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Volume 13
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Healthcare, Volume 13, Issue 4 (February-2 2025) – 92 articles

Cover Story (view full-size image): Breast cancer (BC) is a global health problem and is one of the principal causes of morbidity and mortality in females. In 2030, the worldwide number of new cases diagnosed will reach 2.7 million annually, while the number of deaths will be 0.87 million. The effectiveness of screening in reducing BC mortality is known. The introduction of artificial intelligence (AI) is becoming an important application in medical technologies. Recently, a prevalent field of application concerns the combination of AI and radiological evaluation in mammographic screening. If future studies confirm the benefit and safety of AI in mammography screening, it could become a support tool to overcome the current shortage of radiologists, at least eliminating the need for double reading or of a third radiologist in the case of disagreement. In this way, specialists could shortening the waiting times for patients. View this paper
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13 pages, 204 KiB  
Article
Sociodemographic Determinants of Reproductive Healthcare Service Use Among Pregnant Women in Pakistan
by Zhifei He, Ghose Bishwajit and Fubo Wu
Healthcare 2025, 13(4), 440; https://doi.org/10.3390/healthcare13040440 - 19 Feb 2025
Viewed by 590
Abstract
Introduction: Using the essential reproductive care services such as antenatal care (ANC) and skilled birth services are vital for ensuring safe motherhood and controlling maternal and child mortality. There is no recent evidence on the state of using reproductive care services in Pakistan [...] Read more.
Introduction: Using the essential reproductive care services such as antenatal care (ANC) and skilled birth services are vital for ensuring safe motherhood and controlling maternal and child mortality. There is no recent evidence on the state of using reproductive care services in Pakistan women. The purpose of the cross-sectional study is to explore the timing and frequency of ANC, the hospital and other institutional delivery, the cesarean section (C-section) services and to identify the sociodemographic factors that are associated with the use of these services. Methodology: Using the latest Pakistan Demographic and Health Survey (2017-18 PDHS) for this analysis, the data were collected by face-to-face interviews by trained interviewers, which included 8287 women aged 15–49 years. The data on reproductive services were defined by standard guidelines by the World Health Organization (WHO). Data analyses involved univariate tests and multivariate regression techniques. Results: The percentage of women who attended ANC visits in the first trimester was 62.59%, and those who attended the minimum recommended number of four visits was 49.46%. The percentages of using hospital and C-section services were, respectively, 76.20% and 19.63%. In the regression analysis, place of residence, education, household wealth status, access to using electronic media and learning about family planning from electronic media and before marriage were found to significantly predict the use of ANC and facility delivery services. However, educational and household wealth status stood out as the strongest predictors of all. About half of the women were not having adequate ANC visits and about one-third not making timely ANC contact. More than three-quarters reported choosing to deliver at hospital/other facility, and about one-fifth preferred C-section. Conclusions: The results indicated that, among the predictor of using these services, education and household wealth status were found to have the strongest association, highlighting the role of women’s socioeconomic well-being in availing the basic reproductive healthcare services. Hence, this study suggests that the government and medical institutions should further pay attention to the ANC visits and reduce infant birth mortality rates. Simultaneously, increasing women’s educational opportunities, enhancing women’s socioeconomic well-being and social status, can help improve their health awareness and promote healthy behaviors. Full article
(This article belongs to the Special Issue Health Risks, Health Service, and Healthcare Supports for Vulnerable Populations)
22 pages, 635 KiB  
Systematic Review
Effects of Physical Exercise on Cardiometabolic Health in Individuals with Autism Spectrum Disorder: A Systematic Review
by Léa Charlier, Léa Cordeiro, Jorge Lopes Cavalcante Neto, Étore De Favari Signini, Jordana Barbosa-Silva, Camilo Corbellini, Antoine Lipka and Raphael Martins de Abreu
Healthcare 2025, 13(4), 439; https://doi.org/10.3390/healthcare13040439 - 18 Feb 2025
Viewed by 983
Abstract
Background/Objectives: Individuals with autism spectrum disorder (ASD) are at increased risk of developing cardiometabolic diseases. Although physical exercise (PE) has emerged in the literature as an important modulator for reducing such risk, evidence remains unclear. This systematic review aimed to investigate the effects [...] Read more.
Background/Objectives: Individuals with autism spectrum disorder (ASD) are at increased risk of developing cardiometabolic diseases. Although physical exercise (PE) has emerged in the literature as an important modulator for reducing such risk, evidence remains unclear. This systematic review aimed to investigate the effects of PE on cardiometabolic health in individuals with ASD. Methods: A systematic review was carried out according to the PRISMA guidelines, from their inception until 18 July 2023, in the following electronic databases: Scopus, Medline, and Web of Science. Studies were included if they focused on ASD patients undergoing physical exercise, assessing cardiometabolic risk, exercise tolerance, and QoL. The following were excluded: non-exercise interventions, additional therapies, non-English studies, and reviews. The methodological quality of the included studies was assessed through the Downs and Black scale. Results: A total of four studies (149 participants) were included in this review, with the average methodological quality being rated as “fair”. Interventions had mixed effects on cardiometabolic health. The BMI (↓2.8 kg/m2), waist circumference (↓1.86 cm), and lipid profiles improved in some cases. VO2max and HRbaseline showed moderate gains. Secondary outcomes included enhanced endurance, strength, and calorie expenditure, especially in mild ASD. Autistic traits and quality of life improved post-intervention, with better results in the experimental groups. Conclusions: This review indicates that aerobic and functional training improves cardiometabolic health, autistic traits, and QoL in individuals with ASD, particularly in mild cases. Further research is needed to explore the impact of ASD severity on these outcomes. Full article
(This article belongs to the Special Issue Health Intervention of Physical Activity and Sedentary Behaviors)
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24 pages, 1119 KiB  
Review
Digital Health for Equitable Rheumatic Care: Integrating Real-World Experiences to Guide Policy Pathways
by Anindita Santosa, James Weiquan Li and Tze Chin Tan
Healthcare 2025, 13(4), 438; https://doi.org/10.3390/healthcare13040438 - 18 Feb 2025
Viewed by 711
Abstract
Background/Objectives: Digital health technologies show promise in improving rheumatic disease management and reducing healthcare access disparities globally. This paper examines how electronic health records, telemedicine, apps, and wearable devices are used in rheumatic care across different economic settings. Methods: The study [...] Read more.
Background/Objectives: Digital health technologies show promise in improving rheumatic disease management and reducing healthcare access disparities globally. This paper examines how electronic health records, telemedicine, apps, and wearable devices are used in rheumatic care across different economic settings. Methods: The study evaluates digital health technology implementation and outcomes in high-income versus low- and middle-income countries (LMICs). Results: Digital health technologies demonstrate improvements in disease monitoring, treatment adherence, and doctor-patient communication, though impact varies by region. Key barriers include poor infrastructure, limited tech literacy, and the digital divide, particularly affecting LMICs. The proposed evidence-based framework recommends strategic investments in digital infrastructure, healthcare system integration, and professional training to address these challenges. Conclusions: Implementation of digital health technologies, guided by targeted interventions and regional adaptations, can effectively reduce global disparities in rheumatic care. Success requires sustained commitment to addressing infrastructure and literacy barriers while ensuring equitable access across all economic settings. Full article
(This article belongs to the Special Issue Advances in eHealth for Healthcare)
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13 pages, 1052 KiB  
Article
Sex-Specific Factors Affecting Quality of Life After Major Trauma: Results of a Prospective Multicenter Registry-Based Cohort Study
by Viola Freigang, Karolina Müller, Antonio Ernstberger, Volker Alt, Anne Herrmann-Johns and Florian Baumann
Healthcare 2025, 13(4), 437; https://doi.org/10.3390/healthcare13040437 - 18 Feb 2025
Viewed by 413
Abstract
Background: Major trauma is a leading cause of severe disability and mortality. The influence of patient sex on outcome after severe trauma is a topic of ongoing discussion. We present a prospective multicenter study on the effects of trauma severity on health-related [...] Read more.
