in Young People)
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24 pages, 1025 KB  
Article
A Community Advisory Board’s Role in Disseminating Tai Chi Prime in African American and Latinx Communities: A Pragmatic Application of the Consolidated Framework for Implementation Research
by Ejura Yetunde Salihu, Kristine Hallisy, Jéssica S. Malta, Deborah Tolani Joseph, Cheryl Ferrill, Patricia Corrigan Culotti, Rebeca Heaton Juarez and Betty Chewning
Healthcare 2025, 13(24), 3307; https://doi.org/10.3390/healthcare13243307 - 17 Dec 2025
Viewed by 532
Abstract
Background: Community-Based Participatory Research (CBPR) has proven effective in promoting health research in hard-to-recruit and underserved populations. Tai Chi Prime is a National Council on Aging-certified fall prevention program. However, it has not been widely disseminated in African American (AA)/Black and Latinx communities. [...] Read more.
Background: Community-Based Participatory Research (CBPR) has proven effective in promoting health research in hard-to-recruit and underserved populations. Tai Chi Prime is a National Council on Aging-certified fall prevention program. However, it has not been widely disseminated in African American (AA)/Black and Latinx communities. Guided by the Consolidated Framework for Implementation Research (CFIR), this study examined the process of working with a community advisory board (CAB) to adapt and disseminate Tai Chi Prime within these communities, as well as facilitators and barriers to CAB success. Methods: Eight CAB members met with researchers monthly virtually over a two-year period. Meetings focused on reviewing Tai Chi Prime materials, discussing cultural adaptations, and identifying dissemination strategies relevant to AA/Black and Latinx communities. Detailed notes from 24 meetings were compiled. In addition, semi-structured interviews were conducted with five CAB members and two researchers to capture individual reflections on their experiences, roles, and perceived impact. Data was analyzed using directed content analysis. Results: CFIR constructs helped illuminate how CAB members’ embedded community expertise, organizational partnerships, available resources, shared vision and transparent communication influenced the cultural adaptation and dissemination of Tai Chi Prime. Study findings also highlight important areas that extend beyond CFIR, particularly the cultural knowledge and power-sharing responsibilities undertaken by CAB members as co-researchers. These insights underscore the need to integrate equity-focused and community-engaged research principles into implementation frameworks when working with communities of color. Conclusions: Findings highlight the value of leveraging existing academic–community partnerships. Community-engaged researchers can use the lessons learned from this CAB to build a replicable model of sustainable partnerships with their AA/Black and Latinx community partners, as can others involved in health services research and policy. Full article
(This article belongs to the Special Issue Advancing Cultural Competence in Health Care)
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15 pages, 382 KB  
Article
Physical Performance and Mental Health in Institutionalized Older Adults: A Multicenter, Cross-Sectional Observational Study
by Jorge L. Zambrano, Daniela Zurita-Pinto and Laura Hermo-Rebollido
Healthcare 2025, 13(24), 3306; https://doi.org/10.3390/healthcare13243306 - 17 Dec 2025
Viewed by 318
Abstract
Aging and institutionalization, associated with functional and psychological decline, justify studying how physical performance is linked to mental health in older adults. Objectives: To analyze the relationship between physical performance and anxiety, depression, sleep quality, and perceived stress in institutionalized older adults. [...] Read more.
