Healthcare

12 pages, 520 KiB

Open AccessArticle

Gender-Specific Differences in Sedation-Associated Outcomes During Complex Electrophysiological Procedures

by Lyuboslav Katov, Weronika Huggle, Yannick Teumer, Alexandra Buss, Federica Diofano, Carlo Bothner, Wolfgang Öchsner, Wolfgang Rottbauer and Karolina Weinmann-Emhardt

Healthcare 2025, 13(7), 844; https://doi.org/10.3390/healthcare13070844 - 7 Apr 2025

Viewed by 238

Abstract

Background: Interventional electrophysiology is a rapidly advancing field, with sedation essential for patient comfort and immobility during complex electrophysiological procedures (EPS). However, sedatives and analgesics can cause respiratory depression and hypotension. Gender-specific differences (GDs) are often overlooked in medical research, as protocols [...] Read more.

Background: Interventional electrophysiology is a rapidly advancing field, with sedation essential for patient comfort and immobility during complex electrophysiological procedures (EPS). However, sedatives and analgesics can cause respiratory depression and hypotension. Gender-specific differences (GDs) are often overlooked in medical research, as protocols and dosages are typically based on male subjects, potentially compromising treatment safety and efficacy for women. This study examines GDs in CO₂ levels, respiratory rate, arterial blood pressure (ABP), and anesthetic requirements during deep sedation for EPS. Methods: This prospective study at Ulm University Heart Center included 702 patients (405 men and 297 women) treated under deep sedation between August 2019 and October 2023. Standard monitoring included an electrocardiogram (ECG) with heart rate, non-invasive ABP, oxygen saturation (SpO₂), and a frequent venous blood gas analysis (vBGA). The primary composite endpoint was GDs in SpO₂ dips below 90% and pathological vBGA changes. Results: The primary composite endpoint was reached by 177 women (59.6%) and 213 men (52.6%), showing no significant difference (p = 0.102). Women had a 1,6-fold higher risk of experiencing SpO₂ dips below 90% (p = 0.001). Additionally, women had 1.7 times higher hypoxia rates (p < 0.001) and were 1.5 times more likely to have a mean ABP below 65 mmHg (p < 0.001). On average, they received 65.3 mg less total propofol than men (p = 0.005) and a higher midazolam dose per kilogram of body weight (p < 0.001). Conclusions: Although the primary composite endpoint showed no significant GDs, secondary outcomes highlight the need to consider gender-specific sedation adjustments, particularly for women. This study underscores the need for personalized sedation management and patient monitoring regarding GDs. Full article

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17 pages, 682 KiB

Open AccessArticle

Exploring the Roles of Body Dissatisfaction, Cognitive Distraction, and Age in Sexual Distress Related to Sexual Function and Sexual Satisfaction in Men: An Extended Understanding Using a Moderated Mediation Model

by Ivanilda B. Costa, Pedro J. Rosa and Patrícia M. Pascoal

Healthcare 2025, 13(7), 843; https://doi.org/10.3390/healthcare13070843 - 7 Apr 2025

Viewed by 559

Abstract

Background/Objectives: Self-objectification theory posits that objectification of people’s bodies, as a synonym for self-worth, translates into body surveillance and dissatisfaction, which has a negative impact on both social and emotional adjustment. According to empirical data based on cognitive models, body dissatisfaction translates [...] Read more.

Background/Objectives: Self-objectification theory posits that objectification of people’s bodies, as a synonym for self-worth, translates into body surveillance and dissatisfaction, which has a negative impact on both social and emotional adjustment. According to empirical data based on cognitive models, body dissatisfaction translates into cognitive distraction during sexual activity, affecting sexual response. However, the association of body dissatisfaction with other sexual outcomes, such as satisfaction and distress, in heterosexual men is understudied in comparison to women. Methods: This observational, cross-sectional, and correlational study used a convenience sample of 597 heterosexual males with a mean age of 35.52 (SD = 8.78) obtained through a web survey. Results: Results suggested that cognitive distraction mediated the association between body dissatisfaction, sexual distress, and satisfaction. A moderating effect of age was found, detecting a decrease in the mediated effect of cognitive distraction as men aged, reinforcing the idea of age as a protective factor. Conclusions: Our study further supports cognitive models that are useful to understand sexual outcomes and not merely sexual function and reinforce the existence of heterosexual men’s body dissatisfaction and its detrimental effects, suggesting that health practitioners should assess this phenomenon in a context related to sexual health. Full article

(This article belongs to the Special Issue Sexuality, Health, and Gender)

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15 pages, 959 KiB

Open AccessArticle

A Comparison of McGrath Mac and HugeMed Video Laryngoscopes in Pediatric Patients Under 3 Years Old—A Prospective Randomized Trial

by Gamze Tanirgan Cabakli, Kemal Tolga Saracoglu, Ruslan Abdullayev, Ecem Guclu, Pawel Ratajczyk and Ayten Saracoglu

Healthcare 2025, 13(7), 842; https://doi.org/10.3390/healthcare13070842 - 7 Apr 2025

Viewed by 207

Abstract

Background: Children generally face a higher incidence of airway management complications, intubation difficulties, and the risk of failed intubation. Currently, there is sufficient evidence in clinical practice for the use of videolaryngoscopes in pediatric airway management. However, there are a number of standard-blade [...] Read more.

Background: Children generally face a higher incidence of airway management complications, intubation difficulties, and the risk of failed intubation. Currently, there is sufficient evidence in clinical practice for the use of videolaryngoscopes in pediatric airway management. However, there are a number of standard-blade videolaryngoscopes available for children. In addition, there is no clear recommendation on which videolaryngoscope is superior. The primary objective of this study is to compare the first pass success rate and the Percentage of Glottic Opening (POGO) scores with Cormack–Lehane (CML) scores obtained through direct and indirect laryngoscopy with HugeMed and McGrath Mac videolaryngoscopes in pediatric patients with an unanticipated, difficult airway. Materials and Methods: Following the Ethics Committee approval and written parental consents, a total of 40 elective surgical patients, aged 3 and under, with ASA 1–3 risk classification, and undergoing general anesthesia, were included in the study. After induction of general anesthesia, the first group of patients (Group McGrath, n = 20) was intubated with the McGrath Mac videolaryngoscope, and the second group (Group HugeMed, n = 20) with the HugeMed videolaryngoscope. Before intubation, CML and POGO scores were recorded for both groups using direct and indirect laryngoscopy with videolaryngoscopes. Intubation time, number of attempts, need for cricoid pressure, optimization maneuver requirement, and hemodynamic parameters were recorded for both groups. Results: There was no significant difference between groups in demographic data including age, gender, body mass index, ASA, and hemodynamic parameters. A significant improvement was observed in CML and POGO scores using indirect laryngoscopy (p < 0.001). CML scores obtained with the McGrath Mac were significantly lower than the HugeMed Group (p = 0.0034). The mean POGO value calculated with indirect laryngoscopy was significantly higher in the McGrath Group compared to the HugeMed Group (92.63 ± 6.09 vs. 88.75 ± 4.44, respectively). Conclusions: Videolaryngoscopes improved laryngeal visualization in children under 3 years old. Compared to HugeMed, in indirect laryngoscopy, the McGrath Mac videolaryngoscope was found to be superior, with better CML and POGO scores. However, number of tracheal intubation attempts, success rate, complication risk, and hemodynamic parameters did not show any significant difference between the groups. Clinical trial registration number was NCT06484517. Full article

(This article belongs to the Special Issue New Developments in Endotracheal Intubation and Airway Management)

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18 pages, 1607 KiB

Open AccessReview

Indications, Functional Outcomes, Return to Sport and Complications of Anterior and Lateral Approaches for Total Ankle Arthroplasty: A Comprehensive Review

by Michele Mercurio, Erminia Cofano, John G. Kennedy, James J. Butler, Antonio Zanini, Olimpio Galasso, Giorgio Gasparini and Alberto Marangon

Healthcare 2025, 13(7), 841; https://doi.org/10.3390/healthcare13070841 - 7 Apr 2025

Viewed by 285

Abstract

Ankle osteoarthritis (OA) is a degenerative condition that impacts quality of life. Total ankle replacement (TAR) represents a significant advancement in orthopedic surgery. Objectives: The purpose was to provide an overview of the indications, outcomes, and complications of anterior and lateral surgical [...] Read more.