Background: Major trauma is a leading cause of severe disability and mortality. The influence of patient sex on outcome after severe trauma is a topic of ongoing discussion. We present a prospective multicenter study on the effects of trauma severity on health-related quality of life (HRQoL) of female patients. We hypothesized that the impairment of HRQoL after major trauma between the sexes depends not only on sex itself but also on age. Methods: This multicenter prospective registry-based observational study compared sex-based differences in HRQoL of patients who sustained major trauma Injury Severity Score (ISS ≥ 16). The HRQoL was assessed using the EQ-5D-3L (European Quality of Life 5-Dimension 3-Level Version) score over 2 years post-trauma. Results: We included 416 patients (116 female/300 male) with an ISS > 16 (median ISS 22 IQR 18/30). All patients had a lower HRQoL after trauma than the population norm. Increased AIS (Abbreviated Injury Scale) face and extremity scores and ASA (American Society of Anesthesiologists) scores showed a significant decrease in HRQoL. Even though the groups of female and male patients were comparable in injury severity, female patients reported significantly more problems on the anxiety and depression scales than male patients 6 months (p = 0.003) and 24 months (p = 0.044) after trauma (6 months: female 46% vs. male 30%; 24 months: female 44% vs. male 32%). We observed the greatest improvement in the EQ Index over time in patients between 16 and 39 years of age, especially female patients (0.78 to 0.87 in females under 39 years of age, compared to males in the same age group 0.76 to 0.81). Females over 65 years of age initially presented the lowest EQ Index of 0.62. It remained significantly lower over time and was lower compared to male patients of the same age group (female EQ Index after 24 months was 0.68 compared to men over the age of 65 who presented an EQ Index of 0.75). Conclusions: All patients included in this study presented a lower HRQoL after trauma than the population norm. Female patients under 39 years of age reported the most improvement. Females over 65 years of age showed a limited HRQoL, which remained significantly lower over time. Female patients reported significantly more anxiety and depression after major trauma than male patients. Thus, further development and methodologically rigorous testing of ortho-geriatric initiatives, psychosocial support, and prevention measures are required to improve the care after major trauma, particularly for the female elderly. Full article
(This article belongs to the Special Issue Healthcare Advances in Trauma and Orthopaedic Surgery)
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12 pages, 215 KiB  
Article
The Effect of Medication Adherence and Spirituality in Quality of Life of Patients with Rheumatic Diseases
by Maria Kavvadia, Maria Saridi, Aikaterini Toska, Vissarion Bakalis, Stella Zetta, Theodosios Paralikas, Pavlos Sarafis and Evangelos C. Fradelos
Healthcare 2025, 13(4), 436; https://doi.org/10.3390/healthcare13040436 - 18 Feb 2025
Viewed by 639
Abstract
Background: Spirituality is significantly associated with the quality of life of patients suffering from rheumatic diseases, helping them to cope with pain and improve emotional well-being. There is a gap in the literature regarding the relationship between spirituality, quality of life and [...] Read more.
Background: Spirituality is significantly associated with the quality of life of patients suffering from rheumatic diseases, helping them to cope with pain and improve emotional well-being. There is a gap in the literature regarding the relationship between spirituality, quality of life and treatment adherence in patients with rheumatic diseases, especially rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), as relevant studies, especially in the Greek population, are limited. Aims: The present study aimed to evaluate the effect of medication adherence and spirituality on the quality of life of patients with rheumatic diseases. Methods: This was a cross-sectional study conducted in adult patients with rheumatoid arthritis and systemic lupus erythematosus from the region of Crete. Data were collected via a self-administrated questionnaire consisting of four parts, including questions regarding demographic and clinical information; the WHOQoL-BREF, 3, FACIT-Sp-12, and SMAQ questionnaires were used. The level of statistical significance was set at α = 0.05 for all analyses. Results: The study sample consisted of 115 participants, with the majority being women (90%). The majority of the participants suffered from RA (62%), while 38% suffered from SLE. The mean age of the participants was 49.15 years (SD = 11.7), and 46% described their health as good. We found that the dimensions of spirituality are positively related to the dimensions of quality of life. The peace dimension has a strong correlation with psychological health (r = 0.679, p < 0.001) and overall quality of life (QOL Global, r = 0.671, p < 0.001). Meaning also shows a positive correlation with psychological health (r = 0.563, p < 0.001) and overall quality of life (r = 0.506, p < 0.001), whereas adherence to medication shows a low but positive correlation with overall spirituality (r = 0.192, p = 0.040). Conclusions: The findings support that spirituality can be a protective mechanism, improving the mental resilience and adaptability of patients. This study has the potential to contribute to the development of evidence-based guidelines for the integration of spiritual care into clinical practice, with the objective of enhancing the psychological well-being and overall quality of life of patients with rheumatic diseases. Full article
(This article belongs to the Special Issue Relationship Between Musculoskeletal Problems and Quality of Life)
16 pages, 1181 KiB  
Article
An Evaluation of Health Behavior Change Training for Health and Care Professionals in St. Helena
by Wendy Maltinsky, Vivien Swanson, Kamar Tanyan and Sarah Hotham
Healthcare 2025, 13(4), 435; https://doi.org/10.3390/healthcare13040435 - 18 Feb 2025
Cited by 1 | Viewed by 1118
Abstract
Background: Health behavior consultations support self-management if delivered by skilled practitioners. We summarize here the results of a collaborative training intervention program delivered to health and care practitioners working in a remote-island context. The program was designed to build confidence in the implementation [...] Read more.
Background: Health behavior consultations support self-management if delivered by skilled practitioners. We summarize here the results of a collaborative training intervention program delivered to health and care practitioners working in a remote-island context. The program was designed to build confidence in the implementation of communication and behavior change skills and to sustain their use in work settings. The setting for the behavior change training program was the South Atlantic island of St. Helena, a remote low-middle-income country which has a population with high levels of obesity and a prevalence of long-term conditions. Objectives: We aimed to increase knowledge, confidence, and implementation of behavior change techniques (BCTs) and communication skills of health and social care staff through delivering and evaluating training using the MAP (Motivation, Action, Prompt) behavior change framework. A successful training intervention could ultimately improve self-management and patient health outcomes. Methods: Co-production with onsite representatives adapted the program for local delivery. A two-day training program was delivered face-to-face to 32 multidisciplinary staff. Pre- and post-intervention and 18-month follow-up evaluation assessed reactions, learning and implementation using multiple methods, including participant feedback and primary care patient reports. Results: Positive reactions to training and significant improvement in confidence, perceived importance, intention to use and implementation of BCTs and communication skills immediately post-training and at long-term follow-up were observed. Patient reports suggested some techniques became routinely used. Methodological difficulties arose due to staff retention and disruption through the COVID-19 pandemic. Conclusions: The delivery of health behavior change training can be effective in remote contexts with sustainable impacts on healthcare. There are challenges working in this context including staff continuity and technological reliability. Full article
(This article belongs to the Section Nutrition and Public Health)
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15 pages, 1639 KiB  
Article
Imagine the Possibilities Pain Coalition and Opioid Marketing to Veterans: Lessons for Military and Veterans Healthcare
by Christopher K. Haddock, Luther Elliott, Andrew Kolodny, Christopher M. Kaipust, Walker S. C. Poston, Jennifer D. Oliva, Eleanor T. Lewis, Elizabeth M. Oliva, Nattinee Jitnarin and Chunki Fong
Healthcare 2025, 13(4), 434; https://doi.org/10.3390/healthcare13040434 - 18 Feb 2025
Viewed by 1054
Abstract
Background/Objectives: The opioid crisis has disproportionately impacted U.S. military veterans, who face heightened risks of opioid use disorder and overdose due to chronic pain and mental health conditions. The pharmaceutical industry’s role in misrepresenting opioid risks—leading to over USD 50 billion in [...] Read more.
Background/Objectives: The opioid crisis has disproportionately impacted U.S. military veterans, who face heightened risks of opioid use disorder and overdose due to chronic pain and mental health conditions. The pharmaceutical industry’s role in misrepresenting opioid risks—leading to over USD 50 billion in legal settlements—has included targeted marketing to vulnerable populations. This study examines Janssen Pharmaceuticals’ “Imagine the Possibilities Pain Coalition” (IPPC), which aimed to increase opioid use among veterans with chronic non-cancer pain. Insights from this public health industry document analysis offer guidance for military medicine and healthcare policymaking. Methods: Using the Opioid Industry Document Archive (OIDA), housed at Johns Hopkins University and the University of California, San Francisco, researchers conducted retrospective content analysis. Documents referencing veterans were identified through keyword searches on Johns Hopkins’ SciServer portal and reviewed using CoCounsel, an AI-based legal document platform using a human-in-the-loop approach. Relevant documents were examined by the authors to extract material aligned with the research focus. Results: The IPPC employed strategies to influence opioid prescribing for veterans. These included educational materials that minimized addiction risks and exaggerated long-term benefits and empathy-driven narratives prioritizing immediate pain relief over potential harms. Ghostwriting ensured favorable perspectives on opioids in scientific literature, aligning with broader industry strategies to promote opioids for chronic pain. Conclusions: The targeted marketing of opioids to veterans has exacerbated the opioid crisis, as documented in government reports and litigation. Rigorous oversight of industry-funded coalitions and evidence-based practices are critical to insulating military healthcare from corporate influence and addressing the opioid crisis among veterans. Full article
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15 pages, 2044 KiB  
Article
Pilot Study on the Efficacy of a Novel Questionnaire for Assessing Psychological Health in Patients with Chronic Rhinosinusitis with Nasal Polyps Treated with Biologics
by Simonetta Masieri, Carlo Cavaliere, Antonella Loperfido, Elona Begvarfaj, Andrea Ciofalo, Francesco Maria Primerano, Gianluca Velletrani, Marcella Bugani, Pamela Cirilli, Francesco Maria Passali, Stefano Millarelli, Gianluca Bellocchi and Stefano Di Girolamo
Healthcare 2025, 13(4), 433; https://doi.org/10.3390/healthcare13040433 - 18 Feb 2025
Viewed by 566
Abstract
Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) represents a debilitating disease with significant morbidity and decreased quality of life (QoL). The introduction of biologics in its management has allowed new therapeutic options, and Dupilumab represents the first approved biologic. This study aims [...] Read more.
Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) represents a debilitating disease with significant morbidity and decreased quality of life (QoL). The introduction of biologics in its management has allowed new therapeutic options, and Dupilumab represents the first approved biologic. This study aims to evaluate a possible relationship between the clinical response to biological therapy and mental health in patients with severe CRSwNP. Methods: This is a multicenter study conducted at the Otolaryngology departments of three major Italian health institutions. Participants were patients with CRSwNP treated with Dupilumab. Patients were assessed at baseline and during treatment by submitting them to a survey consisting of a dedicated questionnaire focused on psychological health and two patient-reported outcome measures (PROMs): the 22-item Sino-Nasal Outcome Test (SNOT-22) and a Visual Analogue Scale (VAS) for nasal symptoms. Results: 86 patients were included in the study (58 males and 28 females; mean age: 58.2 years). There was a significant improvement in both symptoms and QoL, with an enhanced psychological state observed in patients after the first administration and within the first months of therapy. Conclusions: This study evaluated the possible correlations between Dupilumab treatment and improvements in mental health in patients with CRSwNP, as assessed through a survey, and clinical conditions, assessed through SNOT-22 and VAS. Our findings showed that Dupilumab not only improved clinical symptoms but also had a positive impact on patients’ mental health, with benefits observed already after the first administration and the first months of therapy. This survey highlights the relevance of psychological well-being and its implications for patients with chronic diseases such as CRSwNP. Full article
(This article belongs to the Special Issue Patient-Reported Measures)
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19 pages, 682 KiB  
Article
A Screening Measure of Emotion Regulation Difficulties: Polish Norms and Psychometrics of the Difficulties in Emotion Regulation Scale-8 (DERS-8)
by Paweł Larionow, Monika Mazur and Karolina Mudło-Głagolska
Healthcare 2025, 13(4), 432; https://doi.org/10.3390/healthcare13040432 - 18 Feb 2025
Viewed by 734
Abstract
Background/Objectives: Difficulties in emotion regulation (DER) serve as a transdiagnostic risk factor for a wide range of emotion-based psychopathologies, including anxiety and depression disorders. This study presents a report on the psychometrics of the eight-item Difficulties in Emotion Regulation Scale-8 (DERS-8) and the [...] Read more.
Background/Objectives: Difficulties in emotion regulation (DER) serve as a transdiagnostic risk factor for a wide range of emotion-based psychopathologies, including anxiety and depression disorders. This study presents a report on the psychometrics of the eight-item Difficulties in Emotion Regulation Scale-8 (DERS-8) and the development of its Polish norms. Methods: The sample comprised 1329 Polish adults aged 18–73, with 907 females, 384 males, 36 non-binary, and 2 people with an unidentifiable gender. The participants filled out a series of self-report questionnaires on DER, anxiety and depression symptoms, and well-being. Factor structure and measurement invariance, as well as discriminant validity of the DERS-8, were tested with confirmatory factor analysis. Convergent and divergent validity was assessed via relationships with negative and positive mental health outcomes. Internal consistency reliability was evaluated with alpha and omega coefficients. Demographic differences were also examined. Results: Our empirical evidence supported the strong psychometrics of the Polish DERS-8, including its good level of internal consistency reliability (i.e., 0.89) and strong validity. The one-factor DERS-8 model had a good fit, with its supported scalar invariance between a set of demographic variables and levels of mental health outcomes. DERS-8 scores were strong positive predictors of anxiety and depression symptoms and negative predictors of well-being, emphasizing the potential detrimental effects of DER on the dual continuum of mental health and mental illness. Conclusions: The Polish DERS-8 has strong psychometric properties. Given the development of its percentile rank norms, the scale can be used as a good screening measure of DER in the Polish adult sample. Full article
(This article belongs to the Special Issue Psychological Diagnosis and Treatment of People with Mental Disorders)
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18 pages, 308 KiB  
Article
Knowledge and Use of Evidence-Based Practice in Psychology in the Clinical Practice of Brazilian Psychologists: A Cross-Sectional Study
by Tamara Melnik, Jorge Sinval, Vanessa Dordron de Pinho, José Antônio Spencer Hartmann Junior, Margareth da Silva Oliveira and Fernanda Machado Lopes
Healthcare 2025, 13(4), 431; https://doi.org/10.3390/healthcare13040431 - 17 Feb 2025
Viewed by 960
Abstract
Background/Objectives: The use of scientific evidence for the diagnosis and treatment of mental disorders is crucial for achieving optimal clinical outcomes and providing high-quality care. This study investigates the knowledge, sources of evidence, and attitudes of Brazilian clinical psychologists regarding evidence-based practice [...] Read more.
Background/Objectives: The use of scientific evidence for the diagnosis and treatment of mental disorders is crucial for achieving optimal clinical outcomes and providing high-quality care. This study investigates the knowledge, sources of evidence, and attitudes of Brazilian clinical psychologists regarding evidence-based practice in psychology (EBPP) and discusses barriers to its implementation. Methods: A total of 696 Brazilian clinical psychologists participated in an online questionnaire designed to assess their understanding of EBPP, their familiarity with scientific platforms/databases, and their professional development investments. Latent class analysis (LCA) was conducted, which can be used to identify subgroups of psychologists with similar patterns of professional and training characteristics. Results: The results indicate that while psychologists recognized the importance of EBPP for effective patient care, there was a significant gap in understanding its fundamental principles and concepts. Many participants reported the limited use of scientific databases, missing opportunities to access the latest research advancements. A lower percentage of psychologists consistently implemented EBPP in their clinical practice, highlighting a gap between knowledge and application. Four latent classes emerged from the LCA: I—experienced/established professional psychologist; II—academic psychologist; III—supervised traditional psychologist; and IV—young professional psychologist. Conclusions: This study emphasizes the need for better integration of EBPP into psychology curricula and continuing education programs. Enhancing clinical psychologists’ understanding and proficiency in EBPP can promote evidence-based decision-making and improve the quality of mental health care in Brazil. Efforts should be made to familiarize psychologists with reliable scientific databases, equip them with skills to critically appraise research, and foster a culture of lifelong learning and professional development. Additionally, it is essential to develop strategies tailored to the distinct profiles of professionals identified in this study, considering their training sources, reference usage, and knowledge of EBPP. Full article
(This article belongs to the Special Issue Evidence-Based Practice in Occupational Health: Development and Adaptation of Psychometric Instruments)
15 pages, 3173 KiB  
Article
The Impact and Burden of Chronic Rhinosinusitis with Nasal Polyps on Patients and Their Family Caregivers: A Nationally Representative Survey
by Luca Malvezzi, Veronica Seccia, Antonio Moffa, Frank Rikki Mauritz Canevari, Ilaria Baiardini, Simona Barbaglia, Mattia Battistini, Eleonora Cantoni, Filippo Cipriani, Marta Pirronello, Giovanna Sala, Annalisa Stassaldi and Eugenio De Corso
Healthcare 2025, 13(4), 430; https://doi.org/10.3390/healthcare13040430 - 17 Feb 2025
Viewed by 847
Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNPs) is a chronic inflammatory disease associated with frustrating symptoms, particularly nasal obstruction and loss of smell. We conducted a patient survey on the significant burden of the disease, with a specific focus on conditions that affect [...] Read more.