Aging and institutionalization, associated with functional and psychological decline, justify studying how physical performance is linked to mental health in older adults. Objectives: To analyze the relationship between physical performance and anxiety, depression, sleep quality, and perceived stress in institutionalized older adults. Methods: Multicenter, observational, cross-sectional study in eight nursing homes (N = 105; ≥65 years, M = 80.78 SD ± 7.91). Instruments: SPPB, HADS, PSQI, PSS-10. Descriptives and exploratory bivariate tests. Primary analysis: single multivariable linear regression with SPPB as outcome and HADS-A, HADS-D, PSQI, PSS-10 entered simultaneously, adjusted for age and sex. Robustness: GLM with robust SEs, influence sensitivity excluding Cook’s D > 4/n or leverage > 2 p/n, and a proportional-odds model for SPPB. All statistical tests were two-sided, with α set at 0.05. Results: Mean SPPB was 6.94 ± 3.17; 77.1% of participants showed poor physical performance. Bivariate: All mental health constructs showed significant associations with physical performance. Multivariable model: adjusted R2 = 0.198; F (6,98) = 5.28, p < 0.001. Depression B = −0.230 (95% CI −0.398 to −0.061), p = 0.008; sleep quality (higher = worse) B = −0.187 (95% CI −0.351 to −0.024), p = 0.025; age B = −0.087 (95% CI −0.158 to −0.017), p = 0.016. Anxiety showed a positive adjusted association B = +0.224 (95% CI 0.038 to 0.410), p = 0.019 (consistent with suppression); perceived stress B = −0.062, p = 0.275; sex B = −0.144, p = 0.812. Robust SEs left inferences unchanged. Influence sensitivity (n = 97) preserved directions with the PSQI association attenuating to non-significance. Ordinal results were directionally consistent. Conclusions: After adjusting for age and sex, depression and sleep quality independently relate to physical function, while age is inversely associated; anxiety and perceived stress show no independent effects. Full article
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23 pages, 1404 KB  
Review
Complex Care Needs of People with Technology Dependence in Disaster Situations: A Scoping Review
by Anita Prasser, Joachim Beckert, Michael Köhler and Michael Ewers
Healthcare 2025, 13(24), 3305; https://doi.org/10.3390/healthcare13243305 - 16 Dec 2025
Viewed by 401
Abstract
Background: Providing complex care and support for people with technology dependence (PwTD) is challenging, even under routine conditions. During disasters, when health and power infrastructure are disrupted, the complex care of PwTD must be maintained under extreme conditions. This research aims to summarize [...] Read more.
Background: Providing complex care and support for people with technology dependence (PwTD) is challenging, even under routine conditions. During disasters, when health and power infrastructure are disrupted, the complex care of PwTD must be maintained under extreme conditions. This research aims to summarize the specific needs of PwTD in disasters and to describe how these needs are addressed in real-life events. Methods: We conducted a scoping review, searching four databases (CINAHL, MEDLINE, PsycInfo, SocINDEX) and the websites of relevant disaster relief organizations. A total of 43 of 2625 screened records were included. Content analysis was used to identify and cluster the needs of PwTD and the response to these needs. Results: Case reports were the most reported types of literature. It was repeatedly stated that PwTD have complex care needs that are often difficult to meet in disaster situations. The review identified three interdependent clusters of needs: clinical and supportive care needs, aids and supply needs, and access needs. The needs of patients and relatives were, as far as the situation allowed, met in accordance with existing plans and guidelines and, where these were found to be inadequate, through creative solutions devised by frontline nurses. Conclusions: We conclude that addressing the complex care needs of PwTD in disasters requires a strategy integrating structural preparedness, professional adaptability, and user participation. Nurses could play a key role in developing and implementing such strategies. This review provides a starting point to develop a more practice-oriented research agenda to achieve inclusive disaster risk management. Full article
(This article belongs to the Special Issue The Role of Healthcare in Public Health Risk and Disaster Management: Strategies for Mitigation and Response)
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22 pages, 1333 KB  
Systematic Review
Gait Biomechanical Differences in the Anterior Cruciate Ligament Reconstructed and Contralateral Limb: A Systematic Review with Meta-Analysis
by Heidar Sajedi, Elif Aydın, Mehmet Şirin Güler, Selahattin Akpınar, Ali Esmaeili, AmirAli Jafarnezhadgero and Kate E. Webster
Healthcare 2025, 13(24), 3304; https://doi.org/10.3390/healthcare13243304 - 16 Dec 2025
Viewed by 419
Abstract
Background: In this systematic review with meta-analysis, we aimed to compare the kinematic and kinetic variables of the involved limb with the contralateral limb in individuals who had undergone an anterior cruciate ligament reconstruction (ACLR) recorded during walking from short-term (<6 months) to [...] Read more.