Ankle osteoarthritis (OA) is a degenerative condition that impacts quality of life. Total ankle replacement (TAR) represents a significant advancement in orthopedic surgery. Objectives: The purpose was to provide an overview of the indications, outcomes, and complications of anterior and lateral surgical approaches in TAR, as well as return to sport following surgery. Methods: The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched. The keywords used were “total ankle arthroplasty”, “total ankle replacement”, “ankle anterior approach”, “ankle lateral approach”, “outcomes”, “return to sport”, and “complications”, and the search included articles published from 2014 to 2024. Results: Successful functional outcomes, return to athletic activity, and return to the previous level of sports performance after surgery have been reported at rates of over 60%. The anterior approach restores the normal tibial slope but presents a high risk of wound-healing complications and medial malleolar fractures. The lateral approach allows an anatomic placement of the implant, but it is associated with fibular complications and a high risk of revision surgery. Return to sport is feasible in low-impact sports such as cycling, swimming, and dancing. Conclusions: The anterior and lateral approaches for TAR yielded satisfactory functional outcomes and rates of return to athletic activity. Different intra- and post-operative complications and revision surgery should be managed properly to optimize outcomes. Full article

(This article belongs to the Section Preventive Medicine)

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14 pages, 1533 KiB

Open AccessArticle

Time for Change: A 3-Year Prospective Study on Mediterranean Diet Adherence and Body Composition in Kidney Transplant Recipients

by Marijana Vučković, Josipa Radić, Andrea Gelemanović, Andrej Belančić, Hana Đogaš and Mislav Radić

Healthcare 2025, 13(7), 840; https://doi.org/10.3390/healthcare13070840 - 7 Apr 2025

Viewed by 211

Abstract

Background: The aim of this prospective follow-up study was to evaluate changes in body composition parameters and Mediterranean diet (MeDi) adherence among kidney transplant recipients (KTRs) over a three-year period. Additionally, this study sought to investigate the associations between these changes and clinical [...] Read more.

Background: The aim of this prospective follow-up study was to evaluate changes in body composition parameters and Mediterranean diet (MeDi) adherence among kidney transplant recipients (KTRs) over a three-year period. Additionally, this study sought to investigate the associations between these changes and clinical parameters, including laboratory parameters, new onset of diseases, and death outcome. Methods: A total of 116 KTRs were initially assessed in 2019 and subsequently re-evaluated in 2022. The Mediterranean Diet Serving Score (MDSS) was used to assess dietary adherence to the MeDi at baseline and follow-up assessments. Bioelectrical impedance analysis was used to assess body composition and clinical outcomes were assessed by the data available from medical charts. Results: After three years, MeDi adherence significantly decreased (p = 0.028) from 15 (18.29%) to 5 (6%), with dominantly lower adherence for vegetable, fruit, legume, red meat, olive oil and fish intake. Regarding body composition parameters, the most prominent change was seen in muscle mass, which deteriorated from 41.77% (IQR 6.46) to 39% (IQR 6.14; p = 0.004). However, changes in fat mass level were not significant in the follow-up period. Furthermore, cereal intake, fasting blood glucose (FBG), cholesterol level, level of low-density lipoprotein cholesterol (LDL), triglyceride leve and presence of diabetes mellitus lwere shown to be predictive for the decline of skeletal muscle mass. There were no significant changes in the estimated glomerular filtration rate (eGFR) or albuminuria level during the follow-up period. Associations with the death outcome were found for the MeDi-advised intake of eggs (β = −1.06, HR = 0.35, CI (0.14–0.87), p = 0.023), phase angle (PhA) (β = −2.68, HR = 0.07, CI (0.01–0.43), p = 0.004), cholesterol level (β = 0.95, HR = 2.60, CI (1.40–4.70), p = 0.001) and calcium level (β = −7.21, HR = 0.00, CI (0.00–1.50), p = 0.063). Conclusions: This study highlights a significant decline in MeDi adherence and skeletal muscle mass among KTRs over a three-year follow-up period, with no notable changes in fat mass or kidney function. The predictors of muscle mass loss and associations with mortality underscore the importance of dietary and clinical management in this population. Full article

(This article belongs to the Section Nutrition and Public Health)

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13 pages, 606 KiB

Open AccessStudy Protocol

Patient and Public Involvement in Malnutrition Disorders Health Research: A Methodological Systematic Review Protocol

by Arturo Garcia-Garcia, Cristina Carretero-Randez, Rafaela Camacho-Bejarano, María Teresa Roldán-Chicano, Pedro Raúl Castellano-Santana, Lucía Rocío Camacho-Montaño, Jesica Montero-Marco, Marta Charlo-Bernardos and María Isabel Orts-Cortes

Healthcare 2025, 13(7), 839; https://doi.org/10.3390/healthcare13070839 - 7 Apr 2025

Viewed by 267

Abstract

Background/Objectives: Older adults are particularly susceptible to undernutrition and conditions that can aggravate it, such as frailty and conditions associated with swallowing difficulties or dysphagia. To address these challenges, it is important to consider the perspectives of older adults and their caregivers, [...] Read more.

Background/Objectives: Older adults are particularly susceptible to undernutrition and conditions that can aggravate it, such as frailty and conditions associated with swallowing difficulties or dysphagia. To address these challenges, it is important to consider the perspectives of older adults and their caregivers, especially those with conditions such as frailty or cognitive impairment, as they can provide valuable insights on supporting nutrition in these vulnerable populations. This participatory approach requires structures formed by scientific research committees working together with other stakeholders, involving various actors at all stages of the research process. The aim of this study is to analyze the methodology for involving patients aged 65 and older with malnutrition or at risk of malnutrition as co-investigators in research. Methods: This protocol has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) checklist. A literature search will be carried out in the following electronic databases: PubMed/MEDLINE, EMBASE and CINAHL. Through the COVIDENCE program, the research team will independently review the different screening phases of the identified studies for possible inclusion or exclusion. Expected Results: This systematic review will provide up-to-date evidence on the use of non-scientific actors at different stages of research. The main limitation stems from the use of non-scientific agents in a topic as specific as adults with or at risk of undernutrition, which may make it difficult to extrapolate the results to other settings. The registration number in PROSPERO is CRD42024444374. Full article

(This article belongs to the Section Nutrition and Public Health)

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15 pages, 220 KiB

Open AccessArticle

Assessing the Impact of Hypertension on Health-Related Quality of Life: Insights from Sociodemographic, Economic, and Clinical Features Using SF-36

by Geetha Kandasamy, Mona Almanasef, Khalid Orayj, Asma M. Alshahrani and Shada M. Alahmari

Healthcare 2025, 13(7), 838; https://doi.org/10.3390/healthcare13070838 - 7 Apr 2025

Viewed by 217

Abstract

Background: Hypertension significantly impacts the health-related quality of life (HRQoL) of patients. This study evaluates the influence of sociodemographic, economic, and clinical features on HRQoL among hypertensive patients using the 36-Item Short Form Survey (SF-36). Method: A cross-sectional study was conducted at a [...] Read more.

Background: Hypertension significantly impacts the health-related quality of life (HRQoL) of patients. This study evaluates the influence of sociodemographic, economic, and clinical features on HRQoL among hypertensive patients using the 36-Item Short Form Survey (SF-36). Method: A cross-sectional study was conducted at a public health center in Khamis Mushayt, Saudi Arabia, where 209 adult hypertensive patients were surveyed using simple random sampling. Data were collected through a structured questionnaire covering sociodemographic and clinical details, and multiple linear regression was used to analyze the associations between variables and the SF-36 domains. Results: Of the 209 participants, 122 (58.4%) were female and 87 (41.6%) were male. Complications and multiple antihypertensive medications were linked to poorer physical functioning and general health (p < 0.05). Salt restriction improved physical functioning (B = 12.339, p = 0.008), and exercise reduced body pain (B = −8.487, p = 0.038). Middle-income patients had higher vitality (B = 7.632, p = 0.038) and social functioning (B = 16.465, p = 0.035). Higher-income individuals showed lower social functioning (B = −12.323, p = 0.022). Conclusions: Age, income, marital status, and complications were key determinants of HRQoL in hypertensive patients. Lifestyle interventions like exercise and salt restriction improve physical functioning and reduce pain, while psychological and social support are vital for mental health. Tailored interventions addressing clinical and psychosocial support are crucial for optimizing HRQoL in this population. Full article

32 pages, 1001 KiB

Open AccessReview

The Role of Neuroinflammation in the Comorbidity of Psychiatric Disorders and Internal Diseases

by Grecu Ramona Cătălina, Victor Gheorman, Veronica Gheorman and Mircea-Cătălin Forțofoiu

Healthcare 2025, 13(7), 837; https://doi.org/10.3390/healthcare13070837 - 7 Apr 2025

Viewed by 435

Abstract

Psychiatric disorders and internal diseases frequently co-occur, posing significant challenges due to overlapping symptoms, shared pathophysiological mechanisms, and increased healthcare burdens. Neuroinflammation has emerged as a central mechanism linking these conditions, driven by systemic inflammation, hypothalamic–pituitary–adrenal (HPA) axis dysregulation, and autonomic nervous system [...] Read more.