Background: Chronic rhinosinusitis with nasal polyps (CRSwNPs) is a chronic inflammatory disease associated with frustrating symptoms, particularly nasal obstruction and loss of smell. We conducted a patient survey on the significant burden of the disease, with a specific focus on conditions that affect health, sleep quality, absenteeism, and presenteeism, including the caregivers’ perspectives. Methods: An online questionnaire was sent to 4230 randomly selected recipients, and 200 matched the inclusion criteria for self-reported CRSwNPs symptoms. A total of 100 participants not matching the inclusion criteria for CRSwNPs were recruited as a control group. The study also collected the perspectives of 50 caregivers. Results: Patients with CRSwNPs experienced very bothersome symptoms, such as nasal congestion, headache, and rhinorrhoea, with a profound impact on their health-related quality of life (HRQoL). The patients and their caregivers showed significantly lower quality of sleep, experiencing a poor night’s sleep on average 72.1 and 51.7 days per year, respectively. Smell and taste impairments significantly impacted patients’ social and working lives, with 39.5% feeling in danger because of hyposmia and 34.5% because of limited taste. Out-of-pocket costs were up to EUR 40/month for 68.5% of patients. CRSwNPs alone was responsible for an average of 24.7 days of absenteeism and 25.1 days of presenteeism. Conclusions: Our results highlight how CRSwNPs has a negative impact on patients’ and caregivers’ HRQoL. Most bothersome and health-conditioning symptoms involve nose symptoms and poor sleep quality, resulting in patient absenteeism and presenteeism with a strong burden on cognitive and emotional functioning for both patients and their caregivers. Full article
(This article belongs to the Special Issue Surgical Innovations and New Technologies for Sleep-Related Breathing Disorders)
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13 pages, 514 KiB  
Article
Effects of a Targeted Concurrent Training Program on the Exercise Adherence in Female Breast Cancer Survivors: A Randomized Controlled Trial
by Igor Herrero-Zapirain, Sergio Alvarez-Pardo, Arkaitz Castañeda-Babarro, Fabio García-Heras, Olga Pons-Llanas, Elena Oliete-Ramírez and Juan Mielgo-Ayuso
Healthcare 2025, 13(4), 429; https://doi.org/10.3390/healthcare13040429 - 17 Feb 2025
Viewed by 634
Abstract
Background/Objectives: Increased time and adherence to physical activity, as well as increased intensity of physical activity, is one of the determining factors in improving survival and avoiding disease recurrence in female breast cancer survivors. The study aims to determine the effect of a [...] Read more.
Background/Objectives: Increased time and adherence to physical activity, as well as increased intensity of physical activity, is one of the determining factors in improving survival and avoiding disease recurrence in female breast cancer survivors. The study aims to determine the effect of a 12-session concurrent training program on increasing moderate/vigorous physical activity time in this population. Methods: A total of (N = 72) female breast cancer survivors were randomized into an intervention group and a control group to perform a 12-session concurrent training program. The GPAQ questionnaire measured the time and intensity of physical activity and work they performed before starting the program and three months after completion of the program. Results: A total of (N = 15) women in the intervention group and (N = 22) women in the control group completed the questionnaire before and three months after completing the program. A significant increase in moderate, vigorous, and combined physical activity (PA) was observed in the intervention group (IG) in comparison to the control group (CG) at three months following the intervention. While these results are promising, it is important to note that the observed improvements in PA adherence reflect associations rather than direct causal relationships. While these changes are statistically significant, they also reflect meaningful improvements in clinical outcomes. A notable finding was the significant decrease in sedentary time observed in the IG, which is likely to have contributed to the observed improvement in adherence. Conclusions: Concurrent training shows an increment in the time and intensity of daily physical activity performed by breast cancer survivors, which is a determining aspect of the survival and non-relapse of the disease in this population. Full article
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16 pages, 571 KiB  
Article
Healthcare Resource Utilization, Economic Burden, and Multi-Level Medical Security System for Individuals with Spinal Muscular Atrophy in Shaanxi Province, China
by Mingyue Zhao, Shengjie Ding, Yuhan Zhao, Chenglong Lin and Yubei Han
Healthcare 2025, 13(4), 428; https://doi.org/10.3390/healthcare13040428 - 17 Feb 2025
Cited by 1 | Viewed by 666
Abstract
Objectives: The objective of this study is to quantify healthcare resource utilization, economic burden, and the multi-level medical security system for Spinal Muscular Atrophy (SMA) patients in Shaanxi Province, China, from a societal perspective using a survey. Methods: This observational study employed [...] Read more.
Objectives: The objective of this study is to quantify healthcare resource utilization, economic burden, and the multi-level medical security system for Spinal Muscular Atrophy (SMA) patients in Shaanxi Province, China, from a societal perspective using a survey. Methods: This observational study employed an online survey with a retrospective cross-sectional design in Shaanxi Province, China. The survey examined various aspects of SMA, including resource utilization, direct and indirect economic burdens, and co-payment mechanisms within a multi-level medical security system. Results: Following the inclusion of nusinersen in the National Reimbursement Drug List (NRDL) in 2022, the treatment rate for SMA patients increased significantly. After risdiplam was added to the NRDL in 2023, its use also saw a marked increase. Treatment costs varied by SMA type: Type 1 incurred the highest costs (RMB 300,000 or USD 41,000), followed by Type 2 (RMB 270,000 or USD 37,000), Type 3 (RMB 200,000 or USD 27,000), and Type 4 (RMB 80,000 or USD 11,000). The primary sources of costs were productivity losses due to primary caregivers (32.94%), nusinersen usage (29.29%), and risdiplam usage (17.33%). Out-of-pocket costs for SMA patients accounted for 29.29% of the total costs. In 2023, basic medical insurance covered 49% of direct costs and 32% of total costs. Patients still had to pay 25.73% of the total cost for the direct costs. Conclusions: Basic medical insurance is a critical foundation for patient security and plays a pivotal role in reimbursement. In contrast, commercial insurance has a relatively limited impact on covering the costs for SMA patients. These findings highlight the substantial healthcare burden faced by SMA patients under the current healthcare system in China. Full article
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15 pages, 732 KiB  
Article
What Nurses’ Work–Life Balance in a Clinical Environment Would Be
by Sharifa M Alasiry, Fauzia Naif Alfridi, Hibah Abdulrahim Bahri and Hanan HamdanAlshehri
Healthcare 2025, 13(4), 427; https://doi.org/10.3390/healthcare13040427 - 16 Feb 2025
Viewed by 812
Abstract
Background/Objectives: Nurses’ workplaces are critical to both the levels and types of care nurses can deliver as well as to employee retention. The quality of the workplace environment is a significant predictor of employment outcomes, such as improved care and a decrease in [...] Read more.
Background/Objectives: Nurses’ workplaces are critical to both the levels and types of care nurses can deliver as well as to employee retention. The quality of the workplace environment is a significant predictor of employment outcomes, such as improved care and a decrease in nurses’ desire to leave their work. Moreover, a favourable work environment can significantly improve organisational performance. A healthy nursing workplace is a safe, empowering, and fulfilling place of employment in which all healthcare personnel work tirelessly for patients’ optimal health and wellness. The aim of this study is to identify the association between workplace environment and work engagement among nurses in clinical settings. Methods: A descriptive cross-sectional correlational design was used. Convenience sampling was used to recruit 349 nurses from various hospitals in the central northern region of Saudi Arabia. A four-part electronic questionnaire eliciting information on participants’ sociodemographic characteristics, job characteristics, work-related quality of life (WRQoL), and work engagement was collected. All ethical guidelines for scientific research on human beings were strictly followed. Results: The participants had average levels of WRQoL. However, they had generally moderate to high levels of work engagement, which reflects their moderate to low intention to leave work. The findings demonstrated a statistically significant positive link between the WRQoL and work engagement of the participants. Conclusions: When the nurses’ WRQoL improved, their work engagement increased significantly. Improving WRQoL will almost definitely enhance nurses’ work engagement, which will reduce nurses’ intentions to leave their employment. It is advised that nurses enhance their WRQoL in order to increase their engagement in the workplace, have fewer thoughts about leaving, and make fewer plans to leave. Full article
(This article belongs to the Topic Exploring the Interplay of Psychology and Work-Related Health and Well-Being)
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10 pages, 192 KiB  
Article
Prevalence, Causes, and Risk Factors Associated with Visual Impairment in Qbah, a Rural Community in the Qassim Region of Saudi Arabia
by Sulaiman Aldakhil, Saif Hassan Alrasheed, Raghda Faisal Mutwaly, Bandar Alenezi, Saad Alrabiah, Mohammed M. Alnawmasi, Nawaf M. Almutairi, Saja A. Alhoshan and Bashair N. Alnasser
Healthcare 2025, 13(4), 426; https://doi.org/10.3390/healthcare13040426 - 16 Feb 2025
Viewed by 846
Abstract
Background: Visual impairment can significantly impact an individual’s performance, productivity, and overall quality of life. Objectives: The objective of this paper is to report the prevalence, causes, and risk factors associated with visual impairment in Qbah, a rural community in the Qassim Province [...] Read more.