Background: In this systematic review with meta-analysis, we aimed to compare the kinematic and kinetic variables of the involved limb with the contralateral limb in individuals who had undergone an anterior cruciate ligament reconstruction (ACLR) recorded during walking from short-term (<6 months) to mid-term (6–<12 months) and long-term (≥12 months) periods after surgery. Methods: Five electronic databases (Scopus, PubMed, EMBASE, PEDro, CENTRAL) were systematically searched for articles potentially eligible for inclusion from inception until November 2025. Biomechanical gait patterns were assessed short-term (<6 months), mid-term (6–<12 months), and long-term (≥12 months) post-surgery. Gait biomechanics were extracted from the included articles. Comparisons were made between the affected limb and the contralateral limb. Standardized mean differences (SMDs) with 95% confidence intervals (CI) were computed using a random-effects model. Results: The systematic search revealed 3522 hits, and according to a priori defined in-/exclusion criteria, 32 studies with male and female individuals aged 18–55 years involving 1026 participants were included. Meta-analysis indicated that the peak knee flexion angle was significantly lower in the ACLR compared to the contralateral limb (19 studies: small SMDs = −0.39, 95% CI −0.58 to −0.19, p < 0.0001, I2 = 66%). More specifically, the peak knee flexion angle was 2.63° (95% CI −3.81 to −1.44) lower in the ACLR compared to the contralateral limb. The analysis of time post-surgery revealed significant differences in the short-term (four studies: large SMDs = −1.14, 95% CI −1.61 to −0.67, p < 0.00001, I2 = 56%) and mid-term (five studies: small SMDs = −0.52, 95% CI −0.74 to −0.29, p < 0.0001, I2 = 0%) periods after surgery but not for the long-term follow-up (10 studies: small SMDs = −0.10, 95% CI −0.27 to 0.07, p = 0.26, I2 = 32%). Meta-analysis indicated that the peak knee flexion moment was significantly lower in the ACLR compared to the contralateral limb (11 studies: small SMDs = −0.37, 95% CI −0.59 to −0.14, p = 0.0001, I2 = 46%). A lower peak knee flexion moment was observed in the ACLR limb for both less than 12 months (three studies: moderate SMDs = −0.76, 95% CI −1.44 to −0.07, p = 0.03, I2 = 66%) and over 12 months (eight studies: small SMDs = −0.25, 95% CI −0.43 to −0.07, p = 0.01, I2 = 46%) after surgery time points compared to the contralateral limb. Conclusion: These findings suggest a time-dependent compensatory mechanism, where protective adaptations (e.g., reduced flexion/extension moments) may initially offload the reconstructed limb, with some asymmetries resolving over time. Clinically, these results underscore the need for rehabilitation strategies tailored to address phase-specific deficits, promoting symmetrical loading and functional recovery. Full article
(This article belongs to the Special Issue From Prevention to Recovery in Sports Injury Management)
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13 pages, 1453 KB  
Article
The COVID-19 Pandemic and Acute Coronary Syndrome Admissions and Deaths in Allegheny County, Pennsylvania
by Brandon M. Herbert, Indu G. Poornima, Suresh R. Mulukutla, Zhen-qiang Ma, LuAnn Brink, Yuefang Chang, Akira Sekikawa and Lewis H. Kuller
Healthcare 2025, 13(24), 3303; https://doi.org/10.3390/healthcare13243303 - 16 Dec 2025
Viewed by 345
Abstract
Background/Objectives: This study evaluated the impact of the COVID-19 pandemic on trends of acute coronary syndrome hospitalizations, all-cause deaths, and ischemic heart disease (IHD) deaths in Allegheny County, Pennsylvania. Methods: Inpatient hospital records from two hospital systems within Allegheny County, Pennsylvania, [...] Read more.
Background/Objectives: This study evaluated the impact of the COVID-19 pandemic on trends of acute coronary syndrome hospitalizations, all-cause deaths, and ischemic heart disease (IHD) deaths in Allegheny County, Pennsylvania. Methods: Inpatient hospital records from two hospital systems within Allegheny County, Pennsylvania, were aggregated from January 2017 to November 2020. The primary diagnoses were acute myocardial infarction (AMI) and unstable angina. The Pennsylvania Department of Health provided all-cause and IHD death counts for the same period. We compared absolute percentage changes in admissions by year (March–November) and trends by age-specific groups (<45, 45–64, 65–74, ≥75) from the pre-pandemic (January 2017–February 2020) to pandemic (March 2020–November 2020) period using an interrupted time-series analysis. Results: There were 11,913 AMI hospitalizations pre-pandemic and 2170 AMI hospitalizations during the pandemic period. AMI hospitalizations decreased by 14.8% and unstable angina hospitalizations decreased by 30.7% during the pandemic compared to 2019, with the largest decreases occurring in those aged ≥75. Total mortality increased by 9.2%, and IHD mortality increased by 2.4%. About 80% of the increase in deaths was due to COVID-19, and approximately 75% of deaths occurred in those aged ≥75 and in long-term care facility residents. Conclusions: The COVID-19 pandemic did not markedly alter the longitudinal declining trend of AMI hospitalizations and IHD deaths in Allegheny County. Full article
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12 pages, 219 KB  
Article
Quantifying Cancer Healthcare Costs for Adolescents and Young Adults in Queensland, Australia
by Carla Thamm, Shafkat Jahan, Raymond J. Chan and Gail Garvey
Healthcare 2025, 13(24), 3302; https://doi.org/10.3390/healthcare13243302 - 16 Dec 2025
Viewed by 275
Abstract
Background: Adolescents and young adults (AYAs) with cancer have unique needs as they transition from childhood to adulthood. This study explored the patterns of health service use and the related costs incurred by the health care system and out-of-pocket (OOP) costs for AYAs [...] Read more.