Psychiatric disorders and internal diseases frequently co-occur, posing significant challenges due to overlapping symptoms, shared pathophysiological mechanisms, and increased healthcare burdens. Neuroinflammation has emerged as a central mechanism linking these conditions, driven by systemic inflammation, hypothalamic–pituitary–adrenal (HPA) axis dysregulation, and autonomic nervous system (ANS) imbalance. This review synthesizes current evidence on the role of neuroinflammation in comorbid conditions such as depression, anxiety, cardiovascular disease, and diabetes mellitus, emphasizing bidirectional relationships and shared inflammatory pathways. This analysis identifies gaps in longitudinal studies, biomarker validation, and the integration of multidisciplinary care models. Emerging therapeutic approaches, including IL-6 inhibitors, vagus nerve stimulation, and behavioral interventions, show promise but remain underexplored in combined applications. Furthermore, disparities in research representation limit the generalizability of findings and highlight the need for inclusive clinical trials. Addressing these gaps through precision medicine, advanced biomarker monitoring technologies, and equitable healthcare strategies could transform the management of these complex comorbidities. By advancing our understanding of neuroinflammatory mechanisms and promoting integrated interventions, this review underscores the need for a collaborative, patient-centered approach to improve outcomes and reduce the global burden of psychiatric and internal disease comorbidities. Full article

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28 pages, 2200 KiB

Open AccessArticle

Assessing Patient Satisfaction with Hospital Services: Perspectives from Bihor County Emergency Hospital, Romania

by Aliz Ildiko Bradács, Florica Voiță-Mekeres, Lucia Georgeta Daina, Lavinia Davidescu and Călin Tudor Hozan

Healthcare 2025, 13(7), 836; https://doi.org/10.3390/healthcare13070836 - 7 Apr 2025

Viewed by 271

Abstract

Background/Objectives: The objective of this study is to assess overall patient satisfaction with hospital services, including cleanliness, ward conditions, and food quality. Another key goal is to determine patient willingness to return for future medical services and identify the factors influencing this decision. [...] Read more.

Background/Objectives: The objective of this study is to assess overall patient satisfaction with hospital services, including cleanliness, ward conditions, and food quality. Another key goal is to determine patient willingness to return for future medical services and identify the factors influencing this decision. Moreover, the study explores the relationship between patient satisfaction and continuity of care, as indicated by previous hospitalizations. Methods: We conducted a retrospective cohort study to evaluate patient satisfaction at the Bihor County Emergency Clinical Hospital in Oradea, Romania. A standardized 40-item questionnaire was developed in accordance with the Framework Agreement on the provision of medical assistance within the Romanian healthcare system. The survey, which was administered over a four-year period (2019–2022), covered seven domains: demographic data, accessibility, hotel conditions, quality of care, patient safety and rights, overall satisfaction, and feedback. A total of 12,802 patients completed the questionnaire, and all statistical analyses were performed using R Studio. Results: This study analyzes patient-reported satisfaction and experiences in a large healthcare facility, based on data from 12,802 participants. Overall, 91% of respondents rated the hospital positively, with 62% giving an excellent score. Spiritual assistance was well received (71%), and 70% of patients expressed willingness to return for future medical needs. Hospital cleanliness and ward conditions were rated highly, with 71% of respondents reporting excellent experiences. Food quality was positively reviewed by 66% of participants. Most patients (95%) confirmed proper hygiene practices by medical staff, and 95% were informed about their diagnosis. However, only 67% were aware of the complaint submission process. The dataset spans 2019–2022, with the highest hospitalizations in 2020 (36%) and obstetrics, cardiology, and general surgery being the most common specialties. Conclusions: This dataset reflects a high level of patient satisfaction across multiple dimensions of hospital services, including cleanliness, quality of care, and patient information. However, areas such as complaint handling and transparency in medication handling require further attention to improve the overall patient experience. The findings underscore the hospital’s strong performance in meeting patient expectations while identifying key areas for continued improvement. Full article

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

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8 pages, 175 KiB

Open AccessBrief Report

Can ChatGPT Help General Practitioners Become Acquainted with Conversations About Dying? A Simulated Single-Case Study

by Filipe Prazeres

Healthcare 2025, 13(7), 835; https://doi.org/10.3390/healthcare13070835 - 6 Apr 2025

Viewed by 257

Abstract

Background/Objectives: General practitioners (GPs) should be able to initiate open conversations about death with their patients. It is hypothesized that a change in attitude regarding discussions of death with patients may be accomplished through doctors’ training, particularly with the use of artificial [...] Read more.

Background/Objectives: General practitioners (GPs) should be able to initiate open conversations about death with their patients. It is hypothesized that a change in attitude regarding discussions of death with patients may be accomplished through doctors’ training, particularly with the use of artificial intelligence (AI). This study aimed to evaluate whether OpenAI’s ChatGPT can simulate a medical communication scenario involving a GP consulting a patient who is dying at home. Methods: ChatGPT-4o was prompted to generate a medical communication scenario in which a GP consults with a patient dying at home. ChatGPT-4o was instructed to follow seven predefined steps from an evidence-based model for discussing dying with patients and their family caregivers. The output was assessed by comparing each step of the conversation to the model’s recommendations. Results: ChatGPT-4o created a seven-step scenario based on the initial prompt and addressed almost all intended recommendations. However, two points were not addressed: ChatGPT-4o did not use terms like “dying”, “passing away”, or “death”, although the concept was present from the beginning of the conversation with the patient. Additionally, cultural and religious backgrounds related to dying and death were not discussed. Conclusions: ChatGPT-4o can be used as a supportive tool for introducing GPs to the language and sequencing of speech acts that form a successful foundation for meaningful, sensitive conversations about dying, without requiring advanced technical resources and without placing any burden on real patients. Full article

(This article belongs to the Special Issue Improving the Quality of Nursing: Focus on Palliative Care and End-of-Life Care)

12 pages, 198 KiB

Open AccessPerspective

The Pharmacists of Physical Activity: Physiotherapists Empowering Older Adults’ Autonomy in the Self-Management of Aging with and Without Persistent Conditions

by Mike Studer, Kent Edward Irwin and Mariana Wingood

Healthcare 2025, 13(7), 834; https://doi.org/10.3390/healthcare13070834 - 6 Apr 2025

Viewed by 489

Abstract

Aging has been thought to be factual, inherited, and obligatory. However, aging can be divided into primary (i.e., inevitable physiological changes) and secondary (i.e., age-associated changes driven by life choices, environment, and society) aging. The impact of social norms and life choices is [...] Read more.

Aging has been thought to be factual, inherited, and obligatory. However, aging can be divided into primary (i.e., inevitable physiological changes) and secondary (i.e., age-associated changes driven by life choices, environment, and society) aging. The impact of social norms and life choices is why no two 70-year-olds look the same. The life choice that appears to have the strongest impact on aging is physical activity. Research continues to highlight the power of mitigating age-related losses via physical activity and debunking the notion that age-related changes such as falls, frailty, and functional decline are inevitable. Physiotherapists are the healthcare professionals who reverse or slow down age-related changes and prevent secondary aging from occurring. Physiotherapists are the health profession’s experts in movement science, whose interventions primarily center around physical activity as medicine. Thus, physiotherapists function as pharmacists of physical activity and are well-positioned to prescribe the dosages needed for wellness promotion as well as disease prevention and management. This paper provides guidance from the perspective of the physiotherapist on exercise prescription most optimal and consumable for an older population. Full article

(This article belongs to the Special Issue Role of Physiotherapy in Promoting Physical Activity and Well-Being)

21 pages, 1770 KiB

Open AccessArticle

Maternal Health Risk Detection: Advancing Midwifery with Artificial Intelligence

by Katerina D. Tzimourta, Markos G. Tsipouras, Pantelis Angelidis, Dimitrios G. Tsalikakis and Eirini Orovou

Healthcare 2025, 13(7), 833; https://doi.org/10.3390/healthcare13070833 - 6 Apr 2025

Viewed by 434

Abstract

Background/Objectives: Maternal health risks remain one of the critical challenges in the world, contributing much to maternal and infant morbidity and mortality, especially in the most vulnerable populations. In the modern era, with the recent progress in the area of artificial intelligence [...] Read more.