Background: Visual impairment can significantly impact an individual’s performance, productivity, and overall quality of life. Objectives: The objective of this paper is to report the prevalence, causes, and risk factors associated with visual impairment in Qbah, a rural community in the Qassim Province of Saudi Arabia. Methods: A descriptive cross-sectional study was conducted in Qbah, a rural community, with 587 subjects aged 6 to 80 years. Data were collected as part of a major campaign by Qassim University, and each participant underwent a comprehensive eye examination. Finally, the visual impairment was classified based on the International Classification of Diseases 11th revision, 2018 (ICD-11). Results: The overall prevalence of presenting visual impairment was 159 (27.1%). This included mild visual impairment 84 (14.37%), moderate visual impairment 65 (11.7%), severe visual impairment, and blindness 5 (0.90%). The main causes of visual impairment were uncorrected refractive errors (UREs), at 132 (83.0%), followed by amblyopia, at 14 (8.8%), and cataract, at 9 (5.7%). The prevalence of hyperopia, myopia, and astigmatism was 134 (22.8%), 174 (29.6%), and 13 (2.2%), respectively. Regression analysis revealed that the odds for visual impairment were 2.71 times higher in the elderly compared to the young participants. Women have 2.234 times higher odds of visual impairment compared to men, while the odds of visual impairment were 14.83 times higher in the participants with the URE compared to the emmetropic participants. Almost two-thirds of participants (65.8%) reported never having had an eye examination before. Conclusions: Visual impairment was common in the community, especially among older people and females, and URE was the main cause of visual impairment, followed by amblyopia and cataract. Considerable subjects reported never having had an eye examination before; this highlights the challenges in accessing healthcare in rural areas. These findings emphasize the importance of improving healthcare accessibility in rural regions. Full article
14 pages, 500 KiB  
Article
Self-Efficacy, Social Support, and Depression: Mediators of Medication Adherence in Dialysis Patients
by Reynita Saguban, Sumathi Robert Shanmugam, Evalynn Rondilla, Joyce Buta, Nuha Ayad H. Alatawi, Richard Maestrado, Sameer A. Alkubati, Romeo Mostoles, Jr., Nojoud Abdullah Alrashidi and Maha Sanat Alreshidi
Healthcare 2025, 13(4), 425; https://doi.org/10.3390/healthcare13040425 - 16 Feb 2025
Viewed by 854
Abstract
Introduction: Healthcare providers’ understanding of how self-efficacy and social support affect medication adherence and depression in dialysis patients can lead to holistic interventions and improve outcomes. This study aimed to investigate how self-efficacy and social support indirectly influence the relationship between medication [...] Read more.
Introduction: Healthcare providers’ understanding of how self-efficacy and social support affect medication adherence and depression in dialysis patients can lead to holistic interventions and improve outcomes. This study aimed to investigate how self-efficacy and social support indirectly influence the relationship between medication adherence and depressive symptoms in patients with chronic kidney disease (CKD) undergoing dialysis. Methods: We employed a cross-sectional observational study design with 668 CKD patients from outpatient departments (OPDs) and dialysis centers in the Hail region of Saudi Arabia. The data were collected between April and May 2024. Results: The participants had a relatively high level of self-efficacy (median = 82.00/100) and greater perception of social support (median = 75.500/84) with minimal to mild depressive symptoms (median = 15.00/63); however, 50% of participants scored ≥ 5 (out of 10) on the level of adherence to their medication regimen. Depression was prevalent, with a mean score of 5.03 on the PHQ-9 scale, and was positively correlated with nonadherence. Social support and self-efficacy were negatively correlated with depression, and both partially mediated the link between depression and non-adherence. Conclusions: This study found that, despite high social support and self-efficacy, a significant number of patients with CKD on dialysis exhibited medication non-adherence. Depression has emerged as a key factor influencing adherence, even in the presence of social support and self-efficacy. These findings suggest that depression is crucial for CKD management. Healthcare providers, owing to their frequent interactions with patients with CKD, are ideally placed to screen for depression and incorporate management strategies into patient care plans. By addressing both the biological and psychological aspects of CKD, they can empower patients to take a more active role in their treatment, ultimately leading to improved health outcomes. Full article
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11 pages, 816 KiB  
Article
The Role of Interdisciplinary Convergence for Mental Health Among Korean Military Servicemen: Focusing on Depression and Salivary Dehydroepiandrosterone-Sulfate
by Daeyeon Jang and Wonjung Ryu
Healthcare 2025, 13(4), 424; https://doi.org/10.3390/healthcare13040424 - 15 Feb 2025
Viewed by 548
Abstract
(1) Background/Objectives: The purpose of this study was to examine the effectiveness of the “Thank You, Sorry, Love” (TSL) program for improving relationships on mental health and hormones of military soldiers in Korea. (2) Methods: We focused on soldiers’ levels of depression and [...] Read more.
(1) Background/Objectives: The purpose of this study was to examine the effectiveness of the “Thank You, Sorry, Love” (TSL) program for improving relationships on mental health and hormones of military soldiers in Korea. (2) Methods: We focused on soldiers’ levels of depression and salivary DHEA-S. The effectiveness evaluation of the program used the pretest–posttest control group design, one of the Quasi-experimental design models. The program evaluation used a quasi-experimental design with a pre-test, post-test, and a follow-up for a treatment group and a control group. The sample comprised 40 military soldiers, who were divided into an experimental group (n = 20) receiving the TSL intervention and a control group (n = 20) without intervention. The study was conducted from June to September 2016, and the effectiveness of the intervention was evaluated through pre-test, post-test, and four-week follow-up tests. (3) Results: Our results revealed that soldiers’ depression and DHEA-S levels significantly differed between the two groups. During the analysis of the program’s effectiveness in which the pre-test was controlled, a statistically significant difference was found between the groups in the post-test (F = 12.666, p < 0.01, ES = 0.255) and the follow-up test (F (1, 39) = 13.319, p < 0.01, ES = 0.265) in DHEA-S. (4) Conclusions: These findings imply that the TSL program can be an effective intervention for soldiers suffering from depression while helping to produce clinical guidelines that could be made available in the field of military social work in Korea, which are still in their beginning stages. Full article
(This article belongs to the Topic Migration, Health and Equity)
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18 pages, 769 KiB  
Article
Psychometric Properties and Normative Data Using Item Response Theory Approach for Three Neuropsychological Tests in Waranka Children Population
by María José Fierro Bósquez, Eliana María Fuentes Mendoza, Laiene Olabarrieta-Landa, Trinidad Abiuso Lillo, Erick Orozco-Acosta, Guido Mascialino, Juan Carlos Arango-Lasprilla and Diego Rivera
Healthcare 2025, 13(4), 423; https://doi.org/10.3390/healthcare13040423 - 15 Feb 2025
Viewed by 743
Abstract
Objective: To evaluate the psychometric properties of the Shortened Version of the Token Test (SVTT), the Peabody Picture Vocabulary Test (PPVT-III), and the Rey–Osterrieth Complex Figure (ROCF) using an item response theory (IRT) framework and to establish normative data for Waranka children and [...] Read more.
Objective: To evaluate the psychometric properties of the Shortened Version of the Token Test (SVTT), the Peabody Picture Vocabulary Test (PPVT-III), and the Rey–Osterrieth Complex Figure (ROCF) using an item response theory (IRT) framework and to establish normative data for Waranka children and adolescents based on their ability scores. Methods: A total of 436 healthy people aged between 6 and 17 participated in this study. The factor structure was evaluated using confirmatory factor analysis (CFA) and the difficulty and discrimination parameters using IRT through the two-parameter logistic model for the SVTT and PPTV-III, while for the ROCF, the graded response model was used. The ordinal alpha and McDonald’s omega were used for reliability. Results: For most items, a low ability was enough to achieve the highest scores for the ROCF and SVTT. For the PPVT-III, the items aligned sequentially based on the difficulty, and a low level of ability was enough to achieve the highest score for the first 40 items. The ROCF, SVTT, and PPVT-III demonstrated adequate reliability. The ROCF copy and immediate recall scores were influenced by the mean parents’ years of education (MPE) and quadratic age interaction. The SVTT performance was affected by the quadratic age and sex interaction, and the PPVT-III by the interaction effect of the MPE and quadratic age. Conclusions: This is the first study to analyze the psychometric properties of the ROCF, SVTT, and PPVT-III through IRT models that are accurate and relevant for the validity of the obtained data and generate normative data in the under-represented nation of Ecuador for clinical and research purposes. Full article
(This article belongs to the Section Health Assessments)
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24 pages, 2201 KiB  
Article
Exploring Exercise Addiction, Self-Esteem, and Early Maladaptive Schemas: A Cross-Sectional Study Among Female University Students
by Leticia Olave, Itziar Iruarrizaga, Patricia Macía, Janire Momeñe, Ana Estévez, José Antonio Muñiz and Cecilia Peñacoba
Healthcare 2025, 13(4), 422; https://doi.org/10.3390/healthcare13040422 - 15 Feb 2025
Viewed by 664
Abstract
Background/Objectives: Although physical exercise provides numerous health benefits, it can occasionally become addictive, leading to negative consequences for physical and mental health. Specifically, the role of maladaptive schemas in the relationship between exercise addiction and self-esteem underscores the importance of addressing these cognitive [...] Read more.