Background: Adolescents and young adults (AYAs) with cancer have unique needs as they transition from childhood to adulthood. This study explored the patterns of health service use and the related costs incurred by the health care system and out-of-pocket (OOP) costs for AYAs diagnosed with cancer in Queensland, Australia. Methods: A linked administrative dataset (CancerCostMod) containing all AYA cancer survivors (n = 871; aged 15–24) diagnosed between July 2011 and June 2015 from the Queensland Cancer Registry (QCR) linked these records to Queensland Health Admitted Patient Data Collection (QHAPDC), Emergency Department Information System (EDIS), Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records from July 2011 to June 2018. We quantified total and average health service use, associated costs, OOP costs, and costs variations across sociodemographic characteristics. Results: The public hospital costs incurred for AYAs diagnosed with cancer were higher (AUD 33.7 M) compared to private hospitals (AUD 12.6 M). The median cost per person for public admissions (AUD 9759, IQR = AUD 0–37,245). AYAs claimed 215,900 MBS items and 58,321 PBS items over a five-year period. First Nations Australians and individuals living in regional and mostly disadvantaged areas had higher public hospital admissions, associated costs, and ED admissions compared to their counterparts. Conclusions: This study revealed significant variations in healthcare costs for AYAs diagnosed with cancer. Public hospital costs were higher, with notable differences observed across sociodemographic characteristics. Full article
20 pages, 813 KB  
Article
Artificial Intelligence in Sub-Elite Youth Football Players: Predicting Recovery Through Machine Learning Integration of Physical, Technical, Tactical and Maturational Data
by Pedro Afonso, Pedro Forte, Luís Branquinho, Ricardo Ferraz, Nuno Domingues Garrido and José Eduardo Teixeira
Healthcare 2025, 13(24), 3301; https://doi.org/10.3390/healthcare13243301 - 16 Dec 2025
Viewed by 783
Abstract
Background: Monitoring training load and recovery is essential for performance optimization and injury prevention in youth football. However, predicting subjective recovery in preadolescent athletes remains challenging due to biological variability and the multidimensional nature of training responses. This exploratory study examined whether supervised [...] Read more.
Background: Monitoring training load and recovery is essential for performance optimization and injury prevention in youth football. However, predicting subjective recovery in preadolescent athletes remains challenging due to biological variability and the multidimensional nature of training responses. This exploratory study examined whether supervised machine learning (ML) models could predict Total Quality of Recovery (TQR) using integrated external load, internal load, anthropometric and maturational variables collected over one competitive microcycle. Methods: Forty male sub-elite U11 and U13 football players (age 10.3 ± 0.7 years; height 1.43 ± 0.08 m; body mass 38.6 ± 6.2 kg; BMI 18.7 ± 2.1 kg/m2) completed a microcycle comprising four training sessions (MD-4 to MD-1) and one official match (MD). A total of 158 performance-related variables were extracted, including external load (GPS-derived metrics), internal load (RPE and sRPE), heart rate indicators (U13 only), anthropometric and maturational measures, and tactical–cognitive indices (FUT-SAT). After preprocessing and aggregation at the player level, five supervised ML algorithms—K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Decision Tree (DT), Random Forest (RF), and Gradient Boosting (GB)—were trained using a 70/30 train–test split and 5-fold cross-validation to classify TQR into Low, Moderate, and High categories. Results: Tree-based models (DT, GB) demonstrated the highest predictive performance, whereas linear and distance-based approaches (SVM, KNN) showed lower discriminative ability. Anthropometric and maturational factors emerged as the most influential predictors of TQR, with external and internal load contributing modestly. Predictive accuracy was moderate, reflecting the developmental variability characteristics of this age group. Conclusions: Using combined physiological, mechanical, and maturational data, these ML-based monitoring systems can simulate subjective recovery in young football players, offering potential as decision-support tools in youth sub-elite football and encouraging a more holistic and individualized approach to training and recovery management. Full article
(This article belongs to the Special Issue From Prevention to Recovery in Sports Injury Management)
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19 pages, 445 KB  
Article
Positive Mental Health, Anxiety and Prenatal Bonding: A Contextual Approach
by Laura Xu Ballesteros-Andrés, Raquel Luengo-González, Inmaculada Concepción Rodríguez-Rojo, Montserrat García-Sastre, Daniel Cuesta-Lozano, Jorge-Luis Gómez-González, José Alberto Martínez-Hortelano and Cecilia Peñacoba-Puente
Healthcare 2025, 13(24), 3300; https://doi.org/10.3390/healthcare13243300 - 16 Dec 2025
Viewed by 496
Abstract
Background/Objectives: The establishment of strong prenatal bonding is a key determinant of perinatal well-being, influencing maternal psychological adaptation and infant development. Numerous studies have examined risk factors and psychopathology during pregnancy, but limited research has explored the role of positive psychological constructs, such [...] Read more.