Background/Objectives: Maternal health risks remain one of the critical challenges in the world, contributing much to maternal and infant morbidity and mortality, especially in the most vulnerable populations. In the modern era, with the recent progress in the area of artificial intelligence and machine learning, much promise has emerged with regard to achieving the goal of early risk detection and its management. This research is set out to relate high-risk, low-risk, and mid-risk maternal health using machine learning algorithms based on physiological data. Materials and Methods: The applied dataset contains 1014 instances (i.e., cases) with seven attributes (i.e., variables), namely, Age, SystolicBP, DiastolicBP, BS, BodyTemp, HeartRate, and RiskLevel. The preprocessed dataset used was then trained and tested with six classifiers using 10-fold cross-validation. Finally, the performance metrics of the models erre compared using metrics like Accuracy, Precision, and the True Positive Rate. Results: The best performance was found for the Random Forest, also reaching the highest values for Accuracy (88.03%), TP Rate (88%), and Precision (88.10%), showing its robustness in handling maternal health risk classification. The mid-risk category was the most challenging across all the models, characterized by lowered Recall and Precision scores, hence underlining class imbalance as one of the bottlenecks in performance. Conclusions: Machine learning algorithms hold strong potential for improving maternal health risk prediction. The findings underline the place of machine learning in advancing maternal healthcare by driving more data-driven and personalized approaches. Full article

(This article belongs to the Special Issue Interdisciplinary Perspectives in Maternal Health: Integrating Theoretical Frameworks and Practical Applications)

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13 pages, 245 KiB

Open AccessArticle

How to Assess Health Gains

by Giovanni Guarducci, Gabriele Messina, Chiara Siragusa, Jolanda Gurnari, Anna Maria Gentile and Nicola Nante

Healthcare 2025, 13(7), 832; https://doi.org/10.3390/healthcare13070832 - 5 Apr 2025

Viewed by 253

Abstract

Background/Objectives: As life expectancy rises and the epidemiological landscape of chronic diseases evolves, the necessity to assess and improve the overall health status of the population becomes increasingly fundamental. Therefore, evaluating health gains is a crucial challenge for modern health systems, particularly [...] Read more.

Background/Objectives: As life expectancy rises and the epidemiological landscape of chronic diseases evolves, the necessity to assess and improve the overall health status of the population becomes increasingly fundamental. Therefore, evaluating health gains is a crucial challenge for modern health systems, particularly in the context of limited resources and increasing demand for services. The aim of this study is to assess health gains and their costs, with data provided by a private Italian clinic. Methods: We conducted a retrospective study on 129 patients admitted between June 2020 and August 2023 in a solvent ward for short-term planned hospitalization. The patients completed the EQ-5D-5L questionnaire at both admission and discharge. Quality-Adjusted Life Years (QALYs) were estimated based on the difference in EQ-5D-5L scores between discharge and admission, assuming that health gains persist up to two years post-discharge. Through QALYs value and hospitalization cost, a cost–utility analysis was performed. Descriptive and statistical analyses were carried out using STATA SE/14.0 software. Results: Of the studied sample, 55% was female, the median age was 81 [11] years old, and the median length of stay (LoS) was 16 [16] days. The patients gained, in median, 0.33 [0.38] in QALY, which was higher for males (0.35 [0.34]) than females (0.29 [0.45]). The QALY gained was greater for the non-geriatric patients (0.41 [0.42]) than geriatric ones (0.32 [0.38]) (p > 0.05). Those with a longer LoS showed a higher gain in QALY (0.35 [0.42]) than those with a shorter one (0.23 [0.29]) (p < 0.05). The cost per QALY gained was, in median, EUR 14,337, which was lower in males (EUR 13,803), in non-geriatric patients (EUR 13,743), and in patients with a shorter LoS (EUR 10,670) (p > 0.05). Conclusions: Although QALY gains differed among the groups, the median cost per QALY remained consistent. These results highlight the need for targeted interventions to optimize resource allocation, both by integrating data into allocation strategies and by employing a multidisciplinary approach to tailor interventions. Full article

(This article belongs to the Special Issue Patient Experience and the Quality of Health Care)

18 pages, 1094 KiB

Open AccessArticle

Breaking the Silence: Barriers to Error Disclosure Among Nurses in the Kingdom of Saudi Arabia—A Cross-Sectional Study

by Naglaa Abdelaziz Mahmoud Elseesy, Budoor Ahmad Almezraq, Duaa Amr Hafez, Ohood Felemban and Ebaa Marwan Felemban

Healthcare 2025, 13(7), 831; https://doi.org/10.3390/healthcare13070831 - 5 Apr 2025

Viewed by 281

Abstract

Background: Medical errors are common, and in particular, medication errors are one of the leading causes of morbidity and mortality in healthcare. Nurses must disclose errors to build trust and ensure patient safety despite communication barriers and fear of reprisals. Truthful documentation and [...] Read more.

Background: Medical errors are common, and in particular, medication errors are one of the leading causes of morbidity and mortality in healthcare. Nurses must disclose errors to build trust and ensure patient safety despite communication barriers and fear of reprisals. Truthful documentation and better collaboration can improve patient outcomes. Aim: The aim of this study was to assess barriers to error disclosure among nurses in the Kingdom of Saudi Arabia. Methods: A descriptive cross-sectional survey was conducted in the months of June and August 2024 using a convenience sample of 255 nurses at King Fahad Hospital (KFH), Hofuf. A self-administered questionnaire that contained socio-demographic questions, as well as the Barriers to Error Disclosure Assessment (BEDA) tool, was deployed. Results: The majority of the sample were female (92.2%) and Bachelor’s degree holders (80.8%) who had 1–5 or 6–10 years of experience, representing 45.5% and 29.0% of the sample, respectively. When medical errors occur, only 18% of the nurses disclosed them to patients and their families, and 34.5% of the respondents disclosed medical errors to another team of healthcare professionals. The types of barriers to error disclosure were identified as relating to confidence and knowledge barriers, institutional barriers, psychological barriers, and financial concern barriers. The overall barrier score had an average of 63%. The barriers with the highest scores were those relating to psychological barriers (68.2%), followed by institutional barriers (66.5%) and financial concern barriers (64.5%). Conclusions: Targeted interventions are required for addressing the identified specific needs to support healthcare providers, specifically nurses. New regulations and policy changes are crucial for training programs implementation, enhancing safety culture, and tackling job-related insecurities to minimize barriers to error disclosure and ultimately provide better patient care quality. Further investigations may include a different approach, and it is recommended to provide deeper insights into nurse experiences. Full article

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10 pages, 470 KiB

Open AccessCase Report

Lost in Transition: Challenges in the Journey from Pediatric to Adult Care for a Romanian DMD Patient

by Maria Lupu, Maria-Alexandra Marcu, Diana Anamaria Epure, Oana Aurelia Vladacenco, Emilia Maria Severin and Raluca Ioana Teleanu

Healthcare 2025, 13(7), 830; https://doi.org/10.3390/healthcare13070830 - 5 Apr 2025

Viewed by 305

Abstract

Background: The transition from pediatric to adult care in Duchenne Muscular Dystrophy (DMD) is challenging due to the disease’s complexity and the need for lifelong, comprehensive management. In Romania, ongoing efforts aim to enhance multidisciplinary collaboration, though systemic barriers, such as [...] Read more.

Background: The transition from pediatric to adult care in Duchenne Muscular Dystrophy (DMD) is challenging due to the disease’s complexity and the need for lifelong, comprehensive management. In Romania, ongoing efforts aim to enhance multidisciplinary collaboration, though systemic barriers, such as fragmented healthcare services, persist. Nonsense mutations, including those in exon 30 described here, are often associated with more severe disease progression. Methods: We present the case of a 17-year-old Romanian DMD patient with a nonsense mutation in exon 30 of the dystrophin gene. The patient received multidisciplinary pediatric care addressing his medical needs, including neuromuscular, respiratory, cardiac, and orthopedic management. Transition readiness was assessed using the Transition Readiness Assessment Questionnaire (TRAQ), and the patient’s perspective on the process was documented. Results: Care followed international standards, but the disease progressed predictably, with gradual loss of ambulation, respiratory decline, and cardiac complications. The TRAQ revealed strengths in communication with healthcare providers but moderate confidence in self-management tasks. From the patient’s perspective, fragmented adult services and difficulty accessing specialized neuromuscular support remain major obstacles, underscoring the importance of early, structured transition planning and patient-centered approaches. Conclusions: Transitioning to adult services requires strong communication between pediatric and adult teams and integration of specialized care. Tailored follow-up plans ensure continuity of care and effective disease management. This case reflects broader needs in similar healthcare contexts, highlighting the necessity of robust transition frameworks to respond to patient-specific challenges and ultimately support long-term quality of life. Full article

(This article belongs to the Special Issue Health Service Interventions in Musculoskeletal Disorders)

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15 pages, 644 KiB

Open AccessArticle

Ethical, Legal, and Social Assessment of AI-Based Technologies for Prevention and Diagnosis of Rare Diseases in Health Technology Assessment Processes

by Pietro Refolo, Costanza Raimondi, Violeta Astratinei, Livio Battaglia, Josep M. Borràs, Paula Closa, Alessandra Lo Scalzo, Marco Marchetti, Sonia Muñoz-López, Laura Sampietro-Colom and Dario Sacchini

Healthcare 2025, 13(7), 829; https://doi.org/10.3390/healthcare13070829 - 4 Apr 2025

Viewed by 223

Abstract

Background: While the HTA community appears well-equipped to assess preventive and diagnostic technologies, certain limitations persist in evaluating technologies designed for rare diseases, including those based on Artificial Intelligence (AI). In Europe, the EUnetHTA Core Model^® serves as a reference for assessing [...] Read more.