Background/Objectives: Although physical exercise provides numerous health benefits, it can occasionally become addictive, leading to negative consequences for physical and mental health. Specifically, the role of maladaptive schemas in the relationship between exercise addiction and self-esteem underscores the importance of addressing these cognitive patterns in therapeutic settings to develop practical interventions that enhance exercise with healthier self-perceptions. This study aims to analyze the role of early maladaptive schemas in the relationship between exercise addiction and self-esteem. Methods: The design of this study is non-experimental, correlational, and cross-sectional. The sample comprised 788 university women students (mean age 20.39 years, SD = 2.28). Results: Exercise addiction is negatively associated with self-esteem and shows positive but weak correlations with most early maladaptive schemas, except for Impaired Autonomy. A mediating effect was identified for Disconnection and Rejection (β = −0.08, p = 0.008), Impaired Limits (β = −0.03, p = 0.019), Other Directedness (β = −0.04, p = 0.032), and Over-Vigilance and Inhibition (β = −0.05, p < 0.001). Full mediation was observed for Disconnection and Rejection and Over-Vigilance and Inhibition, while Impaired Limits and Other Directedness showed partial mediation. Conclusions: These findings suggest that the decrease in self-esteem among individuals with exercise addiction could be explained by the activation of maladaptive schemas that influence exercise motivation, with Over-Vigilance and Inhibition standing out in particular. Furthermore, it is necessary to develop cognitive behavioral therapy (CBT)-based interventions focused on modifying early maladaptive schemas and strengthening self-esteem. Additionally, it would be advisable to implement educational programs in university and sports settings that promote well-being and enjoyment over the pursuit of external validation or obsession with body image. These strategies could help prevent exercise addiction and mitigate its negative effects on self-esteem. Full article
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19 pages, 311 KiB  
Article
The Economic Cost of Nursing Care of Palliative Patients in the Emergency Department
by Tânia dos Santos Afonso, Manuel Luís Capelas and Lurdes Martins
Healthcare 2025, 13(4), 421; https://doi.org/10.3390/healthcare13040421 - 15 Feb 2025
Viewed by 459
Abstract
(1) Background: The economic cost of nursing care to palliative patients in avoidable hospital admission is unknown. (2) Methods: An observational, retrospective, and analytical study was used encompassing the economic cost of nursing care in a general hospital emergency department that uses descriptive [...] Read more.
(1) Background: The economic cost of nursing care to palliative patients in avoidable hospital admission is unknown. (2) Methods: An observational, retrospective, and analytical study was used encompassing the economic cost of nursing care in a general hospital emergency department that uses descriptive and inferential statistical analysis. (3) Results: We have a sample of 273 palliative patients in preventable hospital admissions (76.3%, CI 95%: 71.7–80.8), deceased, in 2019. With a median of 84 years, about 80% were admitted home after 5 h of complaints, mainly due to respiratory symptoms. Patients remained for approximately 24 h in the emergency department, totaling a median of EUR 180.98 in nursing care costs per admission. (4) Conclusions: It was evident that with the knowledge obtained about palliative economic nursing costs, we could increase results, manage resources, and consolidate PC integration in health systems, as this study proved. This study was not registered. Full article
(This article belongs to the Special Issue Improving the Quality of Nursing: Focus on Palliative Care and End-of-Life Care)
9 pages, 523 KiB  
Article
The Direct Medical Costs of Sickle Cell Disease in Saudi Arabia: Insights from a Single Center Study
by Yazed AlRuthia
Healthcare 2025, 13(4), 420; https://doi.org/10.3390/healthcare13040420 - 15 Feb 2025
Viewed by 1122
Abstract
Background: Sickle cell disease (SCD) is a rare autosomal recessive disorder that is common in countries with consanguineous marriages. It leads to various complications, including painful episodes, infections, delayed growth, stroke, and organ damage, which contribute to high healthcare utilization and costs. [...] Read more.
Background: Sickle cell disease (SCD) is a rare autosomal recessive disorder that is common in countries with consanguineous marriages. It leads to various complications, including painful episodes, infections, delayed growth, stroke, and organ damage, which contribute to high healthcare utilization and costs. In Saudi Arabia, the prevalence of SCD is notably high, largely due to the frequency of consanguineous marriages. However, there has not yet been a study estimating the direct medical costs of managing SCD based on real-world data. This study aims to assess these costs in Saudi Arabia. Methods: Data were collected from electronic medical records (EMRs) at a university-affiliated tertiary care center. A micro-costing approach was used to estimate the direct medical costs (e.g., laboratory tests, imaging, emergency department visits, hospitalizations, prescription medications, outpatient visits, etc.) retrospectively over a 12-month follow-up period. The baseline characteristics of the patients were presented using frequencies and percentages. The costs of different healthcare services were analyzed using means and the 95% confidence intervals. A generalized linear model (GLM) with a gamma distribution was utilized to examine the association between the overall costs and patient characteristics (e.g., age, gender, duration of illness, surgeries, blood transfusions, etc.), allowing for the estimation of the adjusted mean costs. Results: A total of 100 patients met the inclusion criteria and were included in the analysis. The mean age of the patients was 10.21 years (±6.87 years); 53% were male, and a substantial majority (96%) had the HbSS genotype. Sixty-one percent of the patients had undergone at least one red blood cell (RBC) exchange transfusion, while 21% had undergone surgical procedures, including tonsillectomy, splenectomy, and cholecystectomy. Additionally, 45% had experienced at least one vaso-occlusive crisis (VOC), and 59% had been hospitalized at least once in the past 12 months. Factors such as the frequency of laboratory tests and imaging studies, the length of hospital stay (LOS), the rate of emergency department (ED) visits, surgical procedures, the number of prescription medications, and the frequency of blood transfusions were all significant predictors of higher direct medical costs (p < 0.05). The estimated mean annual direct medical costs per patient were USD 26,626.45 (95% CI: USD 22,716.89–USD 30,536.00). After adjusting for various factors, including age, gender, duration of illness, frequency of lab and imaging tests, LOS, ED visits, surgical procedures, number of prescription medications, rates of VOCs, and RBC exchange transfusions, the adjusted mean annual direct medical cost per patient was calculated to be USD 14,604.72 (95% CI: USD 10,943.49–USD 19,525.96). Conclusions: The results of this study emphasize the substantial direct medical costs linked to sickle cell disease (SCD), which are greatly affected by the frequency of related complications. These insights should motivate policymakers and healthcare researchers to assess both the national direct and indirect costs associated with SCD, especially given the significant number of SCD patients in Saudi Arabia. Full article
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14 pages, 2199 KiB  
Article
Clinical Evidence of the Use of Mepolizumab in the Treatment of Chronic Rhinosinusitis with Nasal Polyps: A Prospective Observational Study
by Antonio Moffa, Francesco Iafrati, Lucrezia Giorgi, Domiziana Nardelli, Luca Carnuccio, Peter Baptista, Ewa Olszewska and Manuele Casale
Healthcare 2025, 13(4), 419; https://doi.org/10.3390/healthcare13040419 - 15 Feb 2025
Cited by 1 | Viewed by 711
Abstract
Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) poses significant therapeutic challenges. The introduction of Mepolizumab, an anti-interleukin-5 monoclonal antibody, offers a new therapeutic option for patients with severe, uncontrolled CRSwNP. This prospective observational study aims to assess the efficacy and safety of [...] Read more.
Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) poses significant therapeutic challenges. The introduction of Mepolizumab, an anti-interleukin-5 monoclonal antibody, offers a new therapeutic option for patients with severe, uncontrolled CRSwNP. This prospective observational study aims to assess the efficacy and safety of Mepolizumab for treating severe CRSwNP in Italy. Methods: A single-center prospective observational study conducted in real-life settings with the patients of our center. Prior to enrollment, each patient underwent an interdisciplinary evaluation involving a pulmonologist and an allergologist if deemed necessary. All patients who were referred for treatment with Mepolizumab in compliance with the AIFA guidelines and the EPOS/EUFOREA update were included in the study population: (1) subjects who were over the age of 18, (2) who had severe CRSwNP, (3) whose condition was not successfully managed with standard therapies alone, and (4) whose blood eosinophil counts were greater than 150 cells/mL. Mepolizumab was administered subcutaneously through a 100 mg injection once every four weeks in addition to the standard-of-care therapy. Results: At the end of the enrollment process, 20 patients with severe CRSwNP were enrolled. Significant improvements were observed in Nasal Polyp Score, quality of life (SNOT-22; p < 0.05), and nasal obstruction and rhinorrhea (p < 0.05), while no significant improvements were seen in olfactory function (p < 0.05). Eosinophil levels also significantly decreased (p < 0.05). Conclusions: Mepolizumab effectively manages severe CRSwNP, showing improvements in symptom control and quality of life with an acceptable safety profile. Full article
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14 pages, 652 KiB  
Article
Epidemiology and Treatment Outcomes in Neonates with Esophageal Atresia: A 30-Year Population-Based Study
by Tanja Kovačević, Branka Polić, Joško Markić, Tatjana Ardalić Čatipović, Marija Bucat, Svjetlana Mikulić, Leona Žuvan, Zenon Pogorelić, Ranka Despot, Vanda Žitko, Julije Meštrović, Bernarda Lozić and Ana Jerončić
Healthcare 2025, 13(4), 418; https://doi.org/10.3390/healthcare13040418 - 14 Feb 2025
Viewed by 836
Abstract
Background and objectives: Outcomes of neonates diagnosed with esophageal atresia (EA), a rare congenital malformation, vary widely. Due to limited and fragmented data globally, major regional centers offer a crucial opportunity to better understand EA’s epidemiology and the management. This study aimed [...] Read more.