Background/Objectives: The establishment of strong prenatal bonding is a key determinant of perinatal well-being, influencing maternal psychological adaptation and infant development. Numerous studies have examined risk factors and psychopathology during pregnancy, but limited research has explored the role of positive psychological constructs, such as positive mental health (PMH). This study aimed to assess whether anxiety mediates the relationship between PMH and the quality of prenatal bonding. Methods: A total of 90 pregnant women participated. PMH was assessed using the Abbreviated Positive Mental Health Questionnaire; anxiety using the Hospital Anxiety and Depression Scale; and prenatal bonding using the Prenatal Assessment Scale for Pregnant Women (EVAP). A simple mediation model was tested, with anxiety as a mediator between PMH (predictor) and prenatal bonding (outcome), controlling the analysis for previous miscarriages, relationship stability, high-risk pregnancy, and employment. Results: The model revealed partial mediation (F = 16.617, p < 0.001). Higher PMH was associated with lower anxiety (B = −0.297, SE = 0.062, p < 0.001) and stronger prenatal bonding (B = 0.777, SE = 0.091, p < 0.001). Interestingly, anxiety emerged as an adaptive response, which could improve maternal sensitivity and communication with the unborn child (B = 0.316, SE = 0.145, p = 0.032). The model explained 56% of the variance in prenatal bonding, even after accounting for relevant covariates. Conclusions: These findings underscore the importance of considering contextual and psychosocial factors when assessing the role of emotions such as anxiety during pregnancy. Rather than being inherently maladaptive, anxiety may play a functional role in facilitating maternal engagement with the baby, especially when grounded in PMH. Given the limited research, our findings support the integration of positive psychology frameworks into perinatal health interventions. Full article
(This article belongs to the Section Women’s and Children’s Health)
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15 pages, 217 KB  
Article
Canine-Assisted Speech Therapy for Children: Caregiver and Therapist Perspectives
by Zhao Yue Zhang, Carlie Driscoll, Jessica Hill, Tiffani Howell and Genevieve Ward
Healthcare 2025, 13(24), 3299; https://doi.org/10.3390/healthcare13243299 - 16 Dec 2025
Viewed by 393
Abstract
Background/Objectives: This study investigated the perceived impact of therapy dogs on speech therapy for children with communication disorders. Methods: Using an interpretive descriptive design, we gathered insights from both therapists and caregivers. Five Australian speech pathologists who incorporate therapy dogs into their practice [...] Read more.
Background/Objectives: This study investigated the perceived impact of therapy dogs on speech therapy for children with communication disorders. Methods: Using an interpretive descriptive design, we gathered insights from both therapists and caregivers. Five Australian speech pathologists who incorporate therapy dogs into their practice participated in semi-structured interviews, and forty-two caregivers of children who received canine-assisted speech therapy completed online surveys. Results: Collectively, the responses revealed that therapy dogs helped children to establish rapport with the therapist, regulate their emotions and behaviours, engage with therapeutic tasks, be motivated to attend, use natural language, and improve social skills. The therapists reported personal and professional benefits, including enhanced job satisfaction and reduced stress, but highlighted the necessity of tailoring sessions to suit both the child and the dog, noting challenges in managing this dynamic. Conclusions: The study concluded that integrating therapy dogs into speech therapy is perceived to enhance therapeutic outcomes for children and improve therapist well-being. These findings offer valuable insights for incorporating therapy dogs into speech therapy practices, potentially improving the communication skills and quality of life of children with speech and language difficulties. Full article
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