Background: While the HTA community appears well-equipped to assess preventive and diagnostic technologies, certain limitations persist in evaluating technologies designed for rare diseases, including those based on Artificial Intelligence (AI). In Europe, the EUnetHTA Core Model^® serves as a reference for assessing preventive and diagnostic technologies. This study aims to identify key ethical, legal, and social issues related to AI-based technologies for the prevention and diagnosis of rare diseases, proposing enhancements to the Core Model. Methods: An exploratory sequential mixed methods approach was used, integrating a PICO-guided literature review and a focus group. The review analyzed six peer-reviewed articles and compared the findings with a prior study on childhood melanoma published in this journal (Healthcare), retaining only newly identified issues. A focus group composed of experts in ethical, legal, and social domains provided qualitative insights. Results: Thirteen additional issues and their corresponding questions were identified. Ethical concerns related to rare diseases included insufficient disease history knowledge, lack of robust clinical data, absence of validated efficacy tools, overdiagnosis/underdiagnosis risks, and unknown ICER thresholds. Defensive medicine was identified as a legal issue. For AI-based technologies, concerns included discriminatory outcomes, explicability, and environmental impact (ethical); accountability and reimbursement (legal); and patient involvement and job losses (social). Conclusions: Integrating these findings into the Core Model enables a comprehensive HTA of AI-based rare disease technologies. Beyond the Core Model, these issues may inform broader assessment frameworks, ensuring rigorous and ethically responsible evaluations. Full article

(This article belongs to the Special Issue Advances in Health Technology Assessment in the Era of AI and Data Science)

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19 pages, 599 KiB

Open AccessSystematic Review

Towards the Identification of Patients’ Needs for Promoting Robotics and Allied Digital Technologies in Rehabilitation: A Systematic Review

by Alessio Fasano, Maria Cristina Mauro, Elena Beani, Giovanna Nicora, Marco Germanotta, Francesca Falchini, Arianna Pavan, Valeria Habib, Silvana Quaglini, Giuseppina Sgandurra and Irene Giovanna Aprile

Healthcare 2025, 13(7), 828; https://doi.org/10.3390/healthcare13070828 - 4 Apr 2025

Viewed by 281

Abstract

Background/Objectives: Robotic rehabilitation holds great potential for improving patient outcomes, but the integration of these technologies into clinical practice is hindered by a lack of comprehensive tools for assessing patients’ needs. This systematic review aimed to identify gaps in the current literature, [...] Read more.

Background/Objectives: Robotic rehabilitation holds great potential for improving patient outcomes, but the integration of these technologies into clinical practice is hindered by a lack of comprehensive tools for assessing patients’ needs. This systematic review aimed to identify gaps in the current literature, with a focus on methodologies and tools for evaluating such needs, particularly those based on the International Classification of Functioning, Disability, and Health (ICF) framework. Methods: A systematic review of qualitative studies published between 2021 and 2023 was conducted, updating a previous (2020) review. Studies were identified through PubMed, Scopus, and Web of Science using inclusion criteria focused on qualitative methods capturing patients’ experiences with robotic and technological rehabilitation devices. Results: The review analyzed 19 new studies and 20 from the prior review, revealing a reliance on semi-structured interviews targeting small, heterogeneous populations. No studies employed standardized ICF-based tools, and gaps were noted in the exploration of conditions such as Parkinson’s disease, frailty, or conditions that allowed for multi-device experiences. Conclusions: The findings emphasize the necessity for tailored surveys grounded in the ICF framework to completely evaluate the needs of patients suffering from sensory, motor, and/or cognitive disorders caused by different health conditions. This work lays the foundation for more inclusive, effective, and patient-centered robotic rehabilitation strategies. Full article

(This article belongs to the Special Issue Assistive Technologies, Robotics, and Automated Machines in the Health Domain: Second Edition)

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10 pages, 606 KiB

Open AccessArticle

The Impact of Mental Health Comorbidities on Unplanned Admissions for Physical Conditions: A Retrospective Observational Analysis

by Fabrizio Cedrone, Omar Enzo Santangelo, Vittorio Di Michele, Alessandro Catalini, Flavia Pennisi, Lorenzo Stacchini, Marco Fonzo, Vincenzo Montagna, Vincenza Gianfredi and Giuseppe Di Martino

Healthcare 2025, 13(7), 827; https://doi.org/10.3390/healthcare13070827 - 4 Apr 2025

Viewed by 182

Abstract

Background: This study aimed to evaluate the impact of mental health comorbidities on unplanned hospital admissions (UHAs) in the Province of Pescara, Southern Italy, during 2015–2022. Mental health comorbidities are underreported in administrative data, yet their association with UHAs has significant public [...] Read more.

Background: This study aimed to evaluate the impact of mental health comorbidities on unplanned hospital admissions (UHAs) in the Province of Pescara, Southern Italy, during 2015–2022. Mental health comorbidities are underreported in administrative data, yet their association with UHAs has significant public health implications. Methods: A retrospective observational design was used to analyze 59,374 hospital admissions extracted from hospital discharge records (HDRs). Admissions of patients under 18 years of age, deliveries, day admissions, and readmissions were excluded. Socio-economic deprivation was assessed using a standardized deprivation index. Multivariate logistic regression analyzed the association between UHAs and mental health comorbidities, adjusting for socio-demographic and clinical factors. Results: Of the 59,374 admissions, 43,293 (72.9%) were unplanned. Mental health comorbidities had a low prevalence (1552 cases, 2.6%) but were significantly more common in UHAs (3.4%) compared to planned admissions (0.4%, p < 0.001). UHAs were also associated with the female gender (OR = 1.10; 95% CI: 1.06–1.14), younger age categories, living in less deprived areas, two or more physical comorbidities (OR = 1.66; 95% CI: 1.56–1.75), and mental health comorbidities (aOR = 9.85; 95% CI: 7.74–12.55, p < 0.001). Conclusions: Mental health comorbidities significantly increase the risk of UHAs independent of socio-economic deprivation or physical comorbidities. These findings underscore the need for enhanced mental health management to reduce UHAs, improve patient outcomes, and address healthcare inequities. Full article

(This article belongs to the Special Issue Perspectives on Primary and Community Healthcare)

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21 pages, 298 KiB

Open AccessReview

Effectiveness of Telecoaching and Music Therapy in Neurological Disorders: A Narrative Review and Proposal for a New Interventional Approach

by Ignazio Leale, Claudia Vinciguerra, Vincenzo Di Stefano, Filippo Brighina and Giuseppe Battaglia

Healthcare 2025, 13(7), 826; https://doi.org/10.3390/healthcare13070826 - 4 Apr 2025

Viewed by 283

Abstract

Neurological disorders represent a significant challenge for healthcare systems, necessitating innovative and multidisciplinary therapeutic approaches. These disorders often lead to difficulties in various aspects of daily life, including physical functioning, mental health, and quality of life (QoL). Telecoaching (TC) and Music Therapy (MT) [...] Read more.

Neurological disorders represent a significant challenge for healthcare systems, necessitating innovative and multidisciplinary therapeutic approaches. These disorders often lead to difficulties in various aspects of daily life, including physical functioning, mental health, and quality of life (QoL). Telecoaching (TC) and Music Therapy (MT) are two emerging modalities that may provide valuable support for individuals with these conditions. This narrative review aims to analyse recent studies investigating the efficacy of TC and MT in this population. A total of 23 studies were included in this narrative review. These studies indicate that TC positively affects physical functioning and adherence to intervention programs, with participants reporting improvements in gait and balance, as well as a reduction in postural instability and fall rates. Similarly, MT has shown promising outcomes in decreasing anxiety and sleep disorders while enhancing cognitive and emotional well-being. Integrating TC and MT into treatment approaches offers a promising alternative for improving QoL and overall well-being. However, further research is needed to consolidate the evidence and optimize the implementation of these interventions in clinical practice. Future research should focus on longitudinal studies and comparative evaluations to further clarify the role of TC and MT in the treatment of neurological disorders, as well as their long-term effects. Full article

(This article belongs to the Special Issue Music Therapy and Physical Activity in Neurological Diseases)

19 pages, 264 KiB

Open AccessArticle

COPSOQ III in China: Preliminary Validation of an International Instrument to Measure Psychosocial Work Factors

by Yiming Huang, Min Zhang, Fuyuan Wang, Yuting Tang, Chuning He, Xinxin Fang and Xuechun Wang

Healthcare 2025, 13(7), 825; https://doi.org/10.3390/healthcare13070825 - 4 Apr 2025

Viewed by 257

Abstract

Background: The Copenhagen Psychosocial Questionnaire (COPSOQ) is an international instrument designed for the assessment and improvement of psychosocial conditions in workplaces and for research purposes. After the International COPSOQ Network took over responsibility for the development of COPSOQ, a new version was published [...] Read more.