Background and objectives: Outcomes of neonates diagnosed with esophageal atresia (EA), a rare congenital malformation, vary widely. Due to limited and fragmented data globally, major regional centers offer a crucial opportunity to better understand EA’s epidemiology and the management. This study aimed to address these gaps by determining total birth prevalence and early treatment outcomes of EA in southern Croatia. Methods: All EA cases (1991–2020) were retrospectively ascertained from medical documentation at the only tertiary referral center for EA in southern Croatia, with birth data collected from the entire background population. We collected data on neonates’ status and diagnosis, operative findings, early postoperative complications, and treatment outcome from this single center. Results: A total of 53 cases were identified, with an average total birth prevalence of 2.44 per 10,000 total births/year. No significant sex differences were found (p = 0.339), and most cases were complex Vogt 3B. The mortality rate dropped from 87 to 8% over a 30-year period (p < 0.001). The 1-year survival rate was 54% (95% CI 40–68%) for liveborns and 64% (50–79%) for liveborns who underwent surgery and intensive care. However, 16% of patients died before surgery due to hemodynamic instability, and among those operated on, high sepsis, pneumonia, and atelectasis rates were observed. Conclusions: EA prevalence in southern Croatia aligns with European data. Survival improved significantly after 2002, coinciding with a dedicated pediatric ICU and enhanced pediatric care training. Further advancements in early diagnosis and a multidisciplinary approach are needed to further reduce mortality. Strengthened postoperative infection control and optimized postoperative respiratory support are also crucial to minimizing complications. Full article
(This article belongs to the Special Issue Contemporary Surgical Trends and Management)
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14 pages, 1000 KiB  
Article
Examining the Impact of Food Security and Accessibility to Healthcare Services on Chronic Disease Risk Among Rohingya Refugees in Bangladesh
by Rizwanur Rahman, Fatema Afrouse, Md. Saiduzzaman Pulak, Md. Rabiul Karim, Mehjabin Haque and Mohammad Afshar Ali
Healthcare 2025, 13(4), 417; https://doi.org/10.3390/healthcare13040417 - 14 Feb 2025
Viewed by 1194
Abstract
Background: Food security and access to healthcare are crucial determinants of health, but their impact on chronic disease risk among forcibly displaced populations is understudied. This study delves into the relationship between food security, accessibility to healthcare services, and chronic disease risk among [...] Read more.
Background: Food security and access to healthcare are crucial determinants of health, but their impact on chronic disease risk among forcibly displaced populations is understudied. This study delves into the relationship between food security, accessibility to healthcare services, and chronic disease risk among Rohingya refugees in Bangladesh. Methods: Drawing from a nationally representative cross-sectional survey, this research investigates how the availability of food, accessibility to healthcare facilities, and utilization of services impact the likelihood of chronic diseases within this marginalized population. Using a cross-sectional survey collated from the UNHCR 2020 Joint Multi-Sector Needs Assessment survey, we deployed a series of multivariate logistic regression models to examine the relationship between food security, healthcare proximity, chronic disease, and sociodemographic characteristics. Results: Food security significantly decreased the risk of chronic diseases (OR = 0.65, 95% CI: 0.43, 0.98). Living far from healthcare facilities increased the risk (OR = 1.63, 95% CI: 1.03, 2.54). Conclusion: This study’s findings underscore the urgent need for targeted interventions aimed at enhancing food security and improving healthcare accessibility to alleviate the burden of chronic diseases among Rohingya refugees. By identifying key social determinants and barriers to healthcare access, this research equips policymakers with evidence-based strategies to design targeted interventions that improve nutrition, healthcare delivery, and chronic disease management for displaced populations. Full article
(This article belongs to the Special Issue Prevention and Management of Chronic Diseases)
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13 pages, 763 KiB  
Study Protocol
Knowledge, Attitudes, and Practices of Occupational Therapists in Promoting Oral Health: A Protocol for Mixed-Methods Systematic Review
by Ming Nam Tse, Kristy Coxon, Navira Chandio, Shruti Nair, Ajesh George, Rosalind Bye, Grace Wong, Carol Tran, Maria O'Reilly, Kanchana Ekanayake and Amit Arora
Healthcare 2025, 13(4), 416; https://doi.org/10.3390/healthcare13040416 - 14 Feb 2025
Viewed by 885
Abstract
Background/Objectives: Poor oral health is a significant global public health concern that adversely affects an individuals’ overall health and general well-being. Occupational therapists are well-suited to promote oral health by supporting activities of daily living (ADLs), thereby improving clients’ oral health outcomes. However, [...] Read more.
Background/Objectives: Poor oral health is a significant global public health concern that adversely affects an individuals’ overall health and general well-being. Occupational therapists are well-suited to promote oral health by supporting activities of daily living (ADLs), thereby improving clients’ oral health outcomes. However, there is limited evidence on the knowledge, attitudes, and practices (KAPs) of occupational therapists regarding oral health, as well as the barriers and facilitators they face in delivering oral healthcare. Methods: This paper outlines a protocol for a mixed-methods systematic review aimed at synthesizing the current evidence on the KAPs of occupational therapists related to oral health, as well as the barriers and facilitators they encounter in promoting it. The upcoming systematic review will follow the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews using a convergent integrated approach to synthesis and integration. The review will include quantitative, qualitative, and mixed-methods studies that report on KAP, barriers, and facilitators associated with occupational therapists’ involvement in oral healthcare. A comprehensive search will be conducted across multiple databases, including MEDLINE (Ovid), CINAHL (EBSCO), SCOPUS, EMBASE (Ovid), and OTseeker to identify relevant studies. Two reviewers will independently screen the studies for eligibility, assess their methodological quality, and extract key data for synthesis. The protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines and is registered with PROSPERO (CRD42024522136). Results: The findings from the planned systematic review are expected to provide valuable insights into the role of occupational therapists in promoting oral health, addressing barriers and facilitators, and shaping policies, training programs, and clinical practices. Conclusions: Ultimately, these findings aim to enhance the integration of oral health into occupational therapy and improve client outcomes. Full article
(This article belongs to the Special Issue Oral Health in Healthcare)
16 pages, 969 KiB  
Article
Longitudinal Relationship Between Activities of Daily Living and Depression in Older Adults Based on Parallel Process Latent Growth Curve Model with Mediation
by Desheng Yan and Guangming Li
Healthcare 2025, 13(4), 415; https://doi.org/10.3390/healthcare13040415 - 14 Feb 2025
Viewed by 871
Abstract
Objective: The parallel process latent growth curve model (PP-LGCM) was used to examine the longitudinal relationship between activities of daily living (ADL) and depression and further tested whether chronic diseases (CDs) were associated with depression via mediating variable ADL. Methods: A sample of [...] Read more.
Objective: The parallel process latent growth curve model (PP-LGCM) was used to examine the longitudinal relationship between activities of daily living (ADL) and depression and further tested whether chronic diseases (CDs) were associated with depression via mediating variable ADL. Methods: A sample of 2014 Chinese older adults aged 60 and over from the China Health and Retirement Longitudinal Survey (CHARLS) was used. The activities of daily living scale, self-rating depression scale, and chronic diseases scale were used to investigate the ADL, depression, and CD levels of older adults. Following certain statistical analysis steps, we used SPSS 26 and Mplus 8.0 to perform statistical analysis on the data. Results: Firstly, ADL significantly declined in older adults from 2011 to 2018, while depression had a significant rise. Secondly, the intercept of ADL was correlated with the intercept of depression (r = 0.487, p < 0.001), and the slope of ADL was positively correlated with the slope of depression (r = 0.844, p < 0.001). Finally, the intercept of ADL mediated 39% of the association of chronic diseases and the intercept of depression. Conclusions: Our findings showed the trajectories of ADL and depression in older adults and demonstrated that ADL have various associations with depression in longitudinal development. In addition, the effect of chronic diseases on depression is partially mediated by ADL. The ADL play a partial mediating role between chronic diseases and depression in older adults, with an indirect effect of 39%, indicating that ADL are very important. Grasping the mediating mechanism of ADL will help alleviate depression levels in older adults with chronic diseases. Full article
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18 pages, 606 KiB  
Article
Nourishing Holistic Well-Being: The Role of Family Dynamics and Family Cooking
by Yen-Cheng Chen, Ching-Sung Lee, Ming-Chen Chiang, Pei-Ling Tsui, Bo-Kai Lan and Yi-Jie Chen
Healthcare 2025, 13(4), 414; https://doi.org/10.3390/healthcare13040414 - 14 Feb 2025
Viewed by 1162
Abstract
Background: Family interactions play a pivotal role in shaping well-being across physical, psychological, and social domains. While substantial research has focused on the nutritional and physical health benefits of family meals, the impact of shared cooking and dining practices on psychological flourishing and [...] Read more.