Background: The Copenhagen Psychosocial Questionnaire (COPSOQ) is an international instrument designed for the assessment and improvement of psychosocial conditions in workplaces and for research purposes. After the International COPSOQ Network took over responsibility for the development of COPSOQ, a new version was published in 2019 (COPSOQ III). However, there is no widely recognized instrument for measuring psychosocial work factors, and insufficient research exists regarding the use of COPSOQ III within the Chinese setting. This study seeks to conduct a preliminary validation of the Chinese long version of COPSOQ III. Methods: A cross-sectional questionnaire survey was conducted with a large sample in a medical consortium in China. Item analysis, reliability, and validity were explored. Results: The data management platform showed that 1067 respondents who met the inclusion criteria completed the questionnaire, among which 1054 questionnaires were valid. The content validity results showed that the I-CVI and S-CVI/AVE of each item ranged from 42.86 to 100.00, and the S-CVI/AVE was 92.52, indicating that the Chinese long version of COPSOQ III had good content validity. An exploratory factor analysis (EFA) extracted seven factors, which explained 63.96% of the variation. The results of confirmatory factor analysis (CFA) indicated that the model was well fit (χ²/df = 4.50, CFI = 0.910, TLI = 0.897, IFI = 0.910, RMSEA = 0.058). The Cronbach alpha coefficient of the questionnaire was 0.92. Conclusions: The Chinese long version of COPSOQ III is of good reliability and validity, like the original, and can be used to assess psychosocial work factors in China. Full article

24 pages, 1781 KiB

Open AccessArticle

Accelerating the Delivery of Psychological Therapies After Stroke: A Feasibility Stepped-Wedge Cluster Randomised Controlled Trial

by C. Elizabeth Lightbody, Kulsum Patel, Emma-Joy Holland, Chris J. Sutton, Christopher Brown, Svetlana V. Tishkovskaya, Audrey Bowen, Jessica Read, Shirley Thomas, Temitayo Roberts and Caroline L. Watkins

Healthcare 2025, 13(7), 824; https://doi.org/10.3390/healthcare13070824 - 4 Apr 2025

Viewed by 181

Abstract

Background: Psychological problems post-stroke are common and debilitating, yet insufficient evidence-based psychological support exists for stroke survivors, either in stroke or general mental health services. Many stroke survivors with significant needs remain unsupported. To address this problem, we need pathways to identify, treat [...] Read more.

Background: Psychological problems post-stroke are common and debilitating, yet insufficient evidence-based psychological support exists for stroke survivors, either in stroke or general mental health services. Many stroke survivors with significant needs remain unsupported. To address this problem, we need pathways to identify, treat and manage psychological difficulties after stroke. The Accelerating Delivery of Psychological Therapies after Stroke (ADOPTS) study aimed to explore the feasibility of collaboratively developing, implementing and evaluating intervention packages (IPs) to facilitate access to, and increase the provision of, psychological support post-stroke. Methods: Stakeholder groups were formed across four sites in north-west England, comprising stroke and psychological services, to collaboratively develop site-specific IPs incorporating a psychological care pathway, staff training, a staff manual for stroke-specific psychological support and supervision. A feasibility stepped-wedge cluster randomised trial recruited patients admitted with stroke during the usual care (pre-implementation of the IP) and intervention (post-implementation) periods. The feasibility of IP implementation and their potential usefulness were evaluated through assessing wellbeing and the support received, and through a process evaluation incorporating interviews with staff, patients and carers. Feasibility evaluation included the recruitment rate and attrition rate; exploratory analysis (mixed-effects linear or logistic regression models) was used to assess the ‘promise’ of the intervention in achieving psychological distress outcomes (mood (PHQ-9), anxiety (GAD-7)), assessed using validated measures at 6 weeks and 6 months. Results: IPs were collaboratively developed at each site but implementation took longer than the per-study-protocol duration of three months. Nineteen training sessions (152 attendees) were delivered for nursing, therapy, NHS Talking Therapies and voluntary staff. Nursing staff were underrepresented due to difficulties with releasing staff. Manuals were developed for each site, incorporating a mood screening and referral algorithm, but these were not finalised at one site. Stroke and NHS Talking Therapies champions were identified in each site to facilitate cross-service staff supervision. A total of 270 patients were recruited over 14 months (133 usual care, 137 intervention), with 227 and 198 at 6 weeks and 6 months, respectively. Stroke staff found the training, manual and pathway helpful, and reported greater confidence in managing and referring psychological issues. NHS Talking Therapies staff found the training useful for adapting their therapy. However, the intervention took longer to implement in all sites, requiring an additional time period to be added to the stepped-wedge design. Conclusions: It is feasible to collaboratively develop and implement IPs for post-stroke psychological support. However, an alternative to the stepped-wedge design used here would be more appropriate for a future study. This study was registered in ISRCTN—the UK’s Clinical Study Registry (trial registration: ISRCTN12868810, registration date: 4 February 2016). Full article

(This article belongs to the Special Issue Stroke and Ageing)

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10 pages, 807 KiB

Open AccessArticle

The Role of Gender in the Relationship Between Waist-to-Hip Ratio, Triglyceride–Glucose Index, and Insulin Resistance in Korean Children

by Seamon Kang, Xiaoming Qiu, Simon Kim and Hyunsik Kang

Healthcare 2025, 13(7), 823; https://doi.org/10.3390/healthcare13070823 - 4 Apr 2025

Viewed by 219

Abstract

Background/Objectives: Little is known about the relationship between obesity, the triglyceride–glucose (TyG) index, and insulin resistance (IR). This cross-sectional study of Korean children investigated whether the TyG index mediates the relationship between the waist-to-hip ratio (WHtR) and homeostatic model assessment for IR (HOMA-IR). [...] Read more.

Background/Objectives: Little is known about the relationship between obesity, the triglyceride–glucose (TyG) index, and insulin resistance (IR). This cross-sectional study of Korean children investigated whether the TyG index mediates the relationship between the waist-to-hip ratio (WHtR) and homeostatic model assessment for IR (HOMA-IR). Methods: Six-hundred-and-thirteen Korean children (320 boys and 293 girls) aged 9–12 years old participated in this study. The participants were classified as insulin-sensitive or insulin-resistant based on gender-specific cut-off values of HOMA-IR. The TyG index was calculated as follows: ln [fasting triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2]. Results: Children with IR were older, more likely to be girls, and had fewer favorable metabolic risk factors than children without IR. A mediation analysis revealed that while WHtR has a direct effect on HOMA-IR, it also has an indirect effect on HOMA-IR through the TyG index. The bootstrapped 95% confidence interval (CI) confirmed that the TyG index had an indirect effect on the relationship between the WHtR and HOMA-IR (effect = 0.349, SE = 0.075, 95% CI [0.210, 0.504]). The interaction effect between the WHtR and sex for the TyG index was statistically significant (β = −1.369, SE = 0.631, 95% CI [−2.608, −0.129]), but it was no longer significant when vigorous physical activity was considered as a covariate. Conclusions: Our findings suggest that girls are more vulnerable than boys to an increase in the TyG index caused by an increase in WHtR. This gender disparity observed in the study needs to be investigated causally. Full article

(This article belongs to the Special Issue Obesity and Metabolic Abnormalities)

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17 pages, 647 KiB

Open AccessArticle

A Qualitative Study Exploring the Rehabilitation Experience of Individuals with a Previous Diagnosis of Cancer and/or Sepsis, Their Caregivers, and Health Providers

by Jenna Smith-Turchyn, Christopher Farley, Anastasia N. L. Newman, Jayden Pannu, Bram Rochwerg, Som D. Mukherjee, Marla Beauchamp, Linda C. Li, Hira Mian and Michelle E. Kho

Healthcare 2025, 13(7), 822; https://doi.org/10.3390/healthcare13070822 - 4 Apr 2025

Viewed by 266

Abstract

Background/Objectives: Survivors of cancer have more than double the risk of developing sepsis compared to those with no history of cancer. Those who develop sepsis have lasting side effects reducing their physical function and quality of life. Rehabilitation-related needs and barriers are unknown [...] Read more.

Background/Objectives: Survivors of cancer have more than double the risk of developing sepsis compared to those with no history of cancer. Those who develop sepsis have lasting side effects reducing their physical function and quality of life. Rehabilitation-related needs and barriers are unknown for individuals with cancer who have had sepsis. The aim of this study was to examine the rehabilitation-related experiences of patients with cancer and/or sepsis, their caregivers, and the healthcare team and the educational needs regarding the rehabilitation of patients with sepsis. Methods: We performed a qualitative descriptive study using interviews and focus groups for data generation. We included adults living in Canada who were English-speaking, currently or formerly diagnosed with cancer and/or sepsis, or a caregiver of someone with a current or past diagnosis of cancer and/or sepsis, or a healthcare professional working with this population. Two reviewers used NVivo software for data management and conducted a qualitative data analysis. Results: We included 30 study participants (nine patients, nine caregivers, 12 healthcare professionals; 15 for one-on-one interviews; 15 in the focus groups). We identified three overarching themes relating to rehabilitation: (1) the rehabilitation experience did not meet the patient’s care expectations; (2) barriers to rehabilitation exist on multiple levels; (3) there are important gaps in education on how to improve physical and psychosocial outcomes. We identified two themes related to educational resources: (1) the educational content provided must be specific and meaningful; (2) multi-modal resources are needed to suit diverse partner needs. Conclusions: We identified rehabilitation barriers related to healthcare settings, the pandemic, and workplace culture for those with cancer and sepsis. This study highlights the need to create diverse educational resources on rehabilitation for those with sepsis to improve outcomes and patient/caregiver satisfaction. Full article

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

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22 pages, 640 KiB

Open AccessArticle

Addressing Bureaucratic Burdens on the Portuguese National Health Service: A Simplification Experience Aiming for Value-Based Healthcare

by Francisco Goiana-da-Silva, Raisa Guedes, Filipa Malcata, Juliana Sá, Miguel Cabral, Rafael Vasconcelos, Soraia Costa, Inês Morais-Vilaça, Lara Pinheiro-Guedes, João Sarmento, Filipe Costa, Rita Moreira, Fátima Fonseca, Jaime Alves, Marisa Miraldo, Alexandre Morais Nunes, Hutan Ashrafian, Ara Darzi and Fernando Araújo

Healthcare 2025, 13(7), 821; https://doi.org/10.3390/healthcare13070821 - 4 Apr 2025

Viewed by 364

Abstract

Background/Objectives: The Portuguese NHS has embarked on an administrative restructuring aimed at enabling healthcare professionals, particularly family doctors, to focus on direct patient care and improve overall healthcare outcomes. This article details these measures, their initial benefits for patients and professionals, and explores [...] Read more.

Background/Objectives: The Portuguese NHS has embarked on an administrative restructuring aimed at enabling healthcare professionals, particularly family doctors, to focus on direct patient care and improve overall healthcare outcomes. This article details these measures, their initial benefits for patients and professionals, and explores future strategies to further integrate levels of care and leverage technology to enhance efficiency, patient-centeredness, and ultimately, population health. Methods: Each measure was evaluated to estimate its potential impact on the four pillars of the value-based healthcare (VBHC) framework. Results: We found that most measures aimed at reducing bureaucracy had an estimated impact on more than two of the four pillars. Conclusions: Thus, we conclude that the reduction in bureaucracy will tend to address several of the pillars of the VBHC framework and should be considered as a steppingstone in the process of increasing VBHC. Full article

(This article belongs to the Topic Integrated Health Services across Different Levels: Worldwide Experiences)

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31 pages, 1680 KiB

Open AccessReview

Patient–Practitioner–Environment Synchronization: Four-Step Process for Integrating Interprofessional and Distinctive Competencies in Osteopathic Practice—A Scoping Review with Integrative Hypothesis

by Christian Lunghi, Francesca Baroni, Giandomenico D’Alessandro, Giacomo Consorti, Marco Tramontano, Laurent Stubbe, Josie Conte, Torsten Liem and Rafael Zegarra-Parodi

Healthcare 2025, 13(7), 820; https://doi.org/10.3390/healthcare13070820 - 4 Apr 2025

Viewed by 468

Abstract

Background. A major goal for a significant portion of the osteopathic community is to update osteopathic principles, satisfying three needs: sourcing from the origin, proposing original and unique practical approaches, and describing the entire process in a scientifically updated way. On this line, [...] Read more.

Background. A major goal for a significant portion of the osteopathic community is to update osteopathic principles, satisfying three needs: sourcing from the origin, proposing original and unique practical approaches, and describing the entire process in a scientifically updated way. On this line, several interprofessional proposals for healthcare providers have already been made by implementing patient-centered care and touch-based strategies informed by the enactive model. Enactivism principles can provide a foundation for rethinking osteopathic care by integrating environmental, psychological, social, and existential factors to facilitate the patient’s biobehavioral synchronization with the environment and social context, address health needs, and enhance the quality of multiprofessional healthcare services. However, there is a need to develop a conceptual model that offers a framework for organizing and interpreting disciplinary knowledge, guiding clinical observation and practical strategies, and defining both interprofessional collaboration and the unique focus of the profession. This scoping review and integrative hypothesis aim to fulfill the need for a more detailed and comprehensive understanding of the distinctive osteopathic care to biobehavioral synchrony, emphasizing both interprofessional collaboration and the profession’s unique competencies. Methods. The present article was developed in accordance with established guidelines for writing biomedical scoping reviews. Results. A total of 36 papers were considered for thematic and qualitative analyses, which supported the integrative hypothesis. Considering the current tenets for osteopathic rational practice, we propose an integrative hypothesis to focus on a practical framework for osteopathic patient biobehavioral synchronization. Patient–practitioner–environment synchronization could be promoted through a four-step process: (1) a narrative-based sense-making and decision-making process; (2) a touch-based shared sense-making and decision-making process; (3) hands-on, mindfulness-based osteopathic manipulative treatment; (4) patient active participatory osteopathic approaches to enhance person-centered care and rational practice. Conclusions and future directions: The proposed model fosters patient–practitioner synchronization by integrating updated traditional osteopathic narratives and body representations into practice, offering a culturally sensitive approach to promoting health, addressing contemporary health needs, and improving inclusive health services. Future studies are required to assess the transferability and applicability of this framework in modern settings worldwide. Full article

(This article belongs to the Collection Osteopathic and Manual Therapy Healthcare Reconceptualization: Health Needs and New Evidence)

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16 pages, 940 KiB

Open AccessSystematic Review

Occupational Diseases in Art Conservators and Restorers: A Systematic Review

by Maria R. Ferreira, André V. Brito and Ricardo J. Fernandes

Healthcare 2025, 13(7), 819; https://doi.org/10.3390/healthcare13070819 - 4 Apr 2025

Viewed by 272

Abstract

Background/Objectives: Although cultural heritage conservators and restorers face consistent exposure to a multifaceted range of occupational hazards, research on their health remains limited. This systematic review aims to explore and synthesize the prevalence and types of occupational diseases among conservators and restorers [...] Read more.

Background/Objectives: Although cultural heritage conservators and restorers face consistent exposure to a multifaceted range of occupational hazards, research on their health remains limited. This systematic review aims to explore and synthesize the prevalence and types of occupational diseases among conservators and restorers of cultural heritage. It also intends to map populations, interventions, contexts and other relevant information to assess the current state of knowledge and identify gaps in the literature on the occupational health of conservation and restoration professionals. Methods: The systematic review followed PRISMA 2020 guidelines and the Cochrane handbook. Eligible studies were identified through comprehensive searches of databases, and inclusion criteria were applied to select relevant articles. The protocol was designed according to PRISMA 2020, Prisma-ScR guidelines and the Cochrane handbook. The searches were conducted on 23 May 2024 in PubMed, Scopus and Web of Science (core collection). The risk-of-bias assessment was performed using the Cochrane method for non-randomized studies (RoBANS). Results: Respiratory symptoms were the most prevalent occupational health issue, affecting 28% of cases. General symptoms and abdominal issues each accounted for 20% and 18%, respectively, while musculoskeletal disorders were reported in 14% of cases, primarily affecting the neck, back, shoulders and wrists due to prolonged static postures and repetitive movements. Dermatological and irritation manifestations were reported in 10% of cases. Additionally, 10% of cases involved specific diseases such as pneumonia and cancer. The risk-of-bias assessment revealed significant methodological heterogeneity, with notable gaps in exposure assessment and disease outcome reporting across studies. Conclusions: This analysis highlights the different health risks faced by conservators and restorers of cultural heritage, underscoring the need for standardized methodologies and prospective studies to increase the data on occupational risks. Full article

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19 pages, 297 KiB

Open AccessArticle

Patient Perspectives on the Care in a Long COVID Outpatient Clinic—A Regional Qualitative Analysis from Germany

by Lea Alexandra Gölz, Regina Poß-Doering, Uta Merle, Michel Wensing and Sandra Stengel

Healthcare 2025, 13(7), 818; https://doi.org/10.3390/healthcare13070818 - 3 Apr 2025

Viewed by 317

Abstract

Background/Objectives: Long COVID specialized outpatient clinics (sOCs), which are part of the recommended long COVID care, usually face high demand. Few studies focused on the experience of care in such facilities in Germany. This study investigated how patients experience care in a [...] Read more.