Background: Family interactions play a pivotal role in shaping well-being across physical, psychological, and social domains. While substantial research has focused on the nutritional and physical health benefits of family meals, the impact of shared cooking and dining practices on psychological flourishing and overall family well-being remains underexplored. Objectives: This study examines the relationships among family function, shared culinary practices, psychological flourishing, and family well-being, with particular emphasis on the mediating and moderating roles of psychological flourishing. Methods: A cross-sectional survey was conducted involving 461 participants from Chinese families with diverse family structures in Taipei, Taiwan. Data were analyzed using multiple regression analysis, as well as mediation and moderation analyses, to assess the interrelationships between family function, shared cooking and dining practices, and family well-being. Results: The findings indicate that family function significantly enhances psychological flourishing, which, in turn, mediates the association between family function and family well-being. Furthermore, shared cooking and dining practices were found to positively influence family well-being, underscoring their critical role in strengthening emotional bonds, fostering communication, and improving family cohesion. Conclusions: This study contributes to family nursing science and positive psychology by highlighting shared cooking and dining practices as effective interventions for enhancing family well-being. By incorporating the concept of psychological flourishing, this research expands our understanding of how family dynamics and shared culinary activities contribute to emotional resilience and life satisfaction. Implications: Given the cross-sectional nature of the study, future research should employ longitudinal designs to explore causal relationships and the long-term effects of family interactions on well-being. Practical recommendations include the promotion of family-centered nutrition education programs and the development of public policies that encourage shared family meals as a strategy to enhance both emotional health and physical well-being. Full article
(This article belongs to the Special Issue Perspectives on Family Health Care Nursing)
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30 pages, 876 KiB  
Review
The Role of Nurses Caring for Children Diagnosed with Sickle Cell Anemia and Their Families in a Hospital Setting: A Rapid Review of the Recent Literature
by Eduarda Freitas, David Loura, Mariana Inês, Carla Martins and Inês Duarte
Healthcare 2025, 13(4), 413; https://doi.org/10.3390/healthcare13040413 - 14 Feb 2025
Viewed by 1335
Abstract
Background: Sickle cell anemia (SCA) affects a significant number of children worldwide, for whom the progression of the disease can lead to functional disability-impaired development. Nurses are pivotal in providing holistic care to these children and their families. This review aims to [...] Read more.
Background: Sickle cell anemia (SCA) affects a significant number of children worldwide, for whom the progression of the disease can lead to functional disability-impaired development. Nurses are pivotal in providing holistic care to these children and their families. This review aims to identify recent evidence on the role of nurses in intervening with children with SCA and their families in a hospital setting. Methods: A rapid review reported under the PRISMA methodology was carried out in the CINAHL, MEDLINE, and Scopus databases with the expression (sickle cell anemia OR sickle cell disease) AND (child* OR family OR pediatric*) AND (nurs* OR “nursing interventions” OR “pediatric nursing”) AND (hospital*), considering studies between 2019 and 2024, written in English, identifying articles with insights about the role of nurses in this context. Articles other than primary or secondary studies were excluded. Data were analyzed through a rapid qualitative approach. Results: Fifty-two studies were identified and seventeen articles were included. The nurse’s role is key and multidisciplinary, focusing on the child and family (care management and therapeutic education), the team (training, and the promotion of safety and quality of care), and the health system (optimizing access to care and promoting adequate resources for its implementation). Such a role is important for short-term clinical problems and to prevent long-term complications. Conclusions: Nurses play a central role in empowering families and coordinating multidisciplinary care. Greater investment is needed at a clinical level, through a more effective response to the needs of these patients, and in research, through experimental studies and other designs focused on multidisciplinary interventions. Full article
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14 pages, 2299 KiB  
Article
Perceptions of Healthcare Quality in Duchenne Muscular Dystrophy: A Patient Experience Exploratory Study
by Miriam Pavelth Casillas-Ávila, Ileana Chavez-Maisterra, Benjamín Gómez-Díaz, Vanessa Ivonne Orellana Villazon, Rosa Elena Escobar-Cedillo, Alexandra Berenice Luna-Angulo, Edgar Oswaldo Zamora González, Norma Alejandra Vázquez-Cárdenas, Marlen Escotto-Ramírez, Georgina Martínez-Gómez and Luz Berenice López-Hernández
Healthcare 2025, 13(4), 412; https://doi.org/10.3390/healthcare13040412 - 14 Feb 2025
Viewed by 892
Abstract
Background: Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle weakness, a decline in quality of life, and premature mortality. This study aims to evaluate the perceived quality of healthcare and the experience of DMD patients and their caregivers in [...] Read more.
Background: Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle weakness, a decline in quality of life, and premature mortality. This study aims to evaluate the perceived quality of healthcare and the experience of DMD patients and their caregivers in Mexico, comparing governmental and non-profit healthcare institutions using a newly designed assessment instrument. Methods: In a cross-sectional study, data were gathered from 91 participants through an online self-administered questionnaire informed by the Donabedian model and six dimensions of healthcare quality. Results: Analysis revealed two key mediating factors: perceived quality of healthcare and patient experience. The Mann–Whitney U test showed that non-profit organizations were perceived to provide superior quality care in both aspects (p < 0.05), notably regarding healthcare professionals’ preparedness and other domains of quality. However, the patient-centered care domain indicated that the importance of quality domains may vary according to cultural and social contexts. In Mexico, the humanistic approach of healthcare professionals appeared to compensate for shortcomings in timely diagnosis and other quality domains. This emphasizes the necessity for enhanced patient education and healthcare evaluation, and it highlights that patient satisfaction does not always correlate with high-quality healthcare. The developed instrument can further aid in understanding the experiences of DMD patients across different countries and cultures. Full article
(This article belongs to the Special Issue Patient Centred Care: Current Situation and Development)
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37 pages, 5810 KiB  
Systematic Review
Modern Smart Gadgets and Wearables for Diagnosis and Management of Stress, Wellness, and Anxiety: A Comprehensive Review
by Aman Jolly, Vikas Pandey, Manoj Sahni, Ernesto Leon-Castro and Luis A. Perez-Arellano
Healthcare 2025, 13(4), 411; https://doi.org/10.3390/healthcare13040411 - 14 Feb 2025
Cited by 1 | Viewed by 1850
Abstract
The increasing development of gadgets to evaluate stress, wellness, and anxiety has garnered significant attention in recent years. These technological advancements aim to expedite the identification and subsequent treatment of these prevalent conditions. This study endeavors to critically examine the latest smart gadgets [...] Read more.
The increasing development of gadgets to evaluate stress, wellness, and anxiety has garnered significant attention in recent years. These technological advancements aim to expedite the identification and subsequent treatment of these prevalent conditions. This study endeavors to critically examine the latest smart gadgets and portable techniques utilized for diagnosing depression, stress, and emotional trauma while also exploring the underlying biochemical processes associated with their identification. Integrating various detectors within smartphones and smart bands enables continuous monitoring and recording of user activities. Given their widespread use, smartphones, smartwatches, and smart wristbands have become indispensable in our daily lives, prompting the exploration of their potential in stress detection and prevention. When individuals experience stress, their nervous system responds by releasing stress hormones, which can be easily identified and quantified by smartphones and smart bands. The study in this paper focused on the examination of anxiety and stress and consistently employed “heart rate variability” (HRV) characteristics for diagnostic purposes, with superior outcomes observed when HRV was combined with “electroencephalogram” (EEG) analysis. Recent research indicates that electrodermal activity (EDA) demonstrates remarkable precision in identifying anxiety. Comparisons with HRV, EDA, and breathing rate reveal that the mean heart rate employed by several commercial wearable products is less accurate in identifying anxiety and stress. This comprehensive review article provides an evidence-based evaluation of intelligent gadgets and wearable sensors, highlighting their potential to accurately assess stress, wellness, and anxiety. It also identifies areas for further research and development. Full article
(This article belongs to the Special Issue Smart and Digital Health)
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