Background/Objectives: Long COVID specialized outpatient clinics (sOCs), which are part of the recommended long COVID care, usually face high demand. Few studies focused on the experience of care in such facilities in Germany. This study investigated how patients experience care in a sOC at a German university hospital. Methods: Semi-structured interviews were conducted with patients attending this clinic between October 2022 and January 2023. Data analysis was based on thematic analysis. Results: The themes from interviews with 14 patients (F = 11, M = 3) could be broadly categorized into statements on the pathway to the sOC, and statements on care provided in the sOC. Findings show that patients’ high expectations at the sOC appointment were shaped by previous experiences with care, which were mainly perceived as inadequate. Care in the sOC was predominantly perceived as competent, empathetic and relevant for further care and coping with the disease. A deterioration in health directly related to the consultation (classifiable as post-exertional malaise) was frequently described, as was a high need for ongoing consultation. Conclusions: Overall, the findings point to a need for adaptations in the sOC, such as identifying optimized models of care and tailoring them to the patients’ limited resources. This includes measures to improve care outside the sOC. Full article

22 pages, 2814 KiB

Open AccessSystematic Review

Artificial Intelligence-Based Software as a Medical Device (AI-SaMD): A Systematic Review

by Shouki A. Ebad, Asma Alhashmi, Marwa Amara, Achraf Ben Miled and Muhammad Saqib

Healthcare 2025, 13(7), 817; https://doi.org/10.3390/healthcare13070817 - 3 Apr 2025

Viewed by 369

Abstract

Background/Objectives: Artificial intelligence-based software as a medical device (AI-SaMD) refers to AI-powered software used for medical purposes without being embedded in physical devices. Despite increasing approvals over the past decade, research in this domain—spanning technology, healthcare, and national security—remains limited. This research aims [...] Read more.

Background/Objectives: Artificial intelligence-based software as a medical device (AI-SaMD) refers to AI-powered software used for medical purposes without being embedded in physical devices. Despite increasing approvals over the past decade, research in this domain—spanning technology, healthcare, and national security—remains limited. This research aims to bridge the existing research gap in AI-SaMD by systematically reviewing the literature from the past decade, with the aim of classifying key findings, identifying critical challenges, and synthesizing insights related to technological, clinical, and regulatory aspects of AI-SaMD. Methods: A systematic literature review based on the PRISMA framework was performed to select the relevant AI-SaMD studies published between 2015 and 2024 in order to uncover key themes such as publication venues, geographical trends, key challenges, and research gaps. Results: Most studies focus on specialized clinical settings like radiology and ophthalmology rather than general clinical practice. Key challenges to implement AI-SaMD include regulatory issues (e.g., regulatory frameworks), AI malpractice (e.g., explainability and expert oversight), and data governance (e.g., privacy and data sharing). Existing research emphasizes the importance of (1) addressing the regulatory problems through the specific duties of regulatory authorities, (2) interdisciplinary collaboration, (3) clinician training, (4) the seamless integration of AI-SaMD with healthcare software systems (e.g., electronic health records), and (5) the rigorous validation of AI-SaMD models to ensure effective implementation. Conclusions: This study offers valuable insights for diverse stakeholders, emphasizing the need to move beyond theoretical analyses and prioritize practical, experimental research to advance the real-world application of AI-SaMDs. This study concludes by outlining future research directions and emphasizing the limitations of the predominantly theoretical approaches currently available. Full article

(This article belongs to the Special Issue Artificial Intelligence in Healthcare: Opportunities and Challenges)

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26 pages, 3668 KiB

Open AccessArticle

Effects of Implementing an ICU Discharge Readiness Checklist on Patient Safety Culture: A Quasi-Experimental Research Study

by Vanja Vončina, Hana Brborović, Ognjen Brborović, Alka Makovšek and Jadranka Pavičić Šarić

Healthcare 2025, 13(7), 816; https://doi.org/10.3390/healthcare13070816 - 3 Apr 2025

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Abstract

Background: Discharging patients from intensive care units (ICUs) poses significant risks for adverse events (AEs), contributing to hospital morbidity and mortality. To mitigate premature transitioning, an ICU discharge readiness checklist (ICU-DRC) was developed. Enhanced patient safety culture (PSC) is crucial for reducing AEs [...] Read more.

Background: Discharging patients from intensive care units (ICUs) poses significant risks for adverse events (AEs), contributing to hospital morbidity and mortality. To mitigate premature transitioning, an ICU discharge readiness checklist (ICU-DRC) was developed. Enhanced patient safety culture (PSC) is crucial for reducing AEs and improving outcomes. Given the pressing need to enhance PSC in ICUs, this study evaluates the impact of ICU-DRC implementation on PSC, aiming to address a critical gap in quality improvement. Methods: A prospective quasi-experimental study assessed PSC before and after a year-long ICU-DRC intervention at Merkur Clinical Hospital in Zagreb, Croatia. Healthcare providers from two distinct ICUs participated voluntarily in the Hospital Survey on Patient Safety Culture. The surgical ICU, where the intervention was applied, employed 106 providers, while the medical ICU, which did not implement the intervention, had 42 providers. Results: Initial response rates were 58% for the intervention group and 45% for the control group, with post-intervention rates of 53% and 48%, respectively. The ICU-DRC was utilized with a fidelity of 65.7%. Due to the non-normal distribution found for most variables, non-parametric analytical procedures were applied. In baseline measurements, the control group outperformed the intervention group in three out of fourteen PSC dimensions. Post-intervention, PSC scores in the intervention group significantly improved in one dimension, whereas three dimensions in the control group showed significant declines, resulting in superior PSC outcomes for four dimensions in the intervention group during the second measurement. Conclusions: Applying the ICU-DRC as an isolated safety intervention aimed at optimizing ICU patient throughput resulted in observable patterns of improvement in several PSC dimensions, with statistically significant changes in specific areas. Full article

(This article belongs to the Topic The Imperative of Patient Safety and Safety Culture in Contemporary Healthcare)

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10 pages, 589 KiB

Open AccessArticle

Designing and Implementing a Customized Questionnaire to Assess the Attitude of Patients with Diabetes

by Angela Repanovici, Ileana Pantea and Nadinne Alexandra Roman

Healthcare 2025, 13(7), 815; https://doi.org/10.3390/healthcare13070815 - 3 Apr 2025

Viewed by 211

Abstract

Background/Objectives: Diabetes mellitus presents significant management challenges, requiring comprehensive glycemic control, patient education, self-management, and routine monitoring. The study aims to evaluate existing tools and develop a customized questionnaire to investigate the multifaceted impact of diabetes mellitus on patients’ lives through a [...] Read more.

Background/Objectives: Diabetes mellitus presents significant management challenges, requiring comprehensive glycemic control, patient education, self-management, and routine monitoring. The study aims to evaluate existing tools and develop a customized questionnaire to investigate the multifaceted impact of diabetes mellitus on patients’ lives through a novel questionnaire. Methods: Utilizing Survey Monkey, we efficiently collected data from 150 diabetic patients during annual evaluations over five months (March 2024–July 2024). The sample included 88 men (58.67%) and 62 women (41.33%), with a notable representation of participants having a family history of diabetes (63.42%) and varying levels of education (20% with higher education). Statistical analyses were conducted using IBM SPSS (Version 20.0), and structural equation modeling (SEM) through Amos, including exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to validate the instrument and assess its psychometric properties. Results: The questionnaire targets four critical domains: the role of physical activity in diabetes management, the effects of diabetes on social relationships, the emotional status of diabetic patients, and the influence of diet on metabolic control. Conclusions: The findings provide valuable insights into patient attitudes toward diabetes management, emphasizing the importance of physical activity, social dynamics, emotional well-being, and dietary practices in improving health outcomes for individuals with diabetes. Full article

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Healthcare, Volume 13, Issue 7 (April-1 2025) – 156 articles